I am writing this on the heels of Thanksgiving and Black Friday in hopes of finding Americans in a more thankful and grateful frame of mind.

Now, of course, the challenge is how to keep that up because when we are feeling down it unfortunately doesn’t bring out the best in us.

“Why are Americans so unhappy?” is a question several Indians asked me on my recent trip to Mumbai, Bangalore and Delhi. I felt embarrassed by it in light of seeing the still-incredible amounts of poverty in India and yet seeing how happy people seemed compared to Americans.

I responded, “Americans may be unhappy because of all the financial insecurity since the awful financial problems began in late 2008.”

One of my hosts said, “With all due respect Dr. Mark, they were unhappy long before that. And add to that, they rarely seem calm or content. Most of our country has very little, but we still seem much happier and more content than your country. What is that about?”

I didn’t have an answer, but one came to me on my 27-hour journey back to Los Angeles. Many Americans seem to be addicted to more, sooner. That can lead to feeling that at any given time, no matter what they have, they always want more. And no matter how quickly they get it, they always want it sooner.

If you think that is too simplistic, how many Americans do you know that are happy, or even okay with having less, later?

It seems that India has been so used to having less for ever that they are able to appreciate having anything more than that. They also seem more patient, perhaps because they know that becoming impatient doesn’t help the process.

What is something that you and I as Americans can do to become a little happier even as we wait and hope for our financial situation to stabilize?

A few thoughts and situations come to my mind and I hope you will add in your comments suggestions that you can offer.

First, start every day thinking of 10 people you’re thankful and grateful for. It may be people who stood up for you against other people, stood by you during a crisis or stood up to you to prevent you from doing something stupid (think of all the sponsors in 12-Step Programs who came and took you to a meeting before you fell off the wagon). It may be people who saw good in you and potential in you that you couldn’t see or people who believed in you when you didn’t. On Thanksgiving, I received a wonderful email from the co-author of my next book which will be about the power of positive influence, Dr. John Ullmen. He wrote to say that he has recently gotten into the habit of each day thinking of 10 people he felt thankful to and told me that for several weeks I have always been on the list.

Talk about positive influence. That email from John influenced me to not only feel gratitude towards him for his comment and for doing the lion’s share of the details in writing that book (which we think you will all enjoy when it is published in fall 2012), it influenced me to write this blog entry.

Second, I think how much happiness is directly related to our perspective on the world and others and ourselves. One of the best examples I can remember about a perspective I try to keep is the day 20 years ago when two women in their late 70s came to see me separately on the same day. Both had arthritis.

The first was a rather vain woman whose fingers were moderately swollen. She had one too many plastic surgery procedures, was dressed to the nines and bemoaned how unsightly her swollen fingers looked and how she would now have to get her jewelry re-sized. It’s not up to me to judge my patients and I did my best to empathize with her and help her deal with her upset about her condition.

A few hours later a woman who was about the same age came in and was hunched over with severe arthritis, walking slowly with a cane. She reminded me a little of the witch in Snow White. But what stood out about her from the first woman and from the witch in the Disney classic was the radiant smile on her face. She not only seemed happy, she seemed glowing. The contrast between her and the prior woman was astounding.

It caused me to say to and ask her, “Excuse me, you look in a fair amount of pain and are walking with such difficulty. I need to know. Why such a beautiful smile?”

She looked at me with that smile radiating even more and said, “I was just thinking how great this cane is going to look when I am in a wheelchair in a few years.”

Talk about perspective, if all of us could look at our present through the eyes of our future and see our present glasses as well more than half full, perhaps that could put a smile on our faces that we could hold onto.

Finally, there was the story of Mr. Cohen. It was 4:30 in the afternoon and I had just finished doing an EKG on him. Unlike everyone else living at the Jewish Home for the Aged in Jamaica Plain, Massachusetts, Mr. Cohen was spry and totally alert for his 87 years. As a third- year medical student with much living (and learning) ahead of me, I couldn’t understand why he was staying in this place, which well appointed as it was still remained a last holding unit for people who were waiting to die.

I asked Mr. Cohen why he lived in such a depressing place when he was clearly doing so well. He looked at me with a patient, knowing look and explained: “Two floors below us is my wife, Emma. Three years ago, she developed Alzheimer’s disease and then had a stroke on top of that. On the very best of days, which don’t occur that often, I think she might recognize me. At all other times, she’s lost.”

He went on to tell me to me that Emma and he had fled the Russian revolution together, and that more than a few occasions she had saved his life. The couple made their way to America, started a tailoring business and raised a wonderful family. “I tell my family not to visit as much as they’d like,” he said, “because I want them to make sure they enjoy their families now and because their mom and I are doing fine.”

