Winning without Power Poses: 10 Keys to Success for Commoners

In June 2018, I returned to Arkansas National Guard Youth ChalleNGe (my alma mater), where I gave the keynote speech for their 50th Anniversary celebration. The director and coordinators were gracious enough to give me complete artistic liberty in my talk. I took full advantage of this latitude and gave a talk on why I hate success stories. (I’m sure there were some folks briefly holding their breath in the audience.)

Long story short, I hate the typical depiction of success stories, because they only emphasize the shiny outcome. The path from point A to point Z seems mystical, which disallows aspiring young people from seeing the gritty core of the journey.

After conveying this message, as well as a brief summary of the highs and lows of my own journey, I shared with the audience the ten “keys” that were vital to my success. Unfortunately, what you will find here isn’t a quick fix or a magic pill. It’s a list of hard-learned and hard-earned lessons that require endurance, intestinal fortitude, and integrity. If that’s a list you can get behind, read on.

1. Define success

I’ve encountered countless people over the years that say they want to be successful, but if they are asked more questions about what that is or what their life will look like, they tend to give vague answers. We all know that if we want to take a road trip to an Airbnb we reserved, we have to know where the Airbnb is. How else would we get there? Similarly, to achieve our desired “success,” we have to define what that looks like. Is it a degree? A profession? A level of contentment? A specific dollar amount in savings? In order to arrive at our destination, we have to know what our destination is and plan out the best route to get there.

Arguably, it’s just as important to define success so that we know when we’ve reached it. (How will you know you’ve arrived at if you don’t know where you’re going?) If success is a nebulous thing in our heads, we may find ourselves mindlessly and perpetually trying to reach up and grab that next golden ticket – deeming ourselves only as successful as the content of our last day. That’s a problem, folks, because a lot of days are anything but flashy. And, if we are always striving for the next thing, we will never enjoy the contentment and ease waiting to be derived from the fruits of our labors.

2. Volunteer

Even when I was lost and confused…and when I didn’t have two pennies to rub together, I volunteered. In the beginning, I couldn’t have told you why, but in retrospect, I recognize that I needed to believe that – irrespective of my situation or history – I had something to offer. I needed to connect with other humans in a non-superficial way. I needed to be a part of the world and to be inspired by others who were fighting their own battles and courageously living all the gory details of their own lives. I needed to be around others who aspired to improve the world – not just take from it. I needed perspective, and I needed to be grounded and humbled. Having these needs met became intoxicating (to the point that I eventually needed to detox a bit…but I already addressed that in my self-worth blog).

Volunteering in nursing homes as a teenager and as a long-term care ombudsman as a young adult taught me that we could either live a life of joy or a life of regret. Either way, we all meet our eventual demise. Joining Civil Air Patrol and volunteering for search and rescue taught me that in our most agonizing moments of crisis, we are all relieved when we see another human being – irrespective of their race, gender, religion, nationality, etc. Civil Air Patrol also taught me the value of specificity, the pride of a job well done, and the nobility of pushing myself when I felt I had nothing left. Opening a donation center for foster youth reminded me daily that all children just want to be children. They want to feel normal when everything around them is abnormal. The donation center also taught me that everywhere there are needs awaiting a warm body to step up and meet the need. Volunteering for the booster club taught me that nearly any problem could be solved with comradery and communication. And volunteering for the HOA taught me that everywhere there are hurt people hurting people, but there are just as many people who want to buffer the pains and blows of the world.

In every day, there are lessons to be learned and joys to be had. By giving back and engaging, we’re empowered to change a little section of the world…and we’re reminded to be humble.

3. Be stubborn

When I was in my thirties, I remember my exasperated dad saying, “You are the most stubborn person I’ve ever met!” Without skipping a beat, I responded, “Where do you think I got it from? You’re the most stubborn person I’ve ever met!”

While unbridled and ill-structured stubbornness can get us in trouble and stymie our journeys, well-vectored stubbornness can get us where we’re going.

In order to be successful, I have had to stubbornly pursue my desired outcomes (i.e., becoming a clinical psychologist, developing and maintaining a high-quality marriage, breaking generational cycles, securing debt freedom, etc.) – even in the face of vocal doubters. I’ve had to stubbornly believe that it was possible to avoid becoming a statistic – even if I had never personally known anyone that achieved this. I’ve had to stubbornly withstand pressures that would compromise my integrity, and I’ve had to be willing and able to stand tall…even when that meant standing alone.

Standing alone or feeling alone can test the will of any human, but if we remember where we’re going, why we want to get there, and who we want to be, standing alone can be tolerable. (Optimally, however, part of our stubbornness should be carefully and deliberately selecting the right people to stand around us.)

4. Read Sun Tzu

The first time I was exposed to The Art of War by Sun Tzu, I interpreted it at its face value: war strategy. Fast forward a handful of years, and I randomly came across a Sun Tzu quote while trying to survive a toxic work environment: “If ignorant both of your enemy and yourself, you are certain to be in peril.” Suddenly, I saw The Art of War in a new light. I went back and skimmed the Cliff’s Notes version, and what I found was a whole new world…a world where Sun Tzu was now talking about how to manage difficult relationships and difficult people. I read it with an eye on how to navigate the choppy waters of working for an ego-fragile manager: “…encourage his arrogance…The supreme art of war is to subdue the enemy without fighting.”

Sun Tzu told me not to show my cards unnecessarily: “Be extremely subtle, even to the point of formlessness. Be extremely mysterious, even to the point of soundlessness. Thereby you can be the director of the opponent’s fate.” From this, I extrapolated the thought that if a toxic boss keeps me guessing, why wouldn’t I keep him guessing? I only give him more tools to abuse me if I’m operating in the dark while he has a flood light. Now obviously I’m not suggesting that anyone break company policy or fail to adhere to their job standards. I’m talking about personal shortcomings, fears, and emotions. Why give an abusive boss that power over you?

And speaking of power over you, in situations of abusive power imbalances, we’re prone to getting stuck in cycles of reactivity, and our captors capitalize on this. Staying healthy requires us to get unstuck, recognize unnecessary fights, and remain nonreactive: “He will win who knows when to fight and when not to fight.”

5. Sulk only briefly

A patient of mine once came to her follow-up session and made a confession: In a bout of sadness, she had eaten five tacos the night before. She was ashamed and self-loathing over her five tacos. “So what?” I asked her. She had been so caught in a whirlwind of shame and “shoulds” in her mind that she overestimated the importance of her five sad tacos, and my “So what?” caught her by surprise.

Here’s the deal: Life can be hard, and sometimes – despite our best efforts – we can’t catch a break. In those low moments, we need to lick our wounds and refuel our reservoirs. Thus, we all need to sulk sometimes, and we need to thoughtfully listen to ourselves when this need arises. If we disallow ourselves much-needed sulking time (and instead try to white-knuckle our way through all adversities), we are delaying the inevitable and making it more likely that we’ll eventually be struck down by a more crippling version of depression.

So when you need to lay on the couch, binge-watch Netflix, and eat five tacos, do it. But then get up the next day like a warrior – ready to regroup, dust yourself off, and fight.

