Shame

Asian American Mental Health and Illness, May, 2021

gail louise Real Life; Real Challenges, Shame

“From a very early age I started to sense that an individual has to set an example in society. Your own acts or behavior tell the world who you are and at the same time what kind of society you think it should be.”

    – Ai Weiwei, Chinese Contemporary Artist and Activist
     (as quoted in: The Botanical Bible, Sonya Patel Ellis, 2018)


When Jim and I were first married, we had three friends of Asian descent. 

Shu (S-h-u) was from Taiwan. Shu was serving an internship with me – I was her perceptor as a practicing registered dietitian; Shu was an intern. Two other friends were a Korean. They  were a married couple, Mr and Mrs Bae.  Jim worked with Mr B.

Shu and Mrs Bae were excellent cooks. Both women were my earliest introduction to the interaction of food, culture, politics and the limitations imposed by authoritarian regimes. Shu was from a rich family. Mr Bae’s family was poor. 

Mr B and his generation were small due to the poor diet imposed on Korea during WWII by the Japanese. In contrast, as a child, Shu C. had all the food she desired to eat. Once her skin turned livid orange from eating so many fruits rich in beta carotene, a form of Vitamin A!

The most tasty, authentic, and intriguing Asian meals Jim and I have had the pleasure to eat were those prepared by Shu and Mrs B in their home and in our home. Mrs B.along with her 1 year old son, lived with us for several months. During that time, we ate …  oh so well. To this day, rice is as frequent at our table as potatoes and pasta.  As we raised our children, we ate with chopsticks, every dinner. And Jim and I still eat with chopsticks. Eating with chopsticks is aesthetically pleasing. Chopsticks are quiet and clean. There is no clanging of silverware during conversations.  We use Korean/Japanese sculptured chopsticks.

Ah, you did not know there were different types of chopsticks? And many varieties of rice?

Do you know that Asian people do not all look alike? They do not!

Everyperson, everywhere is unique. 

I am thankful for our uniqueness.

I am thankful for our commonalities.

Hate of Asian Americans and all Asians is on the rise. The shrinking of the white male majority in America, the history of WWII, the Korean and Vietnam wars, the loss of jobs and industries to Asia, especially China, and the many misconceptions about Asians, have blighted the wonderful assets many Asians have brought to America and the world.

A tiny sampling of those accomplishments: 

Mya Lin, the architect of The Vietnam Memorial Monument. Amy Tan, the writer. Chien-Shiung Wu, the nuclear physicist … and so many others. Can we forget the laborers who constructed the transcontinental railroad, many of whom were Asian? Athletic stars such as the NBA’s Jeremy Lin, and linebacker and coach Eugene Chung. …Or quarterback Kyle Murray, whose mother is half Korean and whose father is African-American (Love it; wow!) Finally, my children’s and grandchildren’s friends, who are ethnically much more diverse than my generation’s cohort. I Think of bonsai and the art of flower arranging, ikebana. Forms I hope to learn to enhance my floral arrangement skills. The most exquisite scarves I have ever worn are shiboru, a three dimensional form of folding, stitching, and pleating, all in silk, created by Suziki Kanezo of Japan. These shiboru drape over my shoulders .. under my long hair … so gracefully. 

***

Shame dominates as the most hope and life- killing force on earth. 

For many, death is better than enduring shame. 

Ask me and ask my father.

For all of us, shame comes from stigma. 

My Dad did not seek mental health care and neither do many people of Asian descent. Suicide of young people, ages 12-24 is greatest in Asian-Americans!  Stigma stems from the fear of being identified as disabled. Societal norms and values place a premium on our ability and actual performance towards taking care of one’s own family  and in contributing to our communities.

I do not believe there are many differences here in the things that shamed my father, Asian Americans and myself. For myself, I feared I would not be able to care for our two children and be a loving wife to my husband Jim. All those fears were not in evidence, but they all overshadowed my thoughts, feelings, and emotions.  For my father, I do not know his shames, although once committed to a mental health hospital, and with the possible loss of the family farm just one serious consequence of this, I believe he endured shame as a life sentence. He never discussed his feelings, but lived through many serious suicidal depressions and suicide attempts. 

Asian Americans live with the stereotype as the model minority. The myth goes like this: Asian Americians are fully-integrated, intelligent, industrious, and have overcome racial bias. Individual Asian people feel pressure to meet these standards and expectations.