Each day, he would wake up, go downstairs to his wife’s room, bathe her, replace the diaper she now needed, put her into a sun dress, braid her hair, have breakfast with her and then read his newspapers and books as he sat beside her.

I didn’t get it. Why was he doing this with a woman who couldn’t even recognize him? “This poor man must be eaten up with guilt,” I thought.

I suggested, presumptuously, that Mr. Cohen’s guilt would not help his wife. The old man looked at me with an annoyed expression on his face and shook his head at my stupidity.

“Each day I get to go downstairs and give my wife dignity. That’s what she would do for me and want to do for me. You don’t understand, do you? This is where I want to be. Maybe someday you will understand.”

It’s been nearly 40 years ago since my visit with Mr. Cohen and I think I do finally understand. Instead of guilt, he felt joy in the presence of someone he had loved and been loved by for 60 years.

What are some suggestions from you or stories you can share for becoming more happy?

With former NBA star and General Manager and “Mr. Clutch,” Jerry West coming forth in his about to be released book, “West by West: My Charmed, Tormented Life,” with his admission and full depiction regarding his battle with lifelong depression, a few more pieces have fallen into place.

Keys to West’s depression were a scarily abusive father, lack of love in his childhood, death of a very “kind” brother and a lifelong tendency to go “dark” after defeats or losses in his career. Perhaps the most gutsy revelation in this book was West’s view of his relationship with Lakers owner Jerry Buss and Coach Phil Jackson.  If you read between the lines it may be that West’s feeling that he had worn out his welcome with Buss, who cared obsessively about winning and then his being ignored and dismissed by Jackson retraumatized him by landing him back in the perceived uncaring (where nobody stepped in to protect him from his father) and abusive environment he experienced as a child.

This brings to light how critical it is to our developing personalities when we hit an obstacle, a setback or defeat to be responded to over and over again by an “unconditional” comforting warmth (most often supplied by a non-narcissistic mother who would never be complicit with a husband’s abuse of a child) and a “confident” and informed (dare I say, “coaching”) reassurance (most often supplied by an optimistic, courageous, yet loving father).

When those are consistently the responses by the “caregiving surround,” a term familiarized through  Self-Psychology to mean empathic based caring (or lack thereof as in “non caregiving surround”) experienced by the developing, helpless infant they become internalized into a solid core which that person can always return to and buttress themselves up during times of let down, hurt , disappointment and physical and psychic injury.

When such caregiving is not present or worse is replaced by abuse or shaming, there is nothing to turn inward to help the psyche weather those downturns. Furthermore if instead of “paying forward” the pain and suffering others inflicted on you (because you don’t want to hurt or anger them, which might have been the case for West with Buss and Jackson), when they are hurtful to you, you turn it inward and that is a recipe for a rapid descent into depression (you know, the old Freudian notion, “Anger turned inward” = depression).

In the midst of such experiences, one may at times turn to thoughts of suicide as relief for the pain. In fact, the suicidality as such an antidote to torment can be viewed as a loving and comforting way out of the pain.

In the middle and at the worst of such unattended and non-caregiving agony, one can experience despair. If you think of despair as des-pair, it is a feeling of being unpaired with hope (= hopelessness), help (= helplessness), worth (= worthlessness), meaning (= meaninglessness), usefulness (= uselessness), a point to it all (= pointlessness) in a world in which it seems that everyone else is paired with those feelings.

When felt collectively the despair can mount to a point that “pairing with death” as a relief becomes not only conceivable, but desirable. So knowing there is always that way out if it gets too bad can offer relief.

As one of my nearly continually suicidal clients (who thankfully never acted on it and is now living a life where they’re glad to be alive) once told me: “If I didn’t have my suicidality, I would have killed myself a long time ago.”

From your interviews Jerry it appears that your torment has eased over the past years. For that, you, your fans and I are grateful, because for the life you have lived, you deserve to finally begin to feel it is a life worth living.

Sometimes, when you are in your mind, you’re in enemy territory and what you think of yourself is not to be believed. Not easy to do when you are in a state of des-pair.

Thank you for writing your book Jerry West. It will help many people feel less alone and may in fact cause you with your words to become the loving father to them that you never had.

A significant percentage of men
who feel and act suicidal
and sadly commit suicide
either have been or about to be humiliated

Trey Pennington, a social media thought leader known to hundreds of thousands of people and someone who I followed on twitter, who followed me and even interviewed me about the importance of listening committed suicide this past Sunday at age 46.  He was a consummate and caring host and interviewer and had the ability to make you not only feel smarter and wiser than you are, he also make you feel worthwhile and deserving or even a blessing to be on this planet.