Taco Tuesday only becomes a problem when it turns into Taco Wednesday and Taco Thursday and Taco Friday…

6. Play the right game on the right field

I come from a place where, if you want to be heard, you get loud and animated. This method for not getting punked was like a verbal version of making yourself appear big to ward off a mountain lion. Growing up in a particular context indelibly shapes you, and de-indoctrinating yourself is hard. As an adult, my verbal flares embarrassed my kids and mortified my husband, but when they challenged my tactics, I doubled down – justifying the means, irrespective of the ends.

Somewhere around 2010, I went into my son’s junior high school to confront the administration for treating him unfairly (e.g., skipping progressive discipline steps outlined in their handbook). I believed they were biased against him, because he had an IEP for dyslexia and other learning disabilities.

I remember the confrontation like it was yesterday: The administration staff sat behind the counter, and the vice principal stood behind them. I verbally flared – showing this “mountain lion” how big I was. More simply put: I went off on them. As I was colorfully making my points, I had almost an out-of-body experience. In one part of my mind, I was relaying what the problem was. In another part of my mind, I was observing their reaction – one of shock and discomfort. This part of my mind realized that they weren’t hearing a word I was saying. They were too busy emotionally reacting to my communication style. I also realized that the second I left, they wouldn’t give another thought to my points. Instead, they would all be relieved I was gone and gossip about this kid’s “crazy mom.”

As I drove away, I had to have some real honest conversation with myself: What do I want more? For things to improve for my son? Or to indignantly continue communicating displeasure the way I always had? Fortunately, I chose my son.

I then wrote a polite, but firm, letter – citing dates, facts, policies outlined in the handbook, and FERPA. I also thought about what would motivate them to change, which resulted in my letter advising them that another such infraction would leave me no choice but to contact the school board.

And then they changed.

This was a valuable lesson in my life, which permanently changed how I communicate. To effectively adapt, we must learn, understand, and implement the rules of engagement of our new environment. Even if I’m the world’s best basketball player, I’ll look dumb dribbling a basketball on a rugby field.

7. Beware false prophets

At every step along my journey, I’ve had people trying to convince me of what is “normal”…constant bickering in marriages, infidelity, struggling financially, hating your job, kids acting out. Each time I vented about something that brought me stress or unhappiness, someone was there to tell me that “everyone is like that” and that my “expectations were too high.” In my lowest moments, I actually believed them, which resulted in me feeling hopeless and made me feel like there was something wrong with me for not being able to be content with “normality.”

In a brief moment of clarity as a young adult, I remember waking up one morning and pondering on the fact that most of my friends didn’t have their own place to live, didn’t have a car, didn’t have custody of their children, and used drugs and alcohol daily. This realization was startling, and I asked myself if that was how I wanted to live my life. I clarified for myself that I wanted something completely different, which led to an abrupt and thorough reconstruction of who I surrounded myself with. I applaud this younger version of myself, because – while I was oblivious on so many fronts – I independently realized that what we are surrounded by is what we normalize. I didn’t want that lifestyle to feel normal.

When someone would subsequently say to me (about the topic du jour), “Oh everybody is that way,” I was quick to clap back with, “Well I don’t care what everyone else is doing.” I knew that – to survive and thrive – I couldn’t settle for what was in my immediate periphery. I learned to surround myself with people with similar values – people who were heading in the same direction as me (e.g., self-improvement, happiness, quality relationships, kindness, self-worth).

By the time I was in the Air Force and had a supervisor tell me that my “expectations are too high” regarding the performance and behaviors of my colleagues, I was completely unmoved. I knew my expectations weren’t too high, and I knew that humans tend to settle under the ceilings we set for them.

Bottom line: If we want to excel and continually improve upon the best previous versions of ourselves, we cannot buy into or be distracted by the naysayers who try to convince us to collect dust under mediocrity. After all, misery loves company.

8. Train for a marathon, not a sprint

Robert Strauss said, “Success is a little like wrestling a gorilla. You don’t quit when you’re tired. You quit when the gorilla is tired.” Beating the odds is usually a journey of endurance, yet we humans often lack the patience and perseverance to see it through. At every juncture, we should have already planned our next step, and we should know how that next step is a vital component of the end game.

I haven’t done this perfectly. When I declared psychology as my undergraduate major, I didn’t know that I couldn’t really do anything with that degree. When I entered my doctorate program, I didn’t know an internship was required to graduate. Naïveté isn’t sufficient justification to quit, however. At each new learning point and setback, I had to dig deep, recommit to my end game, and modify my plan for getting there. (Recommendation: Find a good mentor!)

Bigger picture (i.e., beyond just the tangible setbacks), however, is that every “success story” is built on the back of a long, winding, tedious journey. When we see success stories in the media, we see a snapshot of the outcome…the payoff. What we don’t see are the boring days, the lost sleep, the self-doubt, the naysayers, the commitment, the repeated defying of a comfort zone, and the perseverance. To become a success story, you have to have the fortitude to persist through every painful and non-flashy moment of the journey.

9. Be the best you

My potential-future-daughter-in-law, Lexi, has a very particular culinary palette. She’s a big fan of barbeque, chicken nuggets, chicken alfredo, and pizza. In contrast, my husband and I are foodies. We view eating as an experience and an adventure. Therefore, we’ll try anything with a tentacle once, and we’ll eat out of a truck or at a dive as quickly as we’ll eat at a five-star-restaurant. If I made a Venn diagram of Lexi’s food tastes and ours, there would be a small intersection set, but largely, they’d be non-overlapping. So if we’re wise foodies, we’ll consider that non-overlap when we get food recommendations from Lexi, and she’d be wise to cautiously gauge our food recommendations as well.

I use this (real world) analogy to highlight that we should use some discernment when listening to the opinions and advice of others, as we all have different personalities, preferences, strengths, and desired outcomes. What works for Barbara may not work for me – and vice versa.

All my life, I have (like pretty much everyone else) been almost suffocated by a barrage of unsolicited advice. People have told me that I should be more ladylike, more deferent, more vocal, more smiley, more fake, more…whatever. My grandfather told me on his deathbed that I should stop fooling around with school and be a stay-at-home mom. My graduate advisor pressured me to be a researcher – and also told me I shouldn’t try to be “clever.” An Air Force supervisor told me that if I was less “intellectually intimidating,” people would be kinder and more helpful to me. And so on. If I had heeded the advice and pressures of every person who heaved them upon me, there would be nothing left of who I am or what makes me…me. My individual strengths would’ve been completely suppressed.

To chart our own course, we have to get better at wading through and past all the pressures people put on us to live or be more like them. We have to identify the individual strengths that we bring to the table and effectively marry them up with our values. If we do these two things without fail, group-think will not derail us.

10. Don’t fear the fall

Well, maybe it’s not so bad to fear falling, per se, as us humans are pretty fleshy. But if we act and plan based on fear alone, our scenery is unlikely to change. We have to take educated risks, or we risk being stuck in a safe little rut our entire lives.

