How do you stay in the arena?

In her book Daring Greatly, social work researcher Brene Brown defines vulnerability as uncertainty + risk + emotional exposure. Teddy Roosevelt’s “Man in the Arena” speech inspired how Brene interprets her research on shame, vulnerability and leadership as well as her own life.

Vulnerability is never comfortable. There is no courage without vulnerability. We have only two options: 1) either you do vulnerability or 2) vulnerability does you. You do vulnerability knowingly or unknowingly.

If you’re not willing to risk failing, you can’t authentically connect, create or innovate.

We’re in the middle of some big social movements with the potential to change things significantly. They require uncomfortable conversations. To not have those conversations because they make us feel uncomfortable is the definition of privilege. It’s a given that we’re going to make mistakes. It’s a given that, whenever we’re vulnerable, we’re going to get our asses kicked. We have to choose courage over comfort.

We have to dispel the myth that vulnerability is weakness. We have to build cultures where vulnerability is, at least, tolerated if not encouraged. When we live in cultures in which there is zero tolerance for vulnerability, where we can’t have productive conversations, creativity or innovation.

A joyful, wholehearted life requires vulnerability.

Brave leaders are never silent about difficult, uncomfortable topics.

Our jobs are to excavate what’s unsaid.

It’s easier to cause pain than to feel pain. Scapegoating is easier in the short run but, because it places the locus of control on someone else, it’s self-defeating in the long run. Fear- and shame-based people tend to take their pain out on other people. Don’t disempower yourself by offloading your difficult stuff onto other people.

We can’t go it alone. We’re all neurobiologically hard-wired for connecting with other people. In the absence of authentic, honest connections with other people, there’s pain and suffering. When we connect, we begin to heal.

We can’t predict nor engineer the uncomfortable nor the uncertainty out of vulnerability.

Trust doesn’t necessarily precede vulnerability. And, vulnerability doesn’t necessarily precede trust. Instead, it’s a slow stacking over time of vulnerability and trust. We share with people who’ve earned our trust and, therefore, the right to hear our stories.

Your story is a privilege to hear.

Vulnerability without boundaries is not vulnerability. Disclosure, in and of itself, is not necessarily vulnerability. We cannot measure vulnerability by the amount of disclosure. We measure vulnerability by the amount of courage required to show up and be seen when we can’t control the outcome.

Vulnerability is hard, scary and, sometimes, dangerous. But, what’s far more dangerous is to stay armored up — to never be seen.

How do you stay in the arena?

Living in healing: Post-traumatic growth & resilience – part 10 of 10

You know you’re living in healing when you wake up each day looking forward to doing the next right thing and, then, at the end of the day, to a cozy bed and a good night’s sleep.

As John Lennon wrote, “Life is what happpens to you while you’re busy making other plans.” It’s how we respond that can make the difference.

Just in case you need to be reminded again — Drop the rock. You’ll need both hands.

Adapt. The other option doesn’t feel good to you nor to others in your life.

Get and stay involved. Engaging in opportunities for meaningful participation in life contributes a whole lot to making and keeping us resilient.

High expectations are a manifestation of strength, hope and realistic optimism. They’re not toxic positivity. Apply them to yourself and — so you don’t waste your precious time and energy over-functioning — apply them to others as well.

Always remember that in dysfunctional families and systems — including employers and governments — the sickest one is in charge. Don’t consent. Resist!

Lifelong learning will keep you sharp and relevant. When you need help, there’s Google, YouTube and, in the case of anything IT-related, children. Be selective. Only fools believe everything they read and see on TV and the Internet. Use your media literacy skills. Consider the source. Follow the money. Wonder about what’s not being reported in the media as much as why what’s being reported is getting so much time and attention.

Cancel your cable TV subscription, at least until the Fairness Doctrine’s re-established, if it ever is. Do you really want your money to pay for Fox/Faux News? Get your news from credible sources, including those that don’t have a corporate filter — TruthOut, Common Dreams, The Nation, Democracy Now!, The Intercept and trusted bloggers like political historian Heather Cox Richardson PhD (“Letters from an American,” for political news of the day placed in a historical context) and epidemiologist Katelyn Jetelina PhD (“Your Local Epidemiologist,” for pandemic-related news).

Be/stay civically engaged. Do more than just vote. Get involved by volunteering at election polls and/or to support local, state and national candidates via canvassing, phone-banking and, most of all, helping to register voters and get out the vote. Also, save yourself a lot of time, energy and aggravation by learning what people most don’t know to truly understand how we got to where we are today — i.e., know about the Powell memo and its history by reading it on Greenpeace’s website or reading David Cay Johnston’s trilogy of books — Perfectly Legal, Free Lunch and The Fine Print, Hedrick Smith’s Who Stole the American Dream?, or pretty much anything (book, article, book tour talk, interview) by Chris Hedges and/or watching the documentaries, “Heist: Who Stole the American Dream?” and/or “The Brainwashing of My Dad” or PBS Frontline’s “Park Avenue.”

Get out of your head. Instead, check in with your gut. Your gut works like an excellent compass for life. The human body’s enteric nervous system (i.e., what’s in the gut) has far more nerves than our brains do. That’s why there’s validity to the term “gut instincts.” Long before our brain has enough time to process the information to translate what our gut senses into words, our gut tells us all we need to know about how to handle situations. As one of the promises of AA put it, “We’ll intuitively know how to handle situations that used to baffle us.” Have confidence in your gut. Stay tuned into it. It will never lead you astray.

Keep it simple. This one can be especially difficult if you let your intellect get in your own way.

Listen more. Talk less. Attentive listening shows your love and caring for others.

Be trustworthy.

Be vulnerable. Take risks. Life sometimes requires courage. Participate. Don’t waste time by being just a bystander on the sidelines.

Remember Mary Oliver’s poems, “The Journey” and “Wild Geese.” Live your life accordingly.

Shit happens. Sometimes, life is painful. Don’t underestimate yourself or others. Confidence counts. Ask for help when you need it. Humility brings a healthy perspective — you are not alone. Everyone is “at risk” in this day and age. Inevitably, everyone experiences pain. As M. Scott Peck began The Road Less Traveled, “Life is painful.” Assume, expect and accept that you’re gonna hurt occasionally. Not all feelings tickle, y’know. If we don’t let ourselves feel the painful emotions, then we won’t be able to fully feel the pleasurable ones.

Free yourself from the bondage of self. Yet, don’t suffer fools gladly either. Life’s too short and your time and energy are too precious to be wasted. Spend them wisely. There’s nothing more painful than living as if we’re the center of the universe or as if we’re somehow above, below or outside of it. We are a part of the universe. Dive in!