 The pressure to live up to the image as a model Asian American results in the denial of any  letdowns, failures, pain and loss … all of which we all experience or will experience. The drive for perfection can kill. I know the drive for perfection too well, and the toll it takes on family and on oneself. Thinking perfection will cure everything … can be fatal.  

Talking about mental illness/mental health challenges is taboo for most Asian Americans.. As it was in the family into which I was born and was raised.

Let us all be more than tolerant to one another. Let us begin to trust, admire and appreciate each person.

Let us share a spirit of gentleness and work toward a better society.  Many times song expresses what we have not ventured to put into conversation:

 “ Tale as old as time, true as it can be, barely even friends, then somebody bends unexpectedly. Just a little change, small to say the least. Both a little scared, neither one prepared …  Tale as old as time.”

Thank you kindly,

Gail Louise

(Lyrics by Alan Menken 1991)

I Have Long Been Concerned …

gail louise Beyond Recovery to Healing, Real Life; Real Challenges, Shame

I have long been concerned with people who have mental illness and need care, but don’t recognize the need for treatment. Civil commitment (involuntary psychiatric care) can result if the circumstances dictate. But such involuntary care is controversial. Indeed, I have been conflicted about it for many years.

A personal experience has made me examine the issues involved with civil commitment square-on.  My father had involuntary psychiatric care when he was committed to a mental hospital in the 1950s. He always spoke negatively of the experience with feelings of anger. He was dangerous to himself at the time, threatening to shoot himself with a shotgun. One thing is clear however, as episodes of major depression reoccurred over the 1960’s, 70’s, and so on, he never sought help. He relapsed, got more depressed and Instead of getting care and treatment, he would attempt to take his own life. Surviving these suicide attempts, he would cooperate with the offered mental health care…. for a while.

In the 1950s, it was weak to be mentally ill and weak to be treated. I have always wondered whether the experience of forced care, of involuntary care, hurt and shamed my father so much that it clouded his otherwise good judgment.  Did it, finally, interfere with Dad’s asking for more help when needed?

To help me grapple with the issues, I’ve just completed reading the  book, “Committed, The Battle Over Involuntary Psychiatric Care,” written by Dinah Miller and Annette Hanson.(2016) Both writers are physicians.

In their research and writing, Miller and Hanson sought to refocus mental health professionals and others to consider this possibility: “Involuntary psychiatric care may be damaging. It may never be appreciated and the fear of forced care may prevent people from seeking help.”

The book presents a rounded picture of involuntary care. (Many times only one side of the story is featured.) I appreciated the fair handedness with which the authors addressed the issue. They interviewed former patients who had been helped as well as those who had not been helped by the process.

One of the biggest take home messages I learned from the book, was that even people who had been committed and HAD been helped found the experience to be traumatic. That was troubling to learn. Active mental illness itself is traumatic. We are talking about people living enduring a double trauma .

Hanson and Miller made the following recommendations:

  1. Encourage people with psychiatric disabilities to prepare an advanced directive. In the document it is possible to specify which medications are preferred, which facility one is to be admitted to, and even who should care for the person’s children during a hospitalization.
  2. Train inpatient and emergency room staff/personnel in the use of verbal de-escalation techniques.
  3. Crisis intervention training (CIT) should be mandatory and routine for all correctional officers and all state and city police forces. (Currently, these trainings are limited to a handpicked or volunteer teams of specialized officers in some locations.)
  4. Handcuffing patients who are brought to hospital by police should NOT be a standard practice..
  5. Support creation of mental health courts and pretrial diversion services to shorten incarceration times pending trial and to tie a defendant closely to needed community services.
  6. Expand use of mobile treatment teams, assertive community outreach, crisis centers, peer support services, patient directed initiatives, and a variety of housing options.
  7. Suicide hotlines should be made available to everyone and widely publicized. (Hotlines are available now but patients/clinicians are often unaware of them.)
  8. Increase efforts to detect serious mental illness in the early stages. Specifically: more training of primary care physicians and other non-psychiatrists so there is better recognition of when referrals should be made to psychiatrists. If mental disorders were recognized and treated earlier, involuntary treatment could often be avoided.

In 2018, we’ll examine some of these issues.

I appreciate your readership,

GL

Lies your depression tells you when you are suicidal

gail louise MajorDepression, On Suicide, Shame

He was middle aged and in the prime of life when he killed himself. He had family and children. A prestigious appointment at a respected University – and he had received several awards for his research. Wholesome looking and in good shape, he seemed to have had everything to live for. Do you know what? That’s right; he did have many things to live for, including a promising future.