In my most recent leap from the proverbial ledge, I was preparing to leave active duty service in the Air Force and was at a crossroads on whether I should take the safe route of working for someone else (i.e., steady paycheck while I paid off my hefty student loans) or the risky route of opening a private practice (i.e., no guarantee of a paycheck and no guarantee of a viable business). I actually started leaning toward working for someone else “for now,” because I was growing weary of asking my husband to bear various career and financial risks with me. (The fear in the back of my mind haunted me with a barrage of what ifs?) Fortunately, my husband checked me: “You’re just delaying the inevitable. The goal was never to work for someone else, so you either take this risk now or take this risk later. Either way, you’re eventually gonna have to rip the band-aid off.”

People where I come from aren’t business owners. They’re the worker bees, and I too was raised to be a worker bee. (In high school, I longed for a stable, $10/hour factory job.) So venturing into this new land was foreign and terrifying. I had to look at that fear, name it, acknowledge it, and leap anyway.

Leaps don’t always come with a fall. Sometimes they allow us to fly.

 

Joye L. Henrie, PhD

 August 2018

 

No-Showing to Therapy: Is the Patient or Therapist to Blame?

The following is a modified excerpt from a leadership paper Dr. Henrie wrote while still serving in the Air Force. She shares it here as both a call to fellow mental health professionals and a spotlight shined to aid patients in better understanding their therapeutic process, which only stands to validate and empower patients as they engage in therapy.

Every group has its own nuanced culture. Mental health professionals are a peculiar bunch, and some would argue that we have to be peculiar to do the job we do. Perhaps that results in some ghastly senses of humor or wonky strategies for self-care. And perhaps that’s what we have to do or be to survive. Nevertheless, there’s tremendous room for professional and personal growth in our field. All things cannot be accurately attributed to the responsibilities or heaviness of our profession…or if we allow ourselves to persist in inaccurate attributions, we sell ourselves, and our patients, short. And shortcomings in the medical world can have fatal outcomes.

When I was a doctoral student, part of my training was working as a “clerk” (i.e., a supervised, student practitioner) at a private practice in the community. I had three supervisors there, and not one of them had demure personalities. Four and a half hours of supervision per week. Four and a half hours per week of critiquing my every comment, my every movement, my every reaction. Four and a half hours per week of being asked why I was so hard to read…why I didn’t “believe” the strategies I was being sold…why my life was filled with a series of one-way relationships. My early response was one of defense. I felt under attack and fraudulent. While sitting in sessions with my patients, I was sometimes distracted by thoughts of how I might be criticized for what I just said.

Over time, however, my guard started dropping as I gradually came to understand that there was merit in the feedback I received and came to witness how vehemently my supervisors wanted me to grow and succeed. It was the first place I had worked where I consciously recognized that my supervisors wouldn’t summarily cast me in concrete based on their first impression. These were supervisors that wanted to see me climb the proverbial ladder to success, and as I reached each new rung, they erased memory of the prior rung and celebrated the current version of me.

It wasn’t an easy clerkship, and I was certainly having a vastly different experience than my student counterparts. My clerkship emphasized introspection, hard conversations, and personal and professional discomfort. Yet the three years I worked in this clerkship permanently changed who I am as a person and as a professional. Perhaps most importantly, I learned to courageously look in the mirror and examine honestly and objectively my flaws and shortcomings, while simultaneously learning how these flaws and shortcomings insidiously crept in to the work of therapy.

In the mental health world, there is an unfortunate cultural phenomenon of placing blame on patients. One such way that my contemporaries do this is by blaming no-shows and treatment dropouts on patients. It’s common to hear mental health professionals say, “He wasn’t ready for treatment,” or, “She’s just being avoidant.” Frankly, it’s an easy and self-soothing dismissal, and the commonality of this trend allows each of us to comfortably regurgitate these excuses to stave off any professional responsibility of looking in the mirror. And who’s going to question us? We are allegedly the subject matter experts. We have advanced degrees…printed on intimidating-looking paper…hung in expensive-looking frames.

But my clerkship supervisors would allow no such mental laziness, professional negligence, or comforting lies. If one of my patients no-showed, they asked me why. I remember the first time I was saddled with this question, my internal reaction was, “How the hell should I know? I’m not a mind reader.” But this was my internal reaction only because I did not yet have the wisdom to truly understand the question. My supervisors continued to lob this question at me over time. At my next level of understanding, my internal reaction was, “Why are you insinuating it’s my fault? I can’t control what my patients do.” Again, this was my internal reaction only because I did not yet have the wisdom to truly understand the question. As my supervisors continued to mold and groom me (read: Chinese water torture), I eventually developed the wisdom to understand the question. What they were actually asking was, “What did the patient need at the last session that they did not get? What did you do differently? What was lacking that resulted in them not valuing their time with you? Were you fully present? Were you having internal reactions to them? Did they feel judged?…

Once I actually understood the question, it no longer felt threatening. It felt curious and purposeful. And I no longer saw the question as absolute. I came to realize that my supervisors understood that, at times, patients no-show or dropout of treatment for reasons we can’t control, but, at times, they do so because of us. My supervisors wanted me to first exhaust the possibility of my contribution before mentally casting blame on the patient. How can we be excellent, value-added practitioners if we can’t self-reflect or if we can’t understand our role and responsibility in our patients’ treatment investment?

A recent meta-analysis of treatment noncompliance (i.e., no-shows and premature dropouts) revealed a mean noncompliance rate of 42% (Defife, Conklin, Smith, & Poole, 2010). To put the economic gravity of that in perspective, the current TRICARE reimbursement rate for a psychologist’s hour of therapy (in my area) is roughly $132 (see CMAC procedure rates). So if a psychologist sees six patients a day, five days a week, the annual gross would be $205,920. If 42% of patients don’t show up, the psychologist’s annual gross reduces to $119,434. But that’s a rather selfish analysis.

More broadly, high noncompliance rates also mean that slots are “reserved” for patients who often aren’t using them, which results in new patients seeking care not being able to establish services, which is a serious problem in areas where there are shortages of mental health professionals. And if new patients can’t establish mental health services, they can’t get the help they need. It also means that the original patient, the “non-complier,” isn’t getting the care they need, which puts them at higher risk for myriad negative outcomes. And so on.

Countless researchers’ hours and countless government grant-funding dollars have been dedicated to trying to figure out the “vexing” problem of treatment noncompliance (Defife et al., 2010), yet these studies have largely examined the demographics or logistical constraints of patients who no-show. (Notice how patient-blaming that angle of analysis is.) Hell, even the word “noncompliance” suggests that we (the professionals with the fancy paper and fancy frames) order them to do something, and they willfully and belligerently disregard our orders. Only in the last decade or so are researchers starting to ask if something in the therapeutic process happens that results in no-shows. Lo and behold, they’ve found that “perceived disrespect from health care providers…, skepticism of health care service efficacy, and emotional discomfort or embarrassment” (Defife et al., 2010), for example, all contribute to missed appointments.