Keep an open mind. Generously share compassion and understanding. Judgement, especially when applied to other people, can destroy relationships and is usually a waste of time and energy. MYOB. And, remember that what others think of you is actually none of your business either.

Follow “The Golden Rule” — Do unto others as you would have them do unto you.

Be generous. Include yourself in that, too.

Forgive. Do it for yourself. Let go of hurt feelings, anger and resentment. Without forgiveness, all relationships are doomed to be short-lived. Remember to forgive yourself. Don’t confuse forgiveness with failing to set healthy boundaries. Forgive but don’t accept behavior that’s unacceptable. The best amends is to not do it again. Remember that, when you’re a mature adult, no one can abuse you without your permission. When people in your life behave badly, you can practice detachment with love. Sometimes, that means you choose to leave. But, not always. Life isn’t meant to be lived in all or nothing ways. Be gentle and kind. Detachment can also mean clearly understanding that their bad behavior is their responsibility, not yours.

Live in the present. Enjoy it. It’s the only moment we have for sure right now.

Practice mindfulness, as needed. But, don’t overdo it. Sometimes, we need to use our passion in productive, constructive ways. As Kahlil Gibran wrote —

Your reason and your passion are the rudder and the sails of your seafaring soul. If either your sails or your rudder be broken, you can but toss and drift, or else be held at a standstill in mid-seas. For reason, ruling alone, is a force confining and passion, unattended, is a flame that burns to its own destruction. Therefore let your soul exalt your reason to the height of passion, that it may sing; And let it direct your passion with reason, that your passion may live through its own daily resurrection and like the phoenix rise above its own ashes.

Work. Play. Rest. Eat well. Get enough sleep. Stay hydrated. Exercise. Take good care of your body.

Advocate for yourself and for others who are less privileged than you are. Altruism’s a healthy defense, especially when life brings its inevitable challenges.

Laugh. Play. Don’t take life too seriously. After all, it’s only temporary. Everything is temporary. “This, too, shall pass” applies to both the bad times and the good times. Take it in stride. Know that you’re not alone in the challenges that life brings to you. Terminal uniqueness causes optional suffering.

Remember what Ram Dass wrote — “We’re all just walking each other home.”

Remember what Maya Angelou said, ““When people show you who they are, believe them the first time.” Also remember what Maya Angelou wrote — “Do the best you can until you know better. Then when you know better, do better.” Aim for progress, not perfection.

Remember the Serenity Prayer — “God, grant me the Serenity to Accept the things I cannot change, Courage to change the things I can, and Wisdom to know the difference” — including the short version — “f*%k it” — when life is happening too fast to say the entire, original version.

Live with humility. The challenges each of us face may seem insurmountably daunting at times. All challenges are relative in scale. It’s not a competition for who’s worse or better off. Share. Cooperate. Accept that some things cannot be explained.

As a mature adult, gracefully accept that life isn’t fair.

Remember that, sometimes, our family and friends simply need for us to listen. Respect other people’s capacities and strengths. Fixing what’s broken or solving other people’s problems usually isn’t our job anyway. Accompanying others on their journeys brings the joy of intimacy into our lives. Sorrows shared are easier to carry. Joys shared multiply.

“(T)he world is round, and a messy mortal is my friend. Come walk with me in the mud.” -Hugh Prather, Notes to Myself”

Honesty — Above all else, to thine own self be true. Rigorous honesty with ourselves is absolutely essential. Important caveat: That doesn’t mean we need to share all of our “truths” with others. Life without boundaries is painful.

Cassandra, from Greek mythology, was gifted with the ability to see the truth, which Apollo then made a curse after she spurned his romantic advances by making no one listen to or believe her. Watch your energy and manage your time. They’re your most precious commodities. Share them wisely. When you have enough physical energy, courage and emotional and spiritual stamina to be a Cassandra then, yeah, sure, if it’s really that important, go for it! But, only do so knowing what the consequences will be. Most of the time, people’s appreciation for integrity doesn’t last very long. Do it for the right reasons. It’s true that the truth can set you free. An overly active superego (i.e., conscience) can result in anxiety or alienate you in ways that you may not have the capacity to handle. Principles tend to be a whole lot simpler and easier in theory than they are in practice.

Above all else — To thine own self be true. Take good care of yourself. You can’t be good for anyone else unless you’re taking good care of yourself. Life in theory seems so simple while, in practice, it can be quite complicated, confusing and, at times, seemimingly contradictory.

Don’t make decisions based in anger, fear or same, especially of stuff that happened in the past. That was then. This is now. Learn from Orpheus’ tragedy. When his wife died, Orpheus struck a deal with the gods to find her in Hades and bring her back to the surface of the Earth as long as he didn’t look at her before they reached the surface. As Orpheus and his wife approached the Earth’s surface, he became frightened that she might not be following him and, tragically, he looked back to make sure she was still with him. Upon seeing her, she immediately vanished, transported back to Hades, lost for eternity.

“Orpheus” – Sara Bareilles

I know you miss the world
The one you knew
The one where everything made sense
Because you didn’t know the truth
That’s how it works
Till the bottom drops out
And you learn
We’re all just hunters seeking solid ground

Don’t stop
Trying to find me here amidst the chaos
Though I know it’s blinding
There’s a way out
Say out loud
We will not give up on love now
No fear
Don’t you turn like Orpheus
Just stay here
Hold me in the dark and when the day appears
We’ll say
We did not give up on love today

I’ll show you good
Restore your faith
I’ll try and somehow make a meaning of the poison in this place
Convince you love, don’t breathe it in
You were written in the stars that we are swimming in
And it has no name
No guarantee
It’s just the promise of a day
I know that some may never see
But that’s enough
If the bottom drops out
I hope my love was someone else’s solid ground

Remember that sometimes the best thing to do when you’re feeling anger, fear, shame, resentment or uncertainty is absolutely nothing. Silence is golden. Sit. Breathe. Meditate. Sing. Deep breathing during mediation and singing are good for you because, by moving your diaphragm with intention, you’re improving your vagal tone (i.e., your vagus nerve — Google polyvagal theory). Take a walk. Go outside. Enjoy nature. Walking in nature is inherently healing. Dig in the dirt. Grow your garden. Gaze at the moon — la bella luna! — and the stars. Watch the sun rise and set. Listen to the birds. Observe how ants work collectively, setting a good example for us humans.

Dance. Play a musical instrument. Listen to the sounds of water moving in creeks, streams, lakes and oceans. Listen to the wind. Watch the snow fall.