I only wish someone had listened to him (or that he allowed someone to listen to him to ease his torment) and helped him feel the same way so that he could still be among us.

Since I didn’t know him well, I don’t know how much of the following applies to Trey, but it certainly applies to many men I have seen over the years who felt suicidal.

From Vince Foster, to Mark Madoff to Enron’s Vice Chairman J. Clifford Baxter the infamous Bronco chase of O.J. Simpson, the news and the public’s fascination about suicide stops viewers and listeners in their tracks to find out more.  That is because such scenarios have touched something at the core of our humanity (or as you will discover, maybe something even below our humanity).

It may not be readily apparent to women (who commit suicide to get out of unendurable pain) why mere embarrassment should cause you to want to kill yourself.  After all it’s not the death of a child or a divorce which on the surface seem more understandable triggers for self destruction.

However to most men, it isn’t so surprising that extreme humiliation can cause suicidal thoughts and action.

Why is that?

What may be happening neurospsychologically is that the three parts of a man’s mind/brain i.e. his lower, reptilian, “fight or flight” brain; his middle, mammalian, emotional brain; his upper, human, rational brain have been rigidly wired together in service of a particular mission or goal (the soldier fighting a war and being willing to die for his fellow solider, for example).  But then when their current reality or their mission changes and calls for something entirely else that their rigidly wired mind/brain cannot adapt to (the soldier who in civilian life has to put up with people whining about trivial stuff and who only care about themselves), that situation eventually can push that person’s mind/brain to uncouple from the way it is hard wired.  And rather than feeling like merely an internal readjustment to a new reality, for some it can feel like a breakdown.

It’s simply this.  When as smart as you thought you were is as foolish as you turn out to be; when as powerful as you thought you were is as powerless as you turn out to be; when as much of a hero as you thought you were is as much of a villain or coward as you turn out to be, a man’s sense of himself begins to plummet and heads towards shattering.

A man without competence is useless and worthless;
A man without courage is not a man.
A man who is useless, worthless and not a man has no reason to live.

The anticipation of shattering and like Humpty Dumpty never coming back together again can be terrifying and terrorizing.  Therefore, while that man still has some control of his actions and before he completely loses control over his life, taking his life can be ironically an act of self-preservation (vs. self-fragmentation) even as he ends it.

What to do? 

Six steps that may help to talk a man out of suicidality (done in a very calm, reassuring, patient, let-him-talk-as-much-as-he-needs-to way):

1. “Tell me what happened.” This is essentially picking the scab off a deep psychological and emotional wound.  Regardless how out of control and incompetent the man feels, he can still usually report on events that led up to the current crisis.
2. “Tell me more.” This is opening up the pus under the scab.  After the man finishes telling you what happens, he anticipates that you will get into a debate or a discussion or try to have a dialogue with him, none of which he is ready to enter into. Because he is not finished telling his story* is why he will push back or interrupt you if you attempt to say or advise anything.  Instead, pick one of the things he told you in relating his story to you and say, “Tell me more about that.”  Showing more interest in his pain and furthermore wanting to relieve it by having him talk more about it is counterintuitive, not what he is expecting and counterintuitive.
3. “What’s really going on?” This is draining the pus in the wound.  When you ask this after you have patiently heard them out in 2 above, they will start to go deeper and say, “I really f–ked up” or “I blew it and now I’m screwed” or “I’ve destroyed my life forever.”
4. “And the way it makes you feel is ___________ ” leads to emotional exhaling (and putting some distance between him and his suicidal impulse). Invite them to fill in the word or offer examples such as: “worthless,” “hopeless,” “that life is pointless,” “that you can’t go on,” or “what exactly?”  After all the pus has been drained and when you ask and have them fill in the blank with an emotional word(s), they will further calm down. That is because according to UCLA researcher, Dr. Mathew Lieberman, when people attach and express the correct emotional word to what they are feeling it lowers the activation of a part of their emotional brain which results in their beginning to calm down (i.e. exhaling).
5. “At its worst, how bad does that get for you?” Again, by not prematurely cutting them off in their emotional exhale, and having them say something like, “It’s unbearable,” “Like I can’t go on,” or as one of my patients said with a (more relaxed smile), “Duh… I’m suicidal ain’t I?  How bad do you think it got to get me here?”
6. “And that’s why we need to come up with something to make it better, because you can’t tolerate another minute of feeling this way.  Is that correct?” You have now move the person away from their suicidality to a conversation and to hopefully cooperating with you to find another option besides killing themselves.

Re-pairing Des-pair

Despair or as I like to call it, des-pair, means feeling unpaired in a world it which it feels like everyone else is paired with a good job, a happy marriage, loving family, caring and hope and you’re not.  When the pain of feeling so unpaired becomes intolerable and that is when “pairing with death” as a way out and as a way to relieve intolerable pain becomes plausible.