So back to what I learned in clerkship: My supervisors got me in the habit of asking myself why a patient missed an appointment…what I did differently or inadequately…what was going on with me that influenced the missed appointment. When I asked myself this question honestly and objectively, I was often able to identify the cause…things such as (brace yourself for some real-talk): being annoyed by the patient, being creeped out by the patient, being distracted by other things going on in my head, being emotionally rattled from some other event that just occurred in my life (professionally or personally), feeling lazy (poor investment), or remaining emotionally distant (often due to burnout or the strain of life).

The better I got at identifying my contributions to treatment noncompliance, the better I got at predicting when a patient would no-show to or cancel the next appointment. So I eventually got the message loud and clear. I came to believe that I am directly responsible for my no-show rates, and that my no-show rates are one metric by which I can gauge the quality and competency of my work. Once I acknowledged and took ownership of this phenomenon, my no-show, cancelation, and treatment dropout rates dropped dramatically, and at every place I have since worked, I have had the lowest such rates among my peers. In the Air Force, my average no-show rate was 5%, and in my year first year in private practice, my average no-show rate was 3%.

Sure, it’s hard sometimes to dig deep and be fully present and invested, but I remind myself of the consequences of not doing so. When it feels too overwhelming to think about potential negative, long-term outcomes for patients, I think selfishly. I think about the mess I’ll create by not doing the right thing…about the inevitable no-show, the inevitable arrival at the subsequent session, and the damaged relationship with the patient…that I will be responsible for repairing. And when I’m already feeling stressed out, the thought of having to clean up that mess sounds more taxing than doing it right in the first place. That keeps me honest.

Had I not learned the criticality of self-reflection from my clerkship supervisors, I’d likely have no-show rates similar to industry average. And I’d likely blame patients for those rates. And I’d likely feel professionally impotent to change those rates, which begs the question: What would be the point of practicing as a psychologist if I can’t identify the antecedents to and mechanisms of human behavior…including my own?

 

Joye L. Henrie, PhD

July 2018

 

Defife, J.A., Conklin, C.Z., Smith, J.M., & Poole., J. (2010). Psychotherapy appointment no-shows: Rates and reasons. Psychotherapy Theory, Research, Practice, Training, 47(3), 413-417. doi:10.1037/a0021168

My Psychology License is a Glorified Food-Handler’s Permit – And Other Notes on Self-Worth

It’s happened before that I’ve told a person that my psychology license is a glorified food-handler’s permit, and they let out an audible gasp and trip over themselves to offer blanket reassurances. They seem to respond with the assumption that I’m being self-deprecating in making this statement. But I’m doing quite the opposite, actually.

For many professions, there are government agencies designed to standardize, regulate, and monitor the credentialing and activities of those professions. To work in the food service industry in New Mexico, for example, prospective employees are required to meet standards established by the Environmental Health Bureau. They must complete a certified food handler class, which covers basic food safety, personal hygiene, cross-contamination and allergens, time and temperature, and cleaning and sanitation. They then take a proficiency test and must achieve a score of 75% or above, after which they can be issued a food-handler’s permit. This system is designed to protect public health and safety.

Sure, I’d like to think that in my 40s I have the common sense to know how to properly handle food, but just because I do, doesn’t mean my neighbor does. I mean, there’s a reason why I never ate Janet’s casseroles at the work potlucks.

To break the process down to its simplest form: In the interest of public health and safety, a government agency establishes minimum standards for what has to be learned, how this acquired knowledge has to be assessed, and what documentation is required to prove that these standards have been met. This is true for driving a semi, cutting hair, nursing, operating a forklift, shoring up construction trenches, and a wide range of other professions.

This is also true for the field of psychology.

I was required to complete an American Psychological Association (APA)-accredited doctoral program in clinical psychology, as well as an APA-accredited internship program. I was then required to get a billion* hours of post-doctoral supervised clinical experience, after which I had to complete a thousand-page* application, pass a jurisprudence exam, and pay hundreds of dollars to be approved to “sit” for the licensure exam (i.e., Examination for the Professional Practice of Psychology). After my life flashed before my eyes when I hit submit on that exam, I got a passing score, and eventually my “permit” to practice psychology arrived in the mail.

So, the same principle applied here: In the interest of public health and safety, a government agency establishes minimum standards for what has to be learned, how this acquired knowledge has to be assessed, and what documentation is required to prove that these standards have been met.

The only real differences between a food-handler’s permit and a psychology license are: (1) the specified area of expertise, (2) the amount of time required to get the blessing of the government agency, and (3) the amount of debt one racks up in the process.

There are numerous reasons why this clarification has value, but for the purposes of this post, the importance of the clarification relates to self-worth. The permit under which I operate does not define my worth or who I am as a person. It doesn’t tell you what my values are, how I exercise integrity, or how I relate to people. It doesn’t tell you what fears I may have, what bad habits I struggle with, or what my flaws are. My profession doesn’t tell my story, tell you what I bring to the table, or tell you what my family would miss about me if I died tomorrow. (And if my obituary turns into a post-mortem resume, I’ll roll over in my urn.) My profession doesn’t even tell you how smart I am (or am not) or what areas of intelligence I have strengths in. All it tells you is that I have a specific expertise in the field of psychology, for which I am sanctioned to deliver services. It tells you that I jumped through the prerequisites (aka: fiery hoops) necessary to get the license.

Similarly, having a permit to handle food, drive a semi, cut hair, nurse, operate a forklift, or shore up a construction trench doesn’t define the worth or value (or intelligence or capabilities or character) of the people with those permits.

Back in grad school, I was heading to an academic conference in Toronto. I was on a small commuter plane headed to my layover in Detroit. When I found my assigned seat, I plopped down next to a well-groomed woman in a full suit. Being an introvert, I hoped she wouldn’t speak to me, as 30,000-foot small talk is about as pleasant to me as facing a morning with no coffee. We made it about two-thirds of the way through the flight before she started talking to me. Why now? We were almost there! It started with the typical niceties: Where are you from? Where are you going? What do you do? When I answered that last question (i.e., I’m a doctoral student in clinical psychology.), her posture and interest visibly changed. Suddenly, she wanted to talk in depth and offered to “get lunch” with me on our layover. We determined that we wouldn’t have enough time during our layover, so instead she handed me her card and told me to call her when I got back home. Without looking at it, I stuffed the card in my pocket and exited the plane. It wasn’t until that night in my hotel room that I looked at the card. Turns out, she was a three-letter executive at the world’s wealthiest corporation.

I threw the card in the trash.

Why? She didn’t want to do lunch or stay in contact until she knew what I did for a living. Her affect and attention markedly changed when I told her what I did for a living. It seemingly wasn’t me she was interested in; it was my title.

In fairness, she may have been a perfectly nice, well-meaning woman, but I threw the card away because of what it represented. When I was a child growing up in poverty, people generally believed I wouldn’t amount to much. When I worked for a decade in the telecommunications industry, doctors, attorneys, and executives didn’t give me the time of day (unless I was paying them for their services). The class and status divide in our society has always been evident to me, so having this interaction that suggested that I was now “worthy” of someone’s time by virtue of my title was off-putting. I hadn’t changed. My value as a person hadn’t changed. I was just nearing the end of the process required to get my glorified food-handler’s permit.