Laugh. A lot. Humor is key.

Enjoy some solitude but remember that, as human beings, we’re social animals who are inherently interdependent. Being alone is not the same thing as being lonely.

Avoid being hungry, angry, lonely or tired. Eat. Calm down. Call or visit a friend. Get enough sleep.

Let go. Be grateful. Live in gratitude. A change in perspective can make a huge difference. Isn’t it a relief to realize that you’re powerless over everything and everyone except yourself?

When in doubt, look at what animals are doing. Dogs, for example, have good instincts. Curl up for a nap. Get petted. Go for a walk. Wag more. Bark less.

In the land of the “free” you’ve got to be brave

Take a deep breath before you read this deep dive analysis based on my years of doing school violence prevention plus public education and health care policy:

Oxford High School school authorities are now contending with sorting through students’ possessions — backpacks, cell phones, etc. and cleaning up the mess and repairing the damage caused by the shootings. At the same time, they’re also contending with a lot of Monday morning quarterbacking by “J. Doe Public” and school violence prevention “experts,” of which I am but one.

Here’s the reality —

1) Federal funding and focus on violence prevention in schools that came from Congress and the Clinton Administration after the Columbine High School massacre in April 1999 significantly evaporated during the George W. Bush Administration to fund the wars in Iraq and Afghanistan. During the Obama Administration, that trend continued as well as increased funding for the V.A.

2) We have a broken public education market — it is a market more than a system — based on our nation’s profit-driven public education policy. Our current public education policy began from “A Nation at Risk,” a report issued during the Reagan Administration that erroneously concluded that our public schools were failing. It continued to advance with the George W. Bush Administration’s No Child Left Behind policies, which continued to advance even further with the Obama Administration’s Race to the Top.

3) The reality of our nation’s public education policy is this: When kids’ test scores go down, corporate profits go up. Public education policy has been used to privatize public education. It’s seriously encroached on funding for public schools — i.e., gradually, it’s been increasing its capacity to seize and capture Federal, state and local tax dollars designated to fund public schools in our local communities, diverting those funds into for-profit charter and private schools and into the pockets of for-profit corporations that sell both policy-driven, curriculum content as well as high stakes standardized testing.

3) School board meetings have become so contentious over covid-19 vaccine and/or testing and mask mandates as well as identity politics (e.g., critical race theory, trans rights) that the National School Boards Association requested assistance from the Federal government. US Attorney General Merrick Garland responded by appointing an FBI task force. The far right then reacted to what it interpreted as the creation of a police state that would infringe on their rights to participate in their local school board meetings. A request based on fear stemming from a lack of civility and, at times, threats of violence at/during school board meetings resulted in a fear-based response. To hell with what’s true. Fake news! This is how we feel! Therefore, it must be true!

3) We have a health insurance market that, very similar to our data/metrics-driven public education market, is also for-profit. I wish I could say “system” instead of “market;” but, the truth is we don’t have a health care system. We’ve got a health care laws and policies that, as also happened in public education, have gradually — like a frog in a pot of water with heat under it gradually increasing to boiling so that the frog doesn’t jump out but instead passively remains in the pot to die — resulted in the creation of a privatized, profit-driven health care market that’s presently headed even further towards privatization via privatizing Medicare. Medicare has been the most efficient and cost-effective program the Federal government runs. It is popular with all Americans regardless of “identity politics” or political affiliation. Per an Executive Order during the Trump Administration, the Center for Medicare and Medicaid Services is implementing the privatization of Medicare via Direct Contracting Entities. If you’re a Medicare beneficiary who wants to choose your own health care and your own doctors, get ready to let lose those options. So far, the Biden Administration and Congress have done nothing to reverse this Executive Order that they inherited from the Trump Administration. Medicare Advantage Plans, which are an already existing version of Direct Contracting Entitites, are only an advantage to the private insurance companies who get the participaing beneficiaries’ Medicare benefits and, then, control access to specialists by making the primary care provider the gatekeeper and charging co-pays for each visit and each prescription in addition to monthly premiums. Bottom line: Profit-driven, private insurance companies benefit more than Medicare beneficiaries from Medicare Advantage Plans. That Silver Sneakers free annual gym membership isn’t worth Medicare beneficiaries losing control over their health care choices.

4) Thus, both our public education and health care markets have created dysfunctional “systems” that make it impossible for teachers and other public education personnel and doctors and other health care professionals to have the professional autonomy that they need to be the truly attentive and responsive professionals that they want to be for children, adolescents adults, people with disabilities and seniors.

5) We have probably the most highly fragmented public health system of any nation on Earth. During one of the biggest and deadliest pandemics of our lifetime, the public health system in the US hasn’t served us as well as a unified public health system could have. Instead, we’ve relied on corporate welfare to corporations — e.g., the manufacturers of the covid vaccines — to respond to the need to protect the public from the covid-19 pandemic.

6) Thanks in large part to the lack of Federal legislation and regulations to hold our media accountable to, first, serve the public good by reporting the truth and, then, make a profit, many people in the US are making decisions about whether or not to get vaccinated or wear masks and what treatments they get if/when they get infected with covid-19 based on misinformation. Serving the public by requiring reporting the truth cannot happen unless and until the Biden Administration’s two nominees to oversee the FCC are approved by Congress, which still hasn’t happened.

7) If Congress doesn’t pass one of the two voting rights act bills, Democrats definitely will lose the small majority in Congress they presently have and Biden won’t get re-elected President nor will many other Democrats get re-elected due to a) gerrymandering, b) the erosion of voting rights at the state level and c) the elections/appointments of Republicans into leadership positions at the local and state level electoral systems in key states and local municipalities. The game is now solidly rigged for Democrats to lose. So, already, we’re living with just an illusion of democracy. We’re also living with the illusion of a divided two-party system. Democrats and Republicans continue to succeed in distracting us with “identity politics” and social issues like trans rights, abortion rights and gun rights — interesting stories that are great for ratings — while quietly advancing end-stage capitalism and the corresponding undermining of what’s left of our democracy.

8) Meanwhile, Republican leaders — former President Donald Trump and Rep. (R-AZ) Paul Gosar, to name just two — continue to set a bad example for impressionable children, adolescents and adults, some of whom then engage in community- and school -based violence, including the Oxford High School shootings, raiding Michigan’s and other (e.g., Oregon’s) state capitals while armed with guns and, of course, the January 6th insurrection at the US Capitol.