Yet he went out of town for the weekend, quietly rented a motel room and died there by his own hand.

We all ask why. It seemed like the man had the world by a string. Why does anyone commit suicide?

It doesn’t make sense, does it? No it doesn’t and yet people take their lives every day. WHY?

Nearly always there is an intractable depression pushing the person into despair. Depression lies, and its false thoughts and lies are utterly convincing. Yet to the depressed person these thoughts feel completely real and desperately true. In my experience they are intense, persistent, and severely painful.  The person becomes overwhelmed by their depression’s lies.

I’d like to share insights from Amanda Redhead, Mother, Nurse, Writer, and Warrior from her Huffington Post blog entry of Sept 9, 2016:  Five Lies Your Depression Tells You When You Are Suicidal.

Here are five lies that depression imbeds in the head of a sufferer:

  • YOUR LIFE IS ALREADY OVER. YOU HAVE SCREWED UP BEYOND REPAIR!
  • YOUR LOVED ONES ARE BETTER OFF WITHOUT YOU.
  • THE PAIN WILL NEVER END, NEVER END.
  • YOU ARE NOT WORTHY OF LOVE OR LIFE.
  • … THEREFORE, YOU MUST KEEP YOUR THOUGHTS ABOUT HARMING
    YOURSELF QUIET!

One: Your life is already over. You have screwed up beyond repair.

Wonderfully, there is no such thing as a life ‘beyond repair.’  Amanda writes “You may have messed up so royally that you believe that no one will ever forgive you. But there is life beyond this pain and there is life beyond whatever mistakes you have made.”

Two: Your loved ones are better off without you.

This empty lie is probably the biggest of them all.  Far from removing their pain, suicide only creates an emptiness in your loved one’s hearts. That hole remains. Your loved ones find only sadness and the pain of losing you. “You may be feeling like a failure right now but I cannot imagine a greater mistake than having your last act on earth be one that causes intense pain for each and every person you love.”

Three: The pain will never end.

It feels like a pain that will never end.  I remember looking for just a brief reprieve.  Silently I bargained for relief in minute increments. The pain of depression felt very catastrophic and chaotic to me. I couldn’t believe that the rest of the world would or could go on functioning with my pain in it.  A moment in this pain feels like a year.

But there IS an end to the pain, unlikely as it seems now. As Amanda said, “I cannot tell you when that end will happen, but I can tell you that the end is somewhere.” You may have to work for it, your may have to get help or take medication or reach out when you want to stay silent, but the end of the pain is out there on the  horizon.

Four: You are not worthy of life or love.

Another big lie. This lie and others like it are invasive and seem so accurate. Everyone is worthy of love, no matter the mistakes they have committed. Everyone is worth living! You are only seeing the negative things about yourself right now. Remember depression colors your thoughts. You are a valuable human being and deserve to be alive and loved.

Five:   …You must keep your thoughts about harming yourself quiet.

#5 is the ultimate lie: Yes, your depression wants you to stay silent. Depression wants you to take your life. There is great shame around depression, anxiety and suicidality.  When we talk about the depression, we erase some of that shame and stigma.

Please believe me: There is no need to suffer in silence.

Pick up the phone and call one person and tell them what you’re struggling with. This may be the hardest thing you will ever do, but it gives life – your life – another chance.

Here I must add a word of hope:

Yes, depression distorts the depressed person’s thoughts. And depression’s thoughts can be deadly.  The five lies illustrate various cognitive distortions.  And forms of cognitive therapy can assist depression suffers to learn to recognize and combat false and irrational thought patterns – depression’s lies. Today recognizing and analyzing distorted thoughts that feed depression is called cognitive behavior therapy (CBT). There is a promise of hope for recovery.

Psychiatrist Dr Aaron T. Beck laid the groundwork for the study of these distortions. His student, David D Burns, MD, continued research on the topic. Dr Burns’ book, Feeling Good: The New Mood Therapy, was first given to me in the mid-eighties by my psychiatrist. I glanced at it and rejected it, thinking that my doctor was telling me I should learn ‘positive thinking.’ I knew depression was a disease more serious than superficially thinking right. But in the 1990’s I was able to accept the book and its premises. Soon I underwent a group therapy session during which some of the basics of CBT were taught. I was able to learn those basic principles and asked for a therapist to do CBT regularly with me.  The short of the story is that I did find a therapist, who had a PhD in psychology and had done significant graduate work specifically with CBT. He was willing to take me on weekly for several months.  Cognitive Behavioral Therapy became one of the essential pillars undergirding my recovery from suicidal depression.