The six steps above are a way of “re-pairing” with such an individual via empathy.  And when it is successful and they can pair with that kind of understanding and caring, they will no longer need to pair with death.

• Betrayal – The Wound that Will Not Heal for Women
• Catch Mark on Marketplace.org radio startion near you to discuss this and Financial PTSD from 9/9 – 9/11
• Learn to listen into the pain of the people you love and help them with “Just Listen”
• Check out Mark’s business site, Xtraordinary Outcomes

- Deepak Chopra, from Wiki for Peace Workshop 101

Stress is unavoidable.  How you deal with it is something you actually have some power over.  Stress is not entirely bad.  It actually helps you become more attention, more focused and more purposeful and emotionally strong.  When you’re under stress you can still see your goals and what is important and with training and practice can still remain focused on them.

It’s when stress crosses over into distress that things go haywire.  That is because you feel under such a threat that you can no longer see your goals and your goal becomes finding relief or escape from the distress.  That is when you engage in self-defeating behaviors — such a procrastination, saying “Yes,” when you should say, “No,” trying to please everyone, running away, or engaging in terrible health practices like smoking, drinking, eating poorly — all of which make you feel better in the short run, but actually make your life worse in the long run, expecially when you have to apologize to people for what your coping mechanisams did (i.e. caused stress) to them.

The longer you can go before your stress crosses over into distress, the more in control and more success (and happiness) you will have in life. I love Deepak’s advice to: Stop, Detach, Observe, but I am also a huge fan of mindfulness and realize that for the vast majority of people, something as simple and wise as his advice may not initially work.

If you are among those people here are some alternate ways to deal with stress to calm yourself down and refocus and to prevent it from turning into distress:

1. Conjure up images of people who love you past and present – I have five deceased mentor and one living mentor named Warren Bennis (who has been a mentor to thousands of leaders and students over five decades).  In my mind’s eye I see a choir of all of them saying to me the first of Deepak’s words, i.e. “Mark, stop!” (what you’re thinking and how you about to react, which is usually to beat up on myself since I usually act in instead of acting out when I am under distress).  I will often get into an argument with them in my head, because I hate it when I make mistakes or do something foolish.  Fortunately I am often able to remember  what they specifically did for me (usually including standing up for me, standing by me and standing up to me to prevent me from doing something foolish), feel a wave of gratitude towards them, feel in my heart how I miss them, pause and let their love in, ease off the trigger and not act my impulse and then thank them.

2. Reframe the stress as “Opportunity to build emotional toughness” – Or what I refer to as “Opportunity for poise.”  Why this?  Because the people we respect most and often want to be like are those who are able to be present, clear and focused. One of my heroes and someone I am pleased to call a good friend is Jim Mazzo, President of Abbott Medical Optics who dealt amazingly well with a crisis that hit his company a few years ago.

3. Talking yourself down if you are not currently or yet mindful – The Seven Steps of Calming Yourself (source: Get Out of Your Own Way)

The Seven Steps to Calmness is a way to talk and walk yourself through any upset you’ve had, and make things better instead of worse:

1. Physical Awareness. When you’re feeling in distress after a trauma, think to yourself, “I am physically feeling [what] in my [where in your body].” For example, “light headed and sick to my stomach.”
2. Emotional Awareness. “And emotionally I feel [angry? frustrated? scared? sad? disappointed? hurt? upset?] and how my [fill in the emotion you just named] is [name the level of intensity]. For example, “scared out of my wits and more scared than I can ever remember feeling in my life.”
3. Impulse Awareness. “And feeling [name the physical feeling] and [name the emotional feeling], and feeling it [name the level of intensity], makes me want to [name the impulse].” For example, “sitting down and doing nothing.”
4. Consequence Awareness. “If I act on that impulse, the most likely immediate consequence will be ____, and a longer-term consequence will be ____. For example, “I will probably feel even more out of control and even more hopeless.”
5. Reality Awareness. “While I am holding off (for now) on acting on that impulse, another possible and more accurate perception of what might really be going on is [seeing the world as it actually is can further help you not react to the way it isn't]. “For example, “my life being forever different doesn’t mean my life is over.”
6. Solution Awareness. “A better thing for me to do instead would be to [fill in an alternate behavior and what you need to do to achieve those outcomes]. For example, “learn to live with life being never the same again and to start by interacting with (vs. withdrawing) others, comforting each other, thinking together what we can do now vs. focusing on what we can’t and then have each person commit to doing something to achieve our desired outcome.”
7. Benefit Awareness. “If I try that solution, the benefit to me immediately will be [fill in the immediate benefit]. For example, “I’ll begin to feel more in control and less helpless and even less hopeless.”