My only questions are: Has the civil war already begun? and Is it possible to reverse course? To do so, we need the political will and enough traction in what’s left of our crumbling democracy as it exists today. Time is running out. Mid-term elections will happen on schedule next November. Ever since Joe Biden got elected President, Democrats have remained passive — are they in denial? — as they’ve lost ground politically for the next election cycle. The media continues to demonstrate that it cares far more about ratings — making a profit — over serving the public. That’s is why the media will continue to focus on the Oxford High School shootings — like it did the Gabby Petito/Mark Laundrie story — rather than the “bread and butter” issues that matter to everyone regardless of political party affiliation and/or identity politics.

It’s so overwhelming and distracting that the question comes to mind: Where do we even begin to dig ourselves out? Maybe Congress can pass one of the two voting rights act bills to prevent a right-wing Republican takeover, just to buy some more time to potentially reverse end-stage capitalism and, hopefully, prevent another civil war which, in fact, may already have begun.

Just keep this in mind when you hear the media talk about the Green New Deal: When FDR passed the New Deal, when he defended the new taxes and regulations to his wealthy peers, he told them they should thank him because he had saved capitalism. In doing so, he also set the stage for our nation’s most politically stable and economically prosperous years. During those years, Americans invented and manufactured lots of products that we exported worldwide. Since NAFTA, which every Presidential candidate whose ever run for office since has promised to overturn but hasn’t, what we manufacture and export most are guns, ammunition and “defense” (i.e., war) equipment.

We’ve allowed our economic, health care, public education and law/justice policies to commodify us.

Gun sales have dramatically increased during the pandemic in part due to civil rights protests being reported in the media as if they were violent riots. Fake news. Gun violence has correspondingly increased.

In the land of the “free” you’ve got to be brave.

Patients be pro-active! Covid-19 & long-covid patients, educate your PCPs & specialists about interim CDC guidance via their portals &/or email

The CDC’s interim guidance on how to treat Long-COVID (June 14, 2021 and included as the 1st link below) explicitly says to treat mast cell activation syndrome (MCAS). Anecdotally and based on some research, mostly in countries other than the US due to better surveillance, there’s evidence that treating MCAS during acute covid-19 infections may reduce the risk of long-covid. However, the CDC’s June 2021 interim guidance does not define, describe nor explain how to diagnose/treat MCAS.

Because research on how to treat covid-19 and long-covid is ongoing and there now are interim but not yet final “evidenced-based” standards for care, the contents in this blog post are, in relation to acute covid-19 and long-covid, not (yet) considered final, official “evidence-based” practices.

A PCP/gerontologist told me his son, a Harvard Medical School graduate who began his career as a pulmonologist at Kaiser Permanente when the the pandemic began, has been getting much better outcomes since they began to treat MCAS in covid-19 patients among other approaches to rein in the body’s over-functioning immune system. Also, I’ve read that medical staff in some of the better hospitals have been using H1 and H2 inhibitors and mast cell stabilizers to treat covid-19, resulting in better outcomes.

As I’ve been seeing patients for case management as well as psychotherapy, I’ve observed that many PCPs and specialists are not treating MCAS nor referring patients who have covid-19 or long-covid to the relatively few MCAS experts.

The other links below have been authored by and/or feature the world’s most prominent MCAS expert researcher/clinicians. Some healthcare professionals have been dismissing patients presenting with long-covid symptoms (e.g., fatigue, brain fog and other dysautonomia — symptoms caused at least in part by immune system-induced inflammation of the central nervous system) as being due to psychiatric conditions when, in fact, there actually are very obvious and expected reasons for and indications of an immune-related, physical aka physiological causes for those symptoms that can easily be treated if only doctors and other health care professionals knew how to do so. Thus, the need and reason for this blog post – to share the info by the CDC plus the world’s MCAS experts with PCPs and specialists of all kinds since mast cells are part of the immune system and, therefore, exist in all of the body’s tissues.

Please share this blog post with your PCP and other health care professionals via their portals and/or email. Thank you!

Translating research to practice always takes a lot longer than patients and doctors would like. Now, at the beginning of year three into the COVID-19 pandemic, patients still can’t passively assume their primary care physicians (PCPs) and specialists have all of the information that they need to treat COVID-19 and/or Long-COVID. Nor can they assume that their doctors have had time to access the available research from credible research/medical experts, journals and other sources to learn how to more safely/effectively treat their patients. Therefore, it’s up to patients to help make that happen!

Thankfully, the Centers for Disease Control (CDC) issued interim guidance in June 2021, including to treat mast cell activation syndrome (MCAS). However, the CDC’s interim guidance didn’t include any guidance on what MCAS is or how to treat it. So, in the carefully vetted links below, here’s that missing information.

For several years, studies published in credible medical and research journals have shown how to identify, diagnose and treat MCAS. Dysautonomia, more commonly diagnosed as chronic fatigue syndrome/ME and/or fibromylagia, is a rarely accurately diagnosed condition that’s very common during a COVID-19 infection and Long-COVID. However, medical schools spend approximately one minute educating physicians on mast cells, which exist in all of the body’s tissues as part of the immune system. COVID-19, because it’s such a new virus in humans, inevitably triggers MCAS that causes inflammation and, in some patients, persists as part of Long-COVID.

Despite the pandemic being 2+ years old, most doctors still know nothing about MCAS. Until leaders involved in the newly-funded COVID-19 and Long-COVID research have had time to sort out the details, it’s up to patients to educate their doctors. How can patients do this? Send the carefully vetted links (see below) of relevant research/medical journal articles and other information from highly credible sources via your doctors’ portals, email, fax, etc. Patients also can advocate for their doctors’ professional associations to provide them with this much needed continuing medical education.

Here are links to the CDC’s interim guidance, a blog post by one of world’s expert researchers/clinicians that’s the most comprehensive and succinct resource I’ve found so far, and medical/research journal articles and news articles from relevant and very credible sources that patients should share with their doctors, nurse practitioners and physician assistants ASAP — i.e., Don’t wait until you get COVID! Please, feel free to copy and paste the sources below to send to your healthcare providers via portal/email. That’s why I wrote this blog post!

Be/stay well!

For healthcare professionals —

“Management of Post-COVID Conditions — Evaluating and Caring for Patients with Post-COVID Conditions: Interim Guidance,” June 14, 2021, US Centers for Disease Control.

“Mast cell activation symptoms are prevalent in Long-COVID,” Weinstock, Leonard B., Brook, Jill B., Walters, Arthur S., Goris, Ashleigh, Afrin, Lawrence, B., Molderings, Gerhard J., International Journal of Infectious Diseases, September 23, 2021.