If I were to entertain the idea that my license/title/degree makes me more worthwhile, I would also have to logically entertain the idea that pre-license/title/degree, I was less worthwhile. Similarly, I would have to entertain the idea that if I were to leave my profession, that I would return to being less worthwhile.

When I think of the ten most important adults in my personal life (I literally made a list), the highest educational degree obtained by 60% of them is a high school diploma. The other 40% have an associate’s degree or technical certificate. Yet I guarantee that not one of them thinks I believe I am more worthwhile than them by virtue of my license.

See, here’s the thing: If any one of those ten people were in a catastrophic car accident tomorrow and was rendered paraplegic (i.e., unable to work/provide, completely reliant on others for care), I would be overwhelmed with gratitude that they survived. Why? They can’t work or produce. But, so what, right? That’s not why I love and value them. That’s not what they’re bringing to the table. They’re bringing to the table who they are…their strengths and weaknesses, their character, their mind, their love, their way of relating, etc.

I think when most of us consider our loved ones, it’s a no-brainer that we’d be grateful for their survival in such a situation. But here’s the real test: What if YOU were the one in the catastrophic car accident tomorrow, were rendered unable to work/provide, and were completely reliant on others for care? Who would you be? What would be your value? Would you be grateful you survived? Your answers to these questions can tell you a great deal about your sense of self-worth and from where you derive your sense of worth.

Once upon a time, I would’ve answered those questions like this: <Throws papers up in the air> No one. Nothing. No.

But that was back before I understood what I was bringing to the table as a person. I had long bought into a warped illusion that my worth was based on what I achieved, accomplished, and provided to others. (There are many variations of worth illusions: codependency, self-depreciation, pathological self-sacrifice, materialism, etc.) Trying to fill a void of worth with achievement, accomplishment, and generosity was unsustainable, however. It was exhausting. It was lonely. It was nonreciprocal. And it was never enough. The void always needed to be fed more.

In the early stages of me figuring out the unhealthy way in which I perceived my worth, my husband forced me to sit idly beside him while he folded laundry. I made a New Year’s resolution to do zero volunteer work for a year. I distanced myself from the many takers in my life. I was like an alcoholic going through detox.

A handful of years later, I still have to monitor myself and can easily find myself backsliding into old habits. So, I intentionally allow others to pay for coffee or do me favors. I sit with the discomfort of feeling like the scales have somehow been catastrophically imbalanced. I remind myself that my loved ones would want me to survive a car accident – but not because I’m a psychologist – only because I’m me.

So, here’s your come-to-Jesus question: Is it time for you to reevaluate and detox?

 

Joye L. Henrie, PhD

 January 2018

 

 

*Surely y’all know I’m exaggerating (slightly).

An Optimist, a Cynic, and a Realist Walked into a Bar…

Ok, they didn’t actually. But they do often walk into my office…especially the optimists and the cynics. A great many of my patients over the years fell squarely into one category or the other.

The cynics are typically snarky and bitter. They’re heavy and dreary to sit in a room with. They describe the world and interpret events in unilaterally negative terms: “Oh of course it’s raining; I just washed my car. That’s how it always happens.” The cynics are quite convinced they’re right, and they tend to view anyone who sees the world differently as naïve peasants. They claim that their thinking style is a functional protective strategy, because they don’t like to get their hopes up…only to be let down.

My reply? “Well given that you’re now sitting on a therapy couch, how well has that been working out for you?”

The self-professed optimists incessantly use the catch phrase, “I just try to think positive,” and in this effort, they’ll quip with a smile, “It kind of sucks that it’s raining on the same day that I washed my car, but at least that means that the flowers will bloom soon!” (Yes, they usually end with some excitatory punctuation.) They tend to describe the world in flighty, candy-coated terms, and when a difficult therapy subject is broached, they often show some level of discomfort and quickly wiggle out of the topic by citing a quote or cliché. When I call them out on this, they stubbornly state, “My mom [or uncle or friend or cat] used to always tell me to think positive, so that’s what I try to do.”

My reply? “Well given that you’re now sitting on a therapy couch, how well has that been working out for you?”

My initial approach for both the cynic and the optimist is the same: I give them a crash course in the scientific method. (Yes, I take them all the way back to middle school.) “Science is a systematic and logical approach to discovering how things in the universe work,”1 and the scientific method “is an organized way that helps scientists (or anyone…) answer a question or begin to solve a problem.”2

So neither the cynic or the optimist is being a good scientist. Both are viewing the world and interpreting data through a biased lens. Neither are demonstrating thinking styles that demonstrate objectivity or logic. I usually introduce them to their own bias by drawing an image on a white board for them:

Except, I’m going to be honest with y’all. What my patients see in real life looks more like this:

Cynicism and optimism are just different ends of the same spectrum. Cynicism is biased to see all things negatively, whereas optimism is biased to see all things positivity. Neither is accurate or objective. Neither is in touch with reality. In reality, things aren’t all bad or all good. Life is generally an intricate series of “bad,” “good,” and neutral events. Therein lies realism. The true realists of the world observe and account for all data – irrespective of its positive or negative quality. (Cynics often pass themselves off as realists by saying, “I’m just being a realist,” but their use of the term is a bastardization of its definition.) Actual realists take into account all information without a predisposition to interpret it or predict outcomes in one direction or the other. That is an accurate rendition of the scientific method.

As for the application of the scientific method to daily living, I once had a patient (not unlike many people) who had the tendency to mentally beat himself down. His thoughts were riddled with self-doubt. He gave an example of a fitness instructor commenting that the patient was strong. The patient’s automatic assumption was that the fitness instructor was just being nice. I had this patient put his (cynical) hypothesis to the test using a similar graphic3 to the one below:

The patient’s question was, “Was the fitness instructor just being nice?” The patient completely skipped background research and jumped to developing the hypothesis that the fitness instructor was being nice. The patient also skipped the last three steps. So I took him back to testing his hypothesis. I had him develop a list of evidence for and against his hypothesis. In the list of evidence for his hypothesis, he only wrote, “Maybe people are more likely to go back to this fitness instructor if he tells them what they want to hear.” In the list of evidence against his hypothesis, he wrote, “I have been working out regularly. I’ve been able to lift more weight over time. He probably doesn’t actually have anything to gain from lying to me. He probably wouldn’t get much ongoing business if he lied to everyone.” At the end of the exercise, the patient had come up with far more evidence against his hypothesis than for it, so ultimately, he changed his mind and threw out his assumption that the fitness instructor was just being nice.

This is a basic (but solid) example of being a realist. The realist considers all information, whether it supports their existing hypothesis or not. In being a realist, we allow ourselves to experience the world, others, and ourselves more authentically, which can help us better cope with life’s stressor’s and bad news.