If you are a person for whom self-talk does not work (I am such a person), imagine doing the above exercise with someone who cares or cared about you (I imagine my deceased parents and deceased mentors going through the seven steps with me).

Why do the Seven Steps to Calming work? I view trauma as a horrendous and horrifying event that splits apart the thinking, feeling and acting parts of your personality. When that happens, you feel that the next step will be for you to shatter, or what some patients describe as “fragmenting.” At that point, you begin to panic.

The Seven Steps to Calming works because it reconnects the thinking, feeling and acting parts of your personality. More than that, it enables you to adapt to the reality of what is, as opposed what no longer is. One patient told me it felt like suturing their personality back together again.

The “tipping point” of the Calming are the Fifth Step, Reality Awareness, Sixth Step, Solution Awareness, and Seventh Step, Benefit Awareness, because those are the three steps that push you perceiving the world differently and into taking positive action. Taking action into life is essential to recovery. It’s only when you take action that you create a new memory. Thoughts thought do not create new memories as profoundly as actions taken. New memories are important in order to dilute out the impact of the horrendous traumatic ones. If you don’t create new memories through action, you can remain stuck.

To help reinforce this, imagine looking at the rings of a hundred year old tree that has been cut. Each ring represents a year. The ring from a year of drought looks different than that of a year of rains than that of a year of floods than that of a year of fires. All put together they give the tree character and each ring is less important than all of them put together which is the life of that tree (kind of makes you wish someone hadn’t cut it).

Applying this to your life, if 2011 is the year of an awful disaster, when you keep acting into life, 2012 could become the year you met the love of your life, had a child, moved into a new home or a job you love. And although the disaster of 2011 doesn’t go away, the life you live after it dilutes its impact on you.

The Seven Steps to Calming is also a great tool to teach your children to help them overcome setbacks, disappointments and to master stress, and for them to internalize a way of pausing, calming and centering themselves when they hit obstacles later on in life.

Just because you’re afraid, doesn’t mean you are in danger, but until your body and emotions listen to what your mind is trying to tell you, you won’t believe it. (from Get Out of Your Own Way: Overcoming Self-Defeating Behavior).

Learn more:

• Workarounds That Work
• Get Out of Your Own Way
• “Just Listen”

Traversing the psychological terrain between teenage dependence and young adult independence is fraught with anxiety, confusion and fear.  Doing it successfully means letting go of your dependence upon your parents to becoming independent.  The more you need your parents, the less independent and more ashamed you feel.  Such shame begets irritability and that can cause you to snap at them if they say something and snap at them if they say nothing.  That can be very scary to you and chilling to your parents.  Such a “no win” relationship with your parents requires an empathic understanding that goal oriented, project managing type parents find particularly difficult to muster.

Frequently associated with this is a deeply painful and increasingly dark despair. If you think of the word “despair” as “des-pair” and as feeling “unpaired” in a world in which it seems that everyone else is paired with hope vs. hopelessness, help vs. helplessness, meaning vs. meaninglessness, worth vs. worthlessness, a point to living vs. pointlessness, you get an idea of what it is like to feel like these teenagers and young adults who are stuck.

A little pharmacology can relieve some of the symptoms, activity can be a helpful distraction and mindfulness comes close to bringing a little aliveness, but none of these approaches nor all of them resolve the core suffering in teenagers who feel they just can’t make it to the other side and reach young adulthood.

So what is the cure? What hopeless, meaningless, worthless, pointless and useless have in common is “less” as in without hope, help, meaning, worth, a point to go on. The key to helping these teens is to give them a “with” experience.

A few years ago a patient shared an imaginary story about their childhood that he called, “Piano Story” that captured what being stuck is about and what it needs to be healed.

Every day, seven year old Jed would come home from school and walk into his living room where their baby grand piano was nestled in a corner nearly out of site. And each day for more than an hour, Jed would sit under that piano staring up at the plywood belly and palpating the brass keys as he stared. The piano was an oasis and a haven away from the anger, depression and pain in his family that Jed was unable to tune out. He couldn’t go to his bedroom to do that, because he shared it with an older brother who seemed very unhappy and who on more than a few occasions would take it out on him.

As he would stare at the plywood and feel the coolness of those brass pedals, Jed found relief and even a little comfort. He was on his way to becoming autistic. Jed was looking for something in the plywood and the feel of those pedals beyond an escape from the pain in his family that he couldn’t tune out. But he didn’t know what it was.