Existing antihistamine drugs show effectiveness against COVID-19 virus in cell testing

Afrin, Lawrence B., Weinstock, Leonard B. & Molderings, Gerhard. J. “Covid-19 hyperinflammation and post covid-19 illness may be rooted in mast cell activation syndrome.” International Journal of Infectious Disease, 2020 Nov; 100: 327-332.

“Study: Long-Covid Impacts At Least 50 Percent of Those Infected,” News & Guts, 11/2021, with links to medical journal and Washington Post articles presenting more details.

Theoharides, Theoharis C., Cholevas, Christos, Polyzoidis, Konstantinos and Politis, Antonios. “Long-COVID syndrome-associated brain fog and chemo-fog: Luteolin to the rescue.” Biofactors. 2021 Mar-Apr; 47(2): 232–241.Published online 2021 Apr 12. 

For both patients and healthcare professionals

Study identifies those most at risk of long COVID

New theory: What causes severe COVID and long haul symptoms? One theory gaining ground links a more commonly than previously thought immune disorder called Mast Cell Activation Syndrome/Disorder (MCAS/MCAD) with severe COVID-19.

“The Role of MCAS in Long Covid | With World Leading Specialist Dr. Lawrence Afrin,” 2/9/21, (31 min. 5 seconds). The biological mechanisms of Long Covid are still somewhat of a mystery. But as we dig into the jigsaw looking for the pieces, one of the largest we’ve found is Mast Cell Activation Syndrome. In this wide ranging interview with one of the world’s leading specialists in the field, Dr Lawrence Afrin, he sheds light on the presentation, pathophysiology and treatment of the condition, as well as its complexity.

Stomach acid & heartburn drugs linked with COVID-19 outcomes.

Anne Maitland MD, PhD, Assistant Clinical Professor, Mt. Sinai Hospital, NYC, NY (one of the 1st long-covid treatment/research centers), “Living with Mast Cell Activation Syndrome,” 8/3/18, Baltimore: The Ehlers-Danlos Society Global Learning Conference.

Inflammatory Biomarkers in POTS Patients – Blair Grubb MD, Bobby Jones Chiari & Syringomyelia Foundation Annual Gala, 11/19/2021. Describes the role of autoimmunity, including MCAS, in dysautonomia and how to treat it, including recent innovations.

Celebrating Labor Day 2021

It’s been a tough week. Thanks to mostly the unvaccinated and the delta variant, the pandemic continued to surge. Meanwhile, kids, teachers and other school personnel are heading back to school. Many adults who’ve been working from home are now being expected to return to their offices or other places of employment where mask mandates are being ignored. Healthcare workers, especially in hospitals, are beyond burned out. Firefighters, also exhausted, continue to fight fires in California. Residents and workers in Louisiana and parts of the northeast are just beginning their long recovery from wind damage and flooding from Hurricane Ida. Yesterday, news from Texas about its new ban on abortions hit. A few days before that, also from Texas, it was how the state legislature had passed a new law to significantly restrict people’s rights to vote, affecting mostly Democrats — mostly poor, non-white and working-class people. I’ve gotta say, as a therapist whose practice — as is true for all therapists — usually “chills out” in August thanks to end of summer vacations, including mine, I’m exhausted and very grateful it’s Friday and the forecast for this Labor Day weekend looks so inviting.

Got empathy? If so, then you’re probably overly stressed, like most of my clients, and, maybe, like me, exhausted, too. Let’s make this Labor Day weekend the brief retreat we all need! Why? Because, afterwards, we’ve got a whole lotta work to do.

If we don’t put our best “Stacey Abrams'” foot forward in Texas and multiple other states across the country, what’s left that’s still functional in our constitutional democracy will end by 2023. What’s at stake is mind-boggling — climate change, our infrastructure, the economy, civil rights for everyone who’s not white, cis-born male and straight, Social Security and Medicare surviving beyond 2034 (i.e., most people’s retirements and access to health care once they’re 65 years old) and more.

So, what are you going to do to renew your energy this weekend?

This evening, I’m going to participate in a drum circle that kicks off my city’s Labor Day festivities. Tomorrow, I’ll do some errands and chores, get caught up with paperwork and billing and enjoy a long walk with my dog plus, hopefully, a bike ride and pick a friend who’s returning from Europe up at the airport. Sunday’s my day of rest and spiritual renewal — church via Zoom and livestream and probably a couple of Al-Anon meetings plus another walk with my dog. Monday, I’ll enjoy the local Labor Day parade and a concert/dance where a friend’s going to help me continue to learn to swing dance.

By Tuesday, hopefully, I’ll feel renewed and ready to get back to work! However, having taken a step back to look at the big picture, I’ve decided my practice is now full so, as I wrap up with current clients, I’ll have more time and energy to enjoy the things I love to do with people I love as well as some volunteer work to, hopefully, make my small contribution towards turning this currently overwhelmingly daunting mess around.

Hope everyone has a safe, relaxing and renewing Labor Day weekend!

The Importance of Kindness

Interrupting Intergenerational Trauma Transmission – Awareness, Insight and Empowering Yourself and Your Children to Make Informed, Safer and Healthier Choices (part 9 of 10)

Drop the rock. Sounds simple, right? Yet, what’s simple can be very hard to do. We drop the rock and, then, discover, out of habit, without having decided to do so or even realizing we’ve done it, we realize somehow we’ve picked it up and resumed carrying it again. When we’re carrying that rock — usually, the rock is heavy fear and shame that, consciously or unconsciously, dominates our thoughts and feelings and, therefore, influences our behaviors — our hands are not free to do the work that we are intended to do. 

Thomas Merton wrote in No Man Is an Island that, when we wring our hands with anxiety and worry, they’re no longer free to do the good work that God intends for us. When we live in hope and turn our wounds and worries over to God, however we understand a Power greater than ourselves — i.e., we drop the rock. With the help of our spirituality, we empty our hands so that we may use them. 

“Let go and let God” means that by believing that a Power greater than ourselves can restore us to “sanity,” we understand, accept, welcome and, in fact, embrace that a Power greater than ourselves has a clearer, safer and healthier vision for us and for our lives than we do. That spirituality is what frees us from living in the bondage of self, which is a miserable way to live. We embrace this because the pain from “self-will running riot” (12 step programs) has made our lives painful and unmanageable.

So, how do you drop the rock? Tell your story.