 

Joye L. Henrie, PhD

November 2017 

 

 

  1. Bradford, A. (2017) What Is Science? Live Science. https://www.livescience.com/20896-science-scientific-method.html
  2. ScienceBob (Ukn) The Scientific Method. https://sciencebob.com/science-fair-ideas/the-scientific-method/
  3. Learner (Ukn) The Scientific Method. https://www.learner.org/jnorth/tm/handouts/anchor_chart_sci_method.html

Labels Can Be Our Prison or Our Key to Freedom

I was raised in a predominantly black neighborhood in Little Rock, Arkansas. Ours was the only white family on the block. And I attended a grade school that was 94-97% black on any given year in the 1980s. My experiences in my neighborhood and school were positive ones. I had good friends. We laughed. We jumped Double Dutch. We doubled up for bike rides. In many ways, it was an all-American childhood…well, the peer group part of it was anyway. I was a white child being raised by a racist step-father in a black neighborhood. I was forbidden from having my black friends stay the night, and I was lectured about interracial relationships. It was a confusing dynamic at best. Complicating it further was the dysfunction of being raised in an abusive family. Out in my neighborhood and in my school, I was safe. Those were warm and inviting places for me – safe havens, but in my home, there was never safety.

Back in those days, I was too young to understand the racial divisions in our country. I only knew that I loved running around the playground with the twins, Stacy and Tracy, and that DeShunda instilled in me a love for poetry when she and I would read and write poetry together – sometimes to woo her boyfriend, Johnny. I remember wishing I was more “tan” like my friends and wishing I could have cool hairstyles like them. I couldn’t have known then the societal punishments that came with those features (features I coveted).

In the 9th grade, I went to live with a foster family in a different area – a predominantly white area, but we were bused to a school that was still predominantly black. It was the first real race divide I witnessed. During lunch, the teenagers congregated outside to visit with their friends before their first afternoon class. The poor white kids grouped on one area. The wealthier white kids grouped in another area. And the black kids spread out everywhere else. The first time I witnessed this spectacle, I was confused and didn’t really know what to do or where to go. My foster sister pressured me to go hang out with her and her friends (the other poor white kids), but a white boy who took interest in me pressured me to go hang out with him and the wealthier white kids. Eventually, I crossed paths with DeShunda – whom I hadn’t seen since 5th grade. It was a happy and huggy reunion. She invited (aka: didn’t pressure) me to come hang out with her and her friends at lunch. Honestly, this is where I wanted to go. But I was torn. I felt obligated to hang out with my foster sister, because I lived with her. (If someone shares their home and food with you, you’re bound to feel indebted to them.) And so I did.

DeShunda and I talked less frequently – until we eventually didn’t talk at all. Only in retrospect can I see that perhaps she viewed me as a traitor…and I don’t blame her. I abandoned my true friends whom I had known for years, because I succumbed to peer pressure, which happened to be divided along race lines. This is a regret and guilt I lived with in the nearly 30 years since then, and only recently have I made my peace with it. (But I’ll get to that later.)

In 10th grade, I was sent back home by the state to live with my mother – who had by that time divorced my stepfather. We moved to a new area – a commuter city to Little Rock that was predominantly white. Moving there made me feel like I had stepped backwards in time. The black population in this area lived on “The Hill,” and I remember being warned to never go on The Hill alone. Funny thing is, our family was poor enough that we lived in a white area that butted up against the train tracks that separated The Hill from the white neighborhoods. I met this black kid, Antoine, at school, and we built a friendship. Since we both lived in the same direction, we often walked home from school together, and when I wasn’t around for these walks, Antoine looked out for my little brothers as they walked home.

My mom grew concerned about the relationship Antoine and I were building, and so one day, I asked her outright how she would feel about me dating a black guy. She responded, “I would just hope you’d stay in your own race.” I was frustrated by her mentality, but unsurprised. I retorted, “Would you rather I date a nice black guy who treats me well? Or a white guy who cheats on me and beats me?” She again responded, “I would just hope you’d stay in your own race.” Her stance was unequivocal. And so I told Antoine we couldn’t date. Today, I wonder if this was one of the first times Antoine’s race had been thrown in his face like this…if I was the first girl who told him she couldn’t date him because of the color of his skin…if I was the first girl who informed him that white parents would disapprove of his melanin level. Yet another burden that weighed heavy on me for years.

Fast forward to age 17 – when I had dropped out of school, completed military school, and was ready to figure out my next step – an old friend invited me to be her roommate in Salt Lake City, Utah while she attended college. I had nothing to go home to, and I was up for an adventure. So I moved. Fifteen hundred miles away. It may as well have been a foreign country.

I remember standing in Taco Bell one day on 400 South (back in the day when more people went inside than in the drive thru) – waiting to place my order. I looked around at the people in the restaurant. Every single one of them was white. I suddenly felt panicky…out of place. Time stood still, and I felt like I was standing under a spotlight. But then I realized that I looked like all of them. No one would ever guess by looking at me that I felt out of place. And so began my young adult journey of trying to “blend in.”

Problem is – blending in is easier than it sounds. When my late-teen and young-adult peers talked about music and movies and television shows, I was out of the loop. I had been raised in a different culture, listening to different music and watching different movies and television shows. When my new peers got excited about U2 or Depeche Mode or Metallica, I just forced a fake smile, because I had no idea what they were talking about. I couldn’t sing along. I had no desire to go to these concerts. But as is common at that developmental stage in life, I wanted desperately to fit in. I stopped listening to Rob Base, Kris Kross, Outkast, and Bone Thugs. Yet, I couldn’t tolerate what seemed like the screech of rock music. I started wearing less baggy pants and never again wore my Black Sox jersey.

I persisted for years like this. And as for that music dilemma? I started listening to “smooth jazz,” because it seemed “in the middle”…offensive to no one. I sometimes crossed paths with the few black people living in Utah, and I had an internal urge to squeeze them tight. But I knew that would just be weird. (I mean, really. If someone did that to me, I’d assume I was about to be robbed or assaulted.) It wasn’t uncommon for me to be reprimanded by my white counterparts because I couldn’t “take a joke” when it came to race issues or for “overreacting” when someone said something overtly racist. I persisted feeling like I didn’t really fit in anywhere – feeling like an alien that confused people.

It wasn’t until I was in my thirties that I stopped trying to please people or fit in somewhere. I came to realize that no matter what I said or what I did or how I lived my life, there was someone, somewhere that thought I was wrong and should be different. The more I tried to please Sally, the more Frank was displeased with me. So I stopped trying. I rebelled and decided to just live the way I saw fit. I learned that I couldn’t fit in with anyone, if I didn’t fit in with me.

By the time I was in my late thirties, I was a white woman driving a Subaru with a dented fender and cracked windshield…listening to Tupac cranked up as loud as it would go. I also – by this point – was an officer in the United States Air Force, whose culture sometimes pressures officers to show their status through cars and other material goods. This beat-up Subaru certainly didn’t convey that image. I recycled, adopted a rescue dog from the shelter, owned guns, and played Cards Against Humanity. To many, I am a walking contradiction…a person whose contradictions confuse and befuddle others. But these contradictions are my liberty.

See, like nearly everyone else, I had a lifelong litany of people telling me that I should be more this or more that. People expressed (in various ways) their disapproval of who I was, what I did, or how I communicated. One person would say I should be more feminine; the next would say that it was desirable to be a little more rough and tumble. Some people thought I wasn’t religious enough. Others pressured me about my political opinions. People were quick to offer up opinions about the foods I like (or don’t like) and about my weight. Others suggested I parent different or decorate my home different or dress different. Some people even felt the need to tell me I could recycle better, while others scoffed that I would “waste” my time this way.