Then one day, three months into this ritual turned compulsion, a man in his late thirties came into the living room and noticed Jed under the piano. The man walked slowly over to the piano and slowly bent down to speak to Jed. On this day, Jed didn’t notice the man doing that, because Jed was entranced by a knot in the wood under the piano and focused on its elliptical shape and the different colors. He thought it looked like the Solar System and Jed imagined himself in a spaceship venturing out to explore and far away from the life he was living or more accurately wasn’t living.

The man intuitively knew not to say to Jed, “What are you doing under here?” or “Hey want to go do something?” or even “You look pretty sad, let’s go do something fun?” Instead he smiled in a way where his smile touched his eyes and where this mouth and eyes were like two hands reaching out to Jed at which point he said in just the right exact tone: “Hey there, mind if I join you?”

Hitting the tone exactly right, Jed’s “knotty pine fantasy” was interrupted, but he didn’t startle. Without making eye contact and a little anxious, but not fearful, Jed replied, “Suit yourself.”

The man climbed in under the piano and positioned himself perpendicularly to Jed, with each of them leaning back on the respective walls behind them and with their feet about one foot apart from touching.

This continued for three months with Jed and the man under the piano. Gradually, Jed began to stop staring up into the piano’s wood underbelly and started to glance at the man. Then one day, Jed said to the man, “What are you doing here?”

And in the same smile touching eyes touching Jed and with the perfectly inviting, but non intrusive tone of voice, the man said, “You didn’t look like you should be alone.”

As if caught with his vulnerability showing, Jed abruptly looked away, went silent and grabbed on to the solar system knot in the wood above him with his eyes.

Three months later, Jed had begun glancing more frequently at the man, who never seemed to intrude and seemed very content to just be there with Jed. At that point, Jed asked: “Is this normal?”

The man looked at Jed with that smile and those warm eyes and replied, “Is what normal?”

Jed said, “Every day I get home from school and come and sit under this piano for more than an hour. I just wondered if that is normal for a seven year old kid.”

Again with that same connectedness the man smiled with even more understanding and even more love and said, “It’s not typical.”

Jed didn’t know what to do with that expression of patience, kindness and love and again abruptly looked away, but not before some tears of relief in making human contact got through to him.

Three months later (and a full nine months of gestation with the man patiently sitting with Jed under the piano), Jed found himself looking more intently and with deep curiosity at the man, who seemed very present, unobtrusive and apparently quite content with merely keeping Jed company. Jed steeled himself to ask the question that had been gnawing at him and the answer to which would reveal to Jed whether there was hope for him or if he and his situation were truly hopeless (something he had come to believe with nearly complete certainty). “Do I ever get better?” Jed fired at the man, staring into his eyes with a “don’t b.s. me on this!” challenge.

At that point, the man’s smile widened, his eyes sparkled with a loving, caring and tear laden look as if he’d been waiting for Jed to ask this question for six months. “Absolutely!” the man replied with unwavering certainty and confidence.

Jed narrowed his eyes and leaned into the man’s “cup runneth over with love” eyes and inviting full face. “How do you know that?” Jed said with a “truth or dare” and playing for keeps intensity.

The man paused until he could take in all of Jed’s words and position himself such that Jed would not only feel understood by him, but would “feel felt” by him. And then as if sending a healing beam of warmth to remove all the “lesses” from Jed’s feelings of hopelessness, helplessness, worthlessness, meaninglessness, pointlessness, uselessness the man replied: “Because I’m you and we got out.”

At that point Jed was stunned, transfixed in the man’s gaze and started to cry with the relief of finally discovering the home he had been homesick for. He realized that he actually did belong in this world. He belonged to himself.

And with that Jed and the man came out from under the piano. Jed looked back at the piano with appreciation for the haven it had provided him, but realizing that he no longer needed it now that he had found a home in and with himself.

If the above speaks to you about a teenager you love, how can you go under their piano and join them.

First of all, you need to drop your “human doingness” and “solution mindedness” and “fix things mentality.” To be honest, it never served your child, it served your need to stay in control and to not lose control.