Tell your story not just to your current partner in your trauma-bonded relationship or your therapist but also to your 12-step program sponsor, to 12-step meeting attendees (especially newcomers), select friends, your “Higher Power” and, most importantly, when it’s developmentally appropriate to do so, to your children and other members of your family who are receptive to hearing it. Most of us have more than one story or our story is so long that it’s best to tell it in parts as smaller, more digestible stories. It’s important to share the trauma and loss narratives that are an intrinsic part of your history and your family’s history to raise awareness and share the insights that your generation and, equally important, future generations need to know in order to learn how to navigate their own lives to stop the intergenerational transmissions of trauma. If we don’t do that, then the saying, “We’re only as sick as our secrets,” inevitably will continue to play out not only in your own life but also in the lives of your children and subsequent generations. 

Sadly, many people, with the very best of intentions, decide to try to protect themselves and their children, grandchildren and others from the traumas that they experienced by keeping their family dysfunction, wounds and traumas secret. All too often, that results in some manifestation of the intergenerational transmission of those same traumatic experiences. There’s even some evidence that, to some degree, trauma transmits to the next generation on a physical, genetic level.

Oprah Winfrey and Bruce Perry, MD, PhD have written a book, What Happened to You: Conversations on Trauma, Resilience and Healing, that asks the right question — What happened to you? — rather than the wrong question — What’s wrong with you?

The next step is telling your story — not just what someone else did you to but, also, what you did with that experience. Tell your story, not just your perpetrator’s story. 

Take it one step further — do what you can to learn why your dysfunctional, abusive and/or neglectful parent(s) had the life story they had. Once you know what contributed to making them who they are/were, you’ll be able to view them with compassion and forgiveness that you didn’t have access to before. When you answer the question — what happened to you? — over time, you’ll begin to feel clearer and lighter because, while telling your stories, you’re letting go of the shame and fear that never did belong to you. 

It’s not your fault. What happened to you is not your fault. Repeat that however many times you need to do so. And, even better, listen to the stories told by someone who’s got what you want — that inner peace and serenity, lightheartedness and laughter. Listen to them tell their stories to learn from them and to realize in a deep way that you’re not alone, you’re not unique — that you’re a member of the human family. Through our stories our healing becomes contagious. Share it generously.

So, now, let’s get to your story. What did you do with your life as a result of what happened to you? Most of us internalized the shame and fear and, at times, we also projected it onto others, usually those who were closest to us. Here’s where we take a close, honest, gentle look at ourselves, giving ourselves as much compassion, forgiveness and acceptance as we’ve seen in and experienced from others in recovery. 

  • Did we drink alcohol or misuse or abuse drugs to self-medicate our grief, anxiety, stress, fear and/or shame?
  • Did we smoke cigarettes to distance ourselves from our feelings and other people? 
  • Did we become obsessed with trying to change or rescue other people? 
  • Did we spend money or gamble compulsively?
  • Did we bury ourselves and our feelings in work, becoming human doings instead of human beings?

There’s a freedom, serenity and happiness that comes from living our lives shamelessly, from no longer being terrified of and running away from our feelings and other people and, instead, learning how to welcome them to sit with us, from no longer judging others and accepting them exactly as they are today, even if/when they’re still reeling and/or hurting. Inevitably, there will be times in our lives when we’ll still feel anger fear, guilt or shame and when we’ll slip back into old habits. That’s okay. “Progress not perfection” is as good as it gets. Learning to identify our feelings, to sit with them, to tolerate experiencing them, to talk about them, to express them and, even, to welcome them empowers us to no longer make decisions in our lives based on old, toxic emotions. It’s how we free ourselves — how we learn to get out of our own way. Sharing our stories and listening to others as they share theirs empowers us to know that there is safety in numbers, to realize and feel gratitude in knowing with confidence that we are never truly alone.

Healing Happens, But Only If We Let It (part 8 of 10)

The 1st step towards healing is learning how to get out of your own way to allow what can and will come naturally. Healing happens naturally when we let it. However, most of the time, when we turn to psychotherapists who’ve been trained to work within the medical model, they guide us to spend even more time engaged in pathologizing ourselves, our families and our current and/or former partners and/or children to continue living in the problem rather than helping to guide and facilitate what comes naturally — healing.

Our defenses, which served a useful purpose when we experienced the traumas and emotional wounds in our lives, when allowed to persist beyond the situations in which they were needed also can delay and, at times, prevent us from healing. Traumas and losses happened to us. But, they don’t necessarily have to define who we are or influence how we choose to live our lives. Fear, anger, guilt and shame are natural responses when we’ve been wounded. Pain, when injury occurs, serves a positive function. However, after that injury or traumatic situation has passed, the pain from it no longer serves a positive function. The same is true for our emotional responses to emotional wounds. Letting go of our anger, fear, guilt, shame and sadness allows what’s natural — i.e., healing — to occur. 

Maladaptive coping strategies can keep us stuck, preventing the natural healing process from occurring.

The most toxic emotion of all is shame. Although natural and inevitable in human experience, shame is an emotion that’s about who we are while guilt is an emotion about something we’ve done. When we’ve experienced abuse and/or neglect during childhood, it’s not uncommon to internalize the shame from having had those experiences. Yet, as children, we weren’t always the ones who were engaging in the abusive or neglectful behaviors. So, it’s essential that we let go of that shame because a) it doesn’t belong to us and b) it’s toxic and functions as fuel to compulsive behaviors people use to cope with it — e.g., alcohol and other substance misuse or abuse, relationship or sex addiction, eating disorders, workaholism, low self-esteem, lack of confidence, narcissism and, even, personality/character disorders. 

Overcoming maladaptive coping strategies can be the most difficult and challenging task required to begin to allow ourselves to heal. It requires great courage to allow ourselves to experience ourselves, including our emotions, without self-medicating or compulsively engaging in our habits that, as distractions, help us to escape from our traumas and, at the same time, also to escape from ourselves and everyone else who chose to be present with us in our lives. If only self-medicating and/or compulsive behaviors worked well. They do work…temporarily…for a short time. Eventually, if we have the capacity to be honest with ourselves, we begin to realize that our maladaptive coping strategies keep us stuck in our trauma, loss and other emotional wounds. Over time, we realize that they keep us stuck on a merry-go-round of denial that repeatedly brings us right back to emotional pains that, over time, we’ve come to recognize and that have become all too familiar. If you’ve ever observed that your life has become a script that you’ve repeated over and over again, then you’ve got the insight to begin the work of recovery. Over time, we come to realize that those strategies have stopped working for us. We realize this when their byproducts jeopardize our job security, repeatedly ruin our relationships and, eventually, take a toll on our physical, emotional and spiritual health.