People’s opinions – if we give them any credence – can have us reactionarily bouncing around like we’re in a pinball machine. And at the core of others’ opinions is them telling you how THEY would live if they were you. They aren’t you, and you aren’t them. They are making assessments and assumptions based on incomplete data, because they have not lived your life and do not know the complete content of your thoughts and feelings. When we heed others’ unlimited slew of opinions, we are prisoner to the whims of others – and to things that might be beneficial in their lives, but not ours. We get locked into an unresolvable state of anxiety.

The fact of the matter is that if I want to paint my walls with ketchup, it’s none of Linda’s business; she doesn’t live with me. Similarly, if Linda wants to paper her walls with organic, locally-sourced cow dung, it’s none of my business; I don’t live with her. There is an unparalleled freedom that comes from being ourselves and blocking out the peanut gallery’s assessment of how we should be better, faster, bigger, more.

Today, my inner circle is comprised of people who never ask me to be anything other than myself. They accept (and even embrace) the fact that I’m a little weird – that my skin is pink, that my butt is oversized, that I hate shopping, that I’m a good shot, that I like to sew, and that I cuss a little (or a lot). Since I’m a big fan of reciprocity, I’d similarly never ask the people in my inner circle to be anything other than themselves. Loving others for who they are is an act of unconditional love – no strings, no debt. And expecting that others love us for who we are is the most powerful act of self-love in which we can engage.

Joye Henrie, PhD

October 2017

What are You Saying? The Communication of Emotions between Men and Women

Imagine a six-year-old, first grade girl on a playground at recess. She falls and skins her knee. Then she starts crying. What do all the little girls do? They run to her, help her up, inspect her wound, hold her hand, and walk her to the nurse’s office. It’s also likely that a full two hours later, they’re giving her an extra cookie at lunch and asking her if she’s ok.

Now imagine the same playground, but this time, it’s a six-year-old, first grade boy. He falls and skins his knee. Then he starts crying. What do all the little boys do? They laugh and point and call him names. It’s also likely that a full two hours later, they’re still shunning him…keeping their distance to avoid being associated with the ‘crybaby.’

Why does this difference happen? Are little boys inherently mean? ‘No’ is the simple answer.

Here’s how it works: People (as much as we fancy ourselves a sophisticated bunch) learn in essentially the same way as our pet dogs. When we want to teach our dog to sit in response to the command ‘sit,’ we pair the command and the behavior of sitting with a treat, a hardy petting, or some other desirable motivating feedback for the dog.

Similarly, we humans tend to repeat behavior that is rewarded, and we tend to avoid behavior that is punished. From the time the typical American boy is born, he is barraged with messages about toughness, not crying, and avoiding anything that is cast as ‘feminine.’ He learns this at home, in the extended family circle, among peers, at church, etc. By the time a boy enters grade school, he’s already keenly aware of the rules of engagement for his gender, and he unknowingly becomes a propagator of these rules of engagement.

Over the course of the years of the boy’s life, he is consistently confronted with messages regarding what is considered acceptable and unacceptable emotional expression for a male. Most common among these messages is that any negatively-valenced male expression of emotion should be anger. Frustrated? Anger. Scared? Anger. Tired? Anger. Sad? Anger. Defeated? Anger. The free expression of sadness or fear in male adolescence is potential social suicide.

Meanwhile, the course of the girl’s life is painted with reward for the free expression of emotion. The tears are permitted to flow openly. She is encouraged by her home, extended family, peers, church, etc. to articulate her emotional experience on a nearly infinite range of topics. In fact, females are often relationally punished for not doing so – facing labels such as b*tch, cold, or ice queen if her free expression of emotion isn’t deemed robust enough.

Bottom line, boys tend to be punished for emotional expression and rewarded for presenting as stoically flatlined. Girls tend to be punished for not being emotionally expressive enough and rewarded for the free and unbridled expression of emotion.

While this discussion could go many directions (e.g., that it can be damaging to rob boys of healthy emotional expression, that it can be professionally impairing to fail to teach girls time-and-place with regard to emotional expression), my point in writing it is to illuminate the ways in which these reward-and-punishment paradigms can erode effective relationship communication.

By the time the little girl and little boy have grown into a woman and man and decide to leap head-first into a relationship, the woman has a vast and deep emotional vocabulary – the equivalent of a dictionary. She quickly senses when she feels different, and she has been taught to communicate these feelings, their changes, her hypotheses about them, etc. Meanwhile, the man has the equivalent of a trifold brochure of emotion-related vocabulary. He’s been taught to ignore emotional changes, not investigate their origins, and deny their existence. So when the woman talks to him readily, frankly, and extensively about her emotional experience, he might be hearing something akin to white noise.

Here’s a flip-side example: My husband of 23 years is mechanically inclined. Over the years, he has worked on all of our cars – usually out of abject necessity. I’ve learned a lot from him about engines, car maintenance, etc. But he always has to speak at my level – build a knowledge foundation and expand from there. As soon as he says words like “camshaft synchronizer,” my brain short circuits, and I’m no longer following what he’s saying. And if I don’t understand the words in his sentence, my brain just kind of checks out. I feel myself getting agitated as he talks, because I know the loving and respectful thing to do is to pay attention to what he’s saying – but he’s not speaking my language. [It’d be like me staring intently and with sustained enthusiasm while someone is speaking to me in Korean. (I don’t speak Korean.)] Lately I’ve gotten better at stopping my husband when I don’t understand and asking him to translate. Then he says words like “the thing that tells the computer how to time the spark.” Suddenly, I’m following; I’m reengaged…and he doesn’t feel like I’m disinterested in what he’s saying.

In the early years of our relationship, I was guilty of speaking to him in overly emotional terms that weren’t relatable or translatable to him. His brain short circuited when I communicated things through an emotional lens and/or asked him to be emotionally supportive. (In his mind, the only things that were supportive were I-beams, trusses, rebar, etc. How would something invisible lend support?) I spoke from my perspective – with no consideration of his perspective. But neither of us knew that at the time. You can’t communicate what you don’t know. So I interpreted his nonresponse as uncaring, and while he vehemently denied the accusation that he was uncaring, he didn’t have the words to communicate that I needed to translate for him.

Fast forward 20 years and we have settled somewhere in the middle or our respective societally-influenced worlds. I use less words to describe my emotional experiences (so that his brain doesn’t check out). I try to do a better job of making my explanations relatable to him (so that he doesn’t feel frustrated). I take accountability for my own feelings and for self-soothing (so that I’m not displacing blame onto him). He, rather than defaulting to expressions of anger, has learned to articulate if he’s feeling moody – even if he doesn’t know what the particular mood or emotion is (so that I don’t personalize his mood). He regularly articulates his feelings toward me (so that I developed security in where I stood with him). He listens when I do share my emotions (so that I know my experiences are important to him).

Once we understand the common discrepancies in relational communication, it’s so much easier to fix them.