Next you need to pick a calm time to ask your adolescent the following questions and have the following conversation:

1. “I would like to understand something better, would it be okay if I asked you a question?” That will give them the chance to shift from their usual reactive stance to possibly listening to you. If they push back and say, “No,” calmly say, “That’s okay. It can wait and if it’s not important, we can just let it go.” Chances are their need to be in control of their conversations with you will cause them to irritatingly say, “Okay, what is it?”
2. “How alone do you feel?” They may look at you perplexed especially if they perceive you and needing to do or needing to solve. And being off balance, they may even respond, “What?” At that point just repeat the question, “How alone do you feel?”
3. After they give their answer, which is likely to be, “Very,” or “Extremely,” respond, “At its worst, how bad does that get for you?”
4. They may begin to tear up with relief, because your inviting tone is helping them to feel less alone. Allow them to respond in whatever way they choose and say, “And when it’s at its worst, what does it make you want to do?”
5. Allow them to say things such as, “Give up,” “Quit everything” or even “Kill myself.” Don’t react with anxiety or a solution. If you do they will feel that you just gave them an invitation to open up and then you shut them down.
6. Instead say, “Look into my eyes,” and then say (as if you were the man in the Piano Story above), “I didn’t know it was so bad, and I apologize for even causing you to feel that I didn’t want to know. Here’s the deal, you are living in hell and as your parent, I can’t allow you to be in hell alone. So we’re going to fix that, but I may need your help since I’m a ‘solvaholic’ and a solution is not what you need right now. I think what you need is to feel less alone. It’s going to get better and I am so sorry for not realizing this sooner.”

Also:

• Listening Into People’s Eyes
• What Your Teenager Want’s You To Know, But Won’t Tell You
• On Vacation? Teach Your Children Well

Know any sullen, angry, withdrawn, underachieving teenagers? If so, send this to them and ask them what fits and what doesn’t. And then just listen.

“Given all the things I’m doing that have disappointed you, I’m hoping you won’t just see this as another excuse or a way of manipulating you, both of which I’m very capable of doing and during other times have even been a master at.

In fact I’ve been so good at doing both of those, I’m afraid to tell you what I’m about to and have you think I’m just being dramatic and only trying to get attention or get out of taking responsibility for my actions and paying the consequences for them.

Today, I have a little bigger fish to fry.

I’m losing it. I’m losing my mind, my sense of who I am, of where I belong, and I’m spending more and more time wondering if life is worth living.

I know I don’t have any reason to feel like ending it, I know that so many people have it worse than me, I even know that I have all the reasons to live. I just don’t feel any of them.

I have felt alone for some time now. It hasn’t been a few days or even a few weeks. It’s been at least months.

Also the intensity of rage that I feel not only chills you — which I know is why you back off when it gets really ugly between us — it chills me.

I hate hating you more than I hate you. When I hate you at the level I’m capable of hating you I feel like destroying things. That has escalated and finally shifted to thinking of just destroying me.

But in reality, I don’t want to destroy anything, I just want to destroy the pain I feel and make it go away. But it won’t go away and I can’t make it.

The reasons I drink, do drugs and cut on myself — all of which scare the shit out of you — are because they all relieve me. When I’m stone cold sober and drug free and the pain and the craziness intensifies, all I can think about is numbing myself. I don’t do alcohol and drugs to get high, I do them to get by.

And when I cut on myself, which terrorizes you, I feel like I’m cutting out the pain or at the very least that I’m feeling something. And that gives me relief from the pain of feeling nothing.

Assuming you won’t rub my face in this — which might actually wake me up or push me over the edge, but I don’t think you want to play Russian roulette with me — you’ll probably ask me what you can do to help.

And I wish I had an answer to tell you.

Actually the answer I’d like to tell you, I am telling you by telling you this message and hoping you’ll “just listen.”

I think the hole in my being and the missingness at my core needs warmth from you mom — occasional kindness from pathetic, rational, lecturing, clueless dad is not the same — which I either think you can’t get to because all of us — including dad — fight you or because you no longer have any warmth, either because you didn’t get it from grandma or because it got worn out by all of us.

Dad, you’re not off the hook in this. I think you run interference between mom and me and try to keep the peace and then I think you find your home away from home when you get away to go to work or travel for work or play sports with your buddies.

Maybe a start would be if I saw each of you making the effort to understand me especially when you have no chance of really achieving it.

There is a good chance that neither of you will be able to understand me because I am as different from you as you are from each other, but it might help if I saw you continuing to try and continuing to ask or say things to me like:

‘Tell me what’s happening and how you feel in another way, because I see that I’m not getting it and I want to get it. And then tell me at its worst, what that’s like.’

And if I push you away, you might do well to stand firm and say, ‘We can’t go away because as your parents we can’t allow you to feel so alone in hell and we’ve got to do whatever we can to get you out. Sorry to tick you off, it’s in the parents rule book which you’ll figure out when you become one.’ One of my friend’s parents actually sleeps outside her room on the floor which my friend both resents and feels safer with.

More importantly I think it might help if I saw you not getting so frustrated and throwing your hands up, because I keep pushing back and won’t agree to what you think should make me feel better. Going along with it to get you off my back hasn’t worked and actually made me feel worse.

I think I can live with the pain, I just can’t live with suffering. I think the suffering happens when I feel alone in my pain for a long period of time and it doesn’t let up.