The first steps in overcoming those maladaptive coping strategies are we: 

  • begin to have compassion for ourselves
  • recognize that the locus of control resides within us, which empowers us to make more positive, constructive and healthier choices and decisions
  • identify where the boundaries are that enable us to stop internalizing the shame, guilt, anger, fear, etc. and, instead, direct those emotions where they belong — at the person(s) who abused, neglected and/or abandoned us
  • forgive those persons for our own physical, emotional and spiritual well-being rather than identifying as victims and holding onto resentments.

Human healing far exceeds “fixing” or “solving” problems. Transformative change, drawing upon our inherent capacity to heal, usually happens when we learn how to get out of our own way. 

Part of that healing journey involves realizing and embracing humility. We learn that everyone in this day and age is “at risk” in some way. Pain and suffering are inherently parts of life, as is death. If we grew up neglected by needy parents, chances are, we learned how to neglect ourselves and to meet others’ needs before attending to our own. Alcoholic and drug addicted parents teach their children to cope by misusing and abusing alcohol and/or drugs. It might not even occur to us that doing that isn’t normal. When we begin our healing journey, at first, we may not even know what “normal” or — better yet — “healthy” is or looks like.

When we begin our own healing journeys, we also show our children and others in our lives how to live safer and healthier lives. One of the ways that we do that is to share our stories of our healing journeys with each other.

3 Essentials for Recovery: Honesty, an Open-Mind and Willingness (part 7 of 10)

The Big Book of Alcoholics Anonymous describes “HOW” the program works with “HOW” being an acronym for:

  • Honesty
  • Open-mindedness
  • Willingness.

On each chip that members of AA receive, from day one as newcomers through each anniversary, there’s the saying, “To thine own self be true,” taken from Shakespeare’s quote, “Above all else, to thine own self be true.” Alcoholism is described as cunning and baffling. The same is true for all compulsions. That’s why they identify honesty, especially honesty with oneself, as essential for recovery. The same is true for people in trauma-bonded relationships or with histories of trauma-bonded relationships. The Big Book goes on to say that there are those unfortunates who lack the capacity for honesty and, because of their lack of capacity for honesty, the AA program cannot help them.

Rather than trying to reach out or communication with such people who cannot be honest with themselves, members of AA will simply pray for them because, without honesty, AA won’t be able to help them. The same is true for psychotherapy. Without a capacity for honesty — especially with oneself — the help that psychotherapy can provide is significantly limited.

Because the feelings of elation resulting from the initial formation of a trauma bond can be, essentially, addicting, the same is true for people who choose to recover from their trauma and move beyond creating and participating in trauma-bonded relationships.

The 2nd essential ingredient is an open mind. It can be difficult to let go of what’s familiar because even the most painful ruts are what we’re used to experiencing. Having an open mind means being willing to tolerate hearing suggestions from a recovery sponsor, therapist or others such as “drop the rock” or to focus on developing a relationship with yourself rather than getting into another relationship during the first year of recovery. An open mind builds on a foundation of honesty — especially a capacity for rigorous honesty with oneself. Is there an abundance of evidence that we don’t know how to have a healthy, long-term relationship? Have we ever taken the time to develop a healthy relationship with ourselves? If we don’t have a healthy relationship with ourselves, how can we expect to have the capacity to have a healthy, intimate relationship with someone else? An open mind includes having the capacity to be asked such tough, challenging questions.

The 3rd essential ingredient — willingness — means having the capacity and commitment to tolerate what’s uncomfortable at times. It sometimes means being willing to delay gratification. Willingness sometimes requires being willing to do nothing — to practice patience — and, in the beginning, what’s most likely, to have almost blind faith in the process. Sometimes, willingness means having the courage to make a decision or engage in an action,. Somehow, others who’ve been in recovery longer have something we want. Although we don’t yet understand how they got there, even if only out of desperation, we place some degree of faith in them when they say, “Keep coming back. It works, if you work it!” is true even though we are still confused and have no clue how that’s possible for us.

Willingness ultimately means that we’re able to tolerate hearing that we’re not “terminally unique” and, eventually, accept that. By doing so, we acquire a degree of humility. We’re human. And, in doing so, we also acquire self-compassion, which is essential. It also means that we’re willing to try living in the solution — to do things differently and try new things — rather than to cling to what’s familiar, realizing and accepting that, inevitably, we will make mistakes along the way.

Recovery is never a linear process. We’re human and, so, it tends to be messy at times. We’ll stumble and fall and that’s okay. At best, we’ll experience progress, not perfection. Willingness includes forgiveness of ourselves and accepting that it’s okay to make mistakes.

We learn to let go of shame — which is about who we are — and make productive, positive use of guilt — which is about what we do, including how we choose to behave in relation to what we feel. We learn to make use of forgiveness, to let go of mistakes that we and others have made in the past and those we and others will make along the way from here forward.

Honesty, open-mindedness and willingness are how we learn to live in the solution rather than continuing to live in the problem, In doing so, we give ourselves the chance to experience that when we begin to live in the solution rather than live in the problem then the problem goes away. It’s not a problem to be solved by us or others. It’s definitely not a problem that any therapist, friend, lover or 12 step sponsor can solve for us. Instead, it’s a problem to accept and to let go as we learn a new way of living with ourselves and others.

The Big Book of AA also says we’ll not regret the past nor wish to shut the door on it. Although we’re now living in the solution, it’s helpful to remember the past so that we can learn from it.

Among the many things that we’ll learn is that feelings aren’t facts. We’ll learn acceptance and how to practice detachment. Sometimes, we’ll practice detachment with love. We’ll learn that sometimes the best thing to do is nothing — that simply because we have feelings doesn’t mean we have to act on them. In doing so, we’ll become actors rather than reactors. We’ll learn that, although we don’t get to choose our feelings, we do get to choose what we do with them. We’ll begin to recognize when we feel fear and/or shame and how often we’ve let one or both dictate our behaviors and choices. We’ll learn to tolerate experiencing those feelings — sitting with them and talking them through with a trusted therapist, sponsor and/or friend and, then, letting them go — rather than acting on and/or running away from them. Fear and shame no longer will be what influence our choices, behaviors and, ultimately, our lives. That’s what it means to live “happy, joyous and free.”

The Road to Recovery: Building/Returning to Your Relationship with Yourself (part 6 of 10)

Having had a history of trauma-bonded relationships doesn’t mean that you can’t recover. It doesn’t mean that you can’t learn to see things as they really are — the complexities that reflect emotional maturity rather than all v. nothing, good v. evil. Your personal growth and healing doesn’t depend on anyone else nor on your relationship with anyone else. No matter what, if you have the capacity to be honest with yourself, you can repair the relationship that’s most important of all — the one you have with yourself.