While writing this blog, I had yet another couple come in and describe their difficulties in communicating. This couple has been married for over 30 years. The wife said, “I know when he gets angry, there’s something going on in his head,” to which the husband responded, “She says that, but there’s nothing going on in my head.” I abruptly stopped them and fetched the draft of this blog from my desk. As I read it to them, they both nodded knowingly…over and over. By the time I finished, they both had smiles (or at least smirks) on their faces. They knew this was indeed the canyon between them, and like any couple, they were tired of professionals and self-help books prematurely concluding that it was one person’s fault or the other.

Is it my fault that I don’t speak Korean? Or the Korean’s fault that they don’t speak English? Neither. It just is. And if we want to learn to communicate effectively, we will work to master one another’s language.

Joye Henrie, PhD

September 2017

 

(Note: This post contains some generalizations and absolute language. This is not intended to stereotype or be dismissive of outliers. Rather, it is done for expediency in addressing a common issue that arises in the course of psychotherapy.)

The Invisible Creep of PTSD: How Trauma Changes the Way You Experience the World


A long-term patient of mine (who we’ll call Michael) is a combat medic with multiple combat deployments under his belt. When he started treatment with me, he already carried a Posttraumatic Stress Disorder (PTSD) diagnosis – a diagnosis that was spot-on. After we had been working together for several months, Michael was clearly agitated when he came in for his scheduled follow-up. He explained that he had gone into a well-known big box store to return an item. In comedically colorful language, he explained that another driver almost t-boned him on his way to the store, people were walking uncomfortably close to his car in the store’s parking lot, and he crossed paths with some questionable-looking characters as he walked into the store.

By the time he reached the greeter’s podium, he was perspiring and tight-chested. The greeter apparently blew him off, but when Michael attempted to walk past the greeter, the greeter stopped Michael by grabbing him by the shoulder. At this precise moment, approximately 82 of Michael’s brain cells imploded. He went into a blind rage – screaming in the greeter’s face and threatening to annihilate him.

“I’m losing it, doc,” Michael said to me – not even attempting to hide his fear.

Michael’s story is a common story among my military patients with PTSD. And yet, they all think they’re “crazy” or “losing it.” In psychology, it’s common for providers to say, “It’s a normal response to an abnormal situation,” and unbeknownst to folks with PTSD, it’s their daily reality.

It’s like this: The average person walks around with a subconscious threat-management radar operating at all times. If they’re having a picnic in the forest and a bear approaches them, they immediately spring into action and run (or whatever it is you do if you’re unfortunate enough to come face-to-face with a bear). They don’t sit and think, “Hmm. I wonder if that fury mammal will chew on my head?” This is the basis of fight/flight/freeze. Our radar detects threat, and we respond. It’s the same if we’re walking along a city sidewalk and a car comes careening toward us or if we’re standing in a bank when a masked man with a gun yells for everyone to get on the floor.

The threat-management radar of the average person is set at a specificity level to immediately detect clear and overt threat – like the radar-equivalent of a missile.

A person with PTSD, however, has the sensitivity of their threat-management radar turned up as high as it will go. They’re no longer just detecting missiles. They’re detecting mosquitos.

Why? PTSD is, as its name states, a trauma-based disorder. It is the result of exposure to a trauma event that threatens life or limb, and the research suggests that exposures to multiple traumatic events exponentially potentiates the development of full-blown PTSD. Subsequent to these traumatic events, the person’s thoughts and beliefs about the world, themselves, and others changes. They may come to believe that the world isn’t a safe place or that people can’t be trusted or that if only they had done X, the trauma wouldn’t have occurred.

These changes lead and/or run parallel to hypervigilance (i.e., hyper-awareness of and hyper-sensitivity to one’s surroundings and its changes, and exaggerated reactions designed to manage one’s surroundings and its changes). In other words, the person with PTSD is likely to study people in their environment, notice exits (aka: escape routes), want full visibility of their surroundings, notice and investigate noises of unknown origins, etc. This is their radar operating in the hyper-sensitive mode. They’re detecting mosquitos and interpreting benign stimuli (e.g., noise, movement) as potentially threatening.

And their history tells them that they need to be ready to respond, because nonresponse can be the difference between life and death.

Now, this super-human radar setting may be periodically useful to a law enforcement officer…or a person sitting in a movie theater who hears the sound of a shotgun being cocked. But it can lead to malfunction in daily living – at a big box store, at work, sitting at home. This person’s responses to common situations are often disproportionate to the actual threat probability. People around them might view them as over-reacting or may start tip-toeing around the person’s “temper.”

The tragedy of this is that the individual with PTSD – as well as their friends, family, and colleagues – often have no idea what’s really going on, which results in the individual with PTSD feeling “other”…disenfranchised from society…standing on the outside looking in.

And let me assure you: living a life with a threat-management radar set on high sensitivity is exhausting (and unpleasant). This, unfortunately – but understandably, leads many individuals with PTSD to seek relief from the constant barrage of noise and movement and threat – whether through substance use, ‘leaning into’ threat by engaging in risky, adrenaline-fueled behaviors, or any other behavior that soothes them and allows their mind to escape and rest.

I explained all of this to Michael, and he was dumbfounded that someone could put words to a reality he’s been trapped in for years. I told him that it’s important that he starts taking mental inventories of the various stimuli coming at him at any given time – the radio blaring, the drivers cutting him off, the firetrucks blasting by with their sirens on, his son trying to talk to him, etc. Michael needs to not only take a conscious inventory of incoming stimuli, but he needs to actively manage stimuli (e.g., turn off the radio, tell his son he’ll talk to him when they get home). And on the days that he doesn’t succeed at his stimuli inventory or managing incoming stimuli, he needs to make conscious decisions about what he can and can’t adaptively do at the moment. (For example, by the time Michael walked in the big box store and encountered the greeter, he was already perspiring and tight-chested. It was unlikely that he was going to handle any other hiccups well.)

To be clear, I’m not suggesting outright avoidance, as avoidance can be the death-spiral of PTSD. Rather, what I’m suggesting is that strategic adaptations are not only wise, but can ensure maintained functionality. I’d rather Michael start going to a different, calmer big box store than end up in jail for assault or murder. I’d rather that another of my patients sets limits with his wife on when he can or can’t adaptively have a conversation, as opposed to ending up a divorced alcoholic and absent father.

Today, Michael is working on taking continuous mental inventories of his surroundings, setting limits when feeling overwhelmed, communicating these needs and strategies to his loved ones, and not seeing every situation or person as a threat. Michael is still a work in progress, but ‘progress’ is the operative word. Michael doesn’t spend as much time today perseverating on beliefs that he’s “crazy” or beliefs that he should forever be alone to protect others from his “crazy.” The world may still feel like a threatening place to Michael, but now he understands and can articulate why – which makes him feel a little more in control of his world. At his last appointment, Michael told me that he started opening his blinds every day, that he hung up motivational posters in his home gym, that he got a flower for his house, that he started having light saber wars with his son, and that he started dating a woman – despite nagging (but increasingly quieter) beliefs that she’ll eventually reject his “crazy.” Michael is now living – one little step at a time, but by god, he’s living.

Joye Henrie, PhD

September 2017