Depression now sometimes gets a grip on me. But with medication that works for me, with the practice of cognitive behavioral therapy, with a supportive family, and with a doctor’s ongoing psychiatric care I no longer develop full-blown depressions. Depression occasionally gets a start, but CBT’s corrective is powerful, and negative thinking doesn’t get a hold on me for long.

Thanks for reading,
Gail Louise

Communities in Action to Prevent Suicide, part IV

gail louise Communities Preventing Suicide, Learning to Hope, On Support, Shame , , , ,

Dr. Whiteside, concluding her keynote address to the Communities in Action to Prevent Suicide conference, April 2015, asked us to visit the websites below for a look at what suicide attempt survivors have to say for themselves.  Their words offer important insights.

www.livethroughthis.org is a wonderful and compelling collection of portraits each linked to a suicide attempt survivor story, as told by those survivors. LiveThroughThis shows through these remarkable stories that everyone is susceptible to depression and suicidal thoughts. It does this simply by showing portraits and stories of attempt survivors — profoundly sharing that they are people no different than you or I.

As the website’s author Dese’Rae L. Stage writes, “…these feelings could affect your mom, your partner, or your brother, and the fear of talking about it can be a killer.”

The second website attemptsurvivors.com  is a now-completed project of the American Association of Suicidology. This site also features attempt survivors who have spoken up and told their stories. This website’s editor taught me a valuable lesson also. She wrote that people continually ask survivors about suicidal thoughts and actions, saying “Why would you want to do that to yourself?” As she noted, this question represents a shocking and a fundamental misunderstanding. You see, as when inquiring about any potentially fatal health issue the question needs only be, “Why is this happening to people we love?”

Do you see the stark difference between these two questions? The first, intentionally or not, is accusatory and focuses on blaming the suicidal person. The second question reflects concern for the person and asks why it is that this has happened to this individual, without seeing the act as a personal fault — and in truth, suicide is usually the result of a mental illness process.

Thank you for reading and for hearing and listening to them.

Resources on Suicide – and the way forward

gail louise Learning to Hope, More First Things, On Suicide, On Support, Shame , , , , ,

I’ve written a resource page on Suicide – Look on the menu bar, click Suicide and then Resources on Suicide.  There are links there for anyone who may be at risk for suicide or is a survivor of a suicide attempt.  I hope they can be of help for you.

Especially I want to draw attention to the link for the report The Way Forward: Pathways to hope, recovery and wellness with insights from lived experience (2014 pdf), by the National Action Alliance for Suicide Prevention’s Suicide Attempt Survivors Task force.   The report is unique in its breath and scope, and unique in that its co-leads were one, a survivor of suicide attempts and mental health advocate, and the other, a psychologist with years of experience working with people in suicidal crisis.

“For far too many years suicide prevention has not engaged the perspectives of those who have lived through suicidal experiences. Because of social stigma and fear, as well as personal shame, a culture of silence prevailed. The Way Forward represents a seminal moment in this field’s history; it is an opportunity to benefit from the lived experience of suicide attempt survivors. Many of its recommendations are derived from evidence-based practices, and several are aspirational. All are grounded in the evidence of recovery and resiliency that is clear in the lives of our Task Force members.”
– from the report.

From Shame – Moving Toward Healing

gail louise Beyond Recovery to Healing, Brene Brown, PhD, MajorDepression, Real Life; Real Challenges, Shame , , , , , , , ,

During the recent half decade I have been so fortunate, as Brene Brown* describes, to have completed the journey from the “not being good enough” shame struggle to believing and knowing “who I am is enough.” Shame from having mental illness has left me. Shame from being related to other people with mental illness has left me also. I have been graced.

I only recently realized I had made this journey. I understand now how much shame – and my growing resilience in the face of shame – had influenced the course and depth of my mental illness through the years.

It didn’t happen, this journey to being shame-free, automatically. I happened to want to do what is recommended for building shame resilience for other reasons; I wanted to help others cope with mental illness. Often, as part of my work, I told my story of family and personal mental illness. I didn’t realize then, twenty five years ago, how much nurturance I would receive from assisting others.  My story of the power of shame and how I arrived at healing from shame follows …. [Read the Full Article]

 

*   Brene Brown, PhD, LMSW   Audio lecture, 2012: Men, Women & Worthiness, The experience of Shame and the Power of Being Enough.  Available on CD at Soundstrue.com  PO Box 8010/Boulder CO  80306.