“Love After Love” by Derek Walcott (Read by Jon Kabat-Zinn)

The time will come

when, with elation

you will greet yourself arriving

at your own door, in your own mirror

and each will smile at the other’s welcome,

and say, sit here. Eat.

You will love again the stranger who was your self.

Give wine. Give bread. Give back your heart

to yourself, to the stranger who has loved you

all your life, who you have ignored

for another, who knows you by heart.

Take down the love letters from the bookshelf,

the photographs, the desperate notes,

peel your own image from the mirror.

Sit. Feast on your life.

The discard will make what actually happened previously no longer relevant to the person who does/did the discarding. Your making amends to someone who’s discarded you might be ignored or unacknowledged. Scapegoating and projection probably will be used to justify what they need or want in the moment. If your partner/friend or former partner/friend chooses to be a victim, then there is nothing you can do about that. And, as hard as it may be to accept, what they think, feel and do is now really none of your business. 

It’s true. You were far from perfect. You got a lot of stuff wrong. You made a lot of mistakes. You even might have been like a bull in a china shop. But, most of all, what you did that was “wrong” was you stopped being that trauma-bonded, idealized illusion when you became real. To them, that was an abandonment and a betrayal. You left them alone with their trauma. You refused to live in their alternative reality.

They also weren’t perfect. They also got a lot of stuff wrong. They, too, made mistakes or, who knows? Maybe they even did crappy stuff intentionally. What they cannot tolerate acknowledging themselves doing or having done they might project onto you. That’s what’s called “projection,” an unconscious, primitive (and, therefore, very strong) psychological defense mechanism. If they accuse you of doing things you know for sure you didn’t do, then, chances are, they did those things. That’s how projection works.

The reality is there’s always two sides to every story. Chances are, you both contributed to hurting each other, even if unintentionally. The Big Book of Alcoholics Anonymous says we’re not judged by our intentions but by our actions. Your recovery requires accepting responsibility for your actions. You’ve got to look inward and “clean house” internally as part of moving forward. If you don’t, you’re far more likely to repeat the same mistakes again. 

Rather than reiterating history, defending or explaining yourself, hear their projections as inadvertent, unintentional confessions. But, don’t confront them.That only would make things worse by keeping you engaged in a toxic situation and overwhelming them. Instead, be generous by lovingly respecting their defenses. Nevertheless, I include projection here because it might explain to you why your, by now, soon-to-be former or, by now, former partner/friend and their remaining “flying monkeys” have begun to behave differently towards you. In fact, you may be surprised and disappointed to learn that projection and scapegoating are often a family affair. Healthy families help couples or friends stay healthy and together. Trauma-bonded families preserve the relationships within the family at all costs, including by participating in and/or enabling blaming and/or scapegoating anyone who threatens their shared “reality.”

Trauma-bonded families, because they’re shame-based, lack the capacity and/or willingness to be honestly introspective. Instead, they adopt a defensive stance, blaming the scapegoat who, by definition, they cast out. Sure, it hurts to be shunned. But, by definition, that’s what scapegoats are for. On the other hand, scapegoating resolves absolutely nothing. The problematic dynamics in such individuals and family systems still exist. Sadly, that means that such families set each other up to repeatedly fail in their intimate relationships, probably with no insight whatsoever that that’s what they’re doing. At best, they may realize what they’re doing but they choose to do so anyway in order to preserve their relationships with each other by following the same, old dysfunctional family rules: 

1. Acceptance Is Conditional. To gain acceptance, members must comply with the family roles (e.g., Golden Child, scapegoat, flying monkeys), narrative, value system and alternative reality. Expressions of difference are rejected and pathologized.

2. Submission Is Required. Everyone is expected to submit to authority, no matter how wrong, ignorant, arbitrary, cruel, or destructive it is.

3. Someone Must Be Blamed for Problems. Whenever something bad happens, someone must be blamed for it. Typically there is a family scapegoat who is made to bear the main burden of the family’s problems, frustration, and unhappiness, as well as the dominant member’s projected self-loathing.

4. Vulnerability Is Dangerous. Mistakes, accidents, and weaknesses, even ones you take responsibility for, are cause for shaming treatment that can persist for years.

5. You Must Take Sides. Just as there is always blame and shame, there are always sides. If you’re not on the “right” side, then you are wrong. Members feel forced to choose sides. If you don’t comply, then you risk being shunned or scapegoated. Remember, closed systems (i.e., you’re either in by adhering to the rules/loyalty or you’re out — i.e., shunned) are inherently dysfunctional and often abusive. 

6. There Is Never Enough Love and Respect to Go Around. Renewable resources in healthy families, love and respect are limited to the dominant one and whomever else is deemed worthy, usually a favored “golden” child. Respect for one person means disrespect for another (e.g., the “scapegoated” child).

7. Feelings Are Wrong. The feelings that make us human, help us connect and get our needs met, and protect us from harm are selfish and must be repressed. Only the dominant one has free rein to express feelings, have emotional reactions, and make demands.

8. Competition, Not Cooperation, Rules the Day. One-upmanship, favoritism, and constant comparisons create a harshly competitive environment that undermines trust and breeds hostility and betrayal.

9. Appearances Are More Important Than Substance. Even if everyone is suffering, they still smile for the family photo.

10. Rage Is Normalized. Everyone is expected to swallow and endure the dominant one’s irrational, explosive, and possibly also violent rage. This may be magnified by other forms of mental illness and/or addiction.

11. Denial Is Rampant. To sustain the dominant one’s control over the family, there is denial of:

  • abusive incidents
  • a continual atmosphere of fear and shame;
  • an ongoing mistreatment of the scapegoat; and
  • routine forms of neglect.

12. There Is No Safety. Although the scapegoat is targeted with the most abuse, everyone is on hyper alert because no one is safe from blame and rage.

It may be that some family members have tried to give honest feedback but the inability to hear that or listen or stonewalling maintains the status quo. Despite suffering, people tend to favor their comfortable ruts over facing the truth and other emotional challenges required for personal growth. If you lack the capacity for honesty with yourself, then there is no therapy or 12-step program or natural healing process that can help you. If you don’t like or love yourself, then being alone with yourself can feel dauntingly empty, depressing and terrifying. 

Acquiring a more functional family of choice, possibly through the fellowship of a 12-step program, select family, friends or church group can provide a bridge upon which to build a healthier relationship with yourself. Stick with the winners — the people whose lives are like the one you want to build for yourself.