I think if I could feel less alone from the inside out, I could listen to what you and the world are telling me from the outside it.

Feeling alone is feeling that I am unpaired with what everyone seems to have.

Being unpaired with a future worth living causes me to feel hopeless; being unpaired with any help that I or others can provide causes me to feel helpless; being unpaired with a reason to go on causes me to feel that everything is both pointless and meaningless; and being unpaired with doing or accomplishing all the things I’m supposedly capable of causes me to feel worthless.

And feeling unpaired with all of those things cause me to feel des-pair.

I feel like I am trapped in a deep dark cold mine shaft, have run out of food and water and am running out of oxygen and time.

I keep hearing people digging to find me. I hear them thinking they have found me and are all excited. But what I know that they don’t know is that they’re digging in the wrong direction because one of them got a glimpse of a doll in a different mine shaft that I left there many years ago and everyone thinks it’s me.”

Epilogue: Dodging a Bullet, Saving a Son

“Dr. Goulston, please call me when you have a chance,” Frank, a CEO I had been working with, called me with a sense of urgency in his voice. I immediately went into my worry state and returned the call.

“What is it Frank?” I asked doing my best to lay a veneer of calmness over my concern.

“I think you helped me dodge a bullet,” he said with a level of emotion in his voice that was unusual being the highly analytic person he was.

Dodging a bullet sounded better to me that taking a bullet, so I felt immediately relieved. “What do you mean exactly?” I asked.

He explained, “You and I were speaking about my frustration with my moody son who I think is lazy and blowing it in his junior year in high school. After you listened to me, you told me that I was blowing it in not recognizing his pain and you sent me a message (above blog) to give to my son that you told me was the cumulative collection of many of things you have heard teenagers say to their parents. Well I gave it to him, he read it and I asked him what applied to him. He looked at me… no actually he looked right through me and narrowed his eyes in a hostile manner and said, ‘All of it.’ I then said to him, ‘Why didn’t you tell me it was so bad?’ And he replied firmly, but less hostile, ‘Because you didn’t f*%king want to know!’ And he was right. I told him realizing my big error, ‘I’m sorry about that and I’m even more sorry for beating up on you verbally or just walking away in disgust.’”

At this point Frank began to cry with deep emotion in his voice and continued, “Then my son, seemed to let go of much of his anger and looked straight at me and said, ‘I’m sorry for some of the things in that email you sent me that I have already done that you must swear to me you will never tell mom.’”

Frank paused and I asked, “What happened next?”

“That’s where the dodging a bullet comes in,” Frank explained, “I told my son that with his permission I just wanted to bring my laptop with me and sit on his bed and work while he tried to do his homework. I told him it that it wasn’t to spy on him or monitor him, it was just to hang out with him because I couldn’t and wouldn’t allow him to be alone in hell. And he said to me in his still teenage rebellious voice, ‘Suit yourself.’ And that’s what we have been doing and although he won’t admit it, I think we’re turning a corner and he feels a little lighter… as does my wife. I called just to thank you.”

“My pleasure, any thoughts on how you can keep from taking your eye off the ball?” I asked.

“When I clearly saw my son alone in hell, it was a sight that I will never forget, so I don’t think there is much chance I’ll blow it a second time,” Frank said with determination.

“Glad to hear,” I said.

———–

* I recently read the galley of a wonderful new book by Peter Guber called, “Tell to Win” Connect, Persuade and Triumph with the Hidden Power of Story which reminded me of having the above previously unpublished blog. I was so impressed with his book that I was tempted to call this blog, “Tell to Live” which it actually is, but at the last minute chose the one I selected.

• Road Back from Hell – Hell is a Suicidal Teenager
• About Teenage Violence: It’s the Rage
• The Rage of Angels

Right now, in the time it takes for you to read this, a teenager in your town or city wishes she were dead. A teenager in your state is thinking of a way to kill himself. Perhaps he’ll use a gun or a rope or pills or his car or simply go out for a swim from which he won’t return. A teenager in this country has just reached for that gun or is stepping up on that chair and placing his head through the noose of that rope. Or she’s counting out enough pills to finish the job or starting to slice into her wrist and watch the little beads of blood seep to the surface, harbingers of the hemorrhage that will start when she deftly severs her radial artery.

And somewhere out there in the global community to which we all belong, a teenager has just ended his life as the culmination to his absolute, unshakable belief that he belonged nowhere.

Although the suffering of that teenager is over, it has not yet begun for her family. When that teenager’s mother and father make the awful discovery that awaits them, life as they know it will be over. After this moment, if you ever look directly into the eyes of that mother or father, you will see how much of their own lives has been ripped out of them with the suicide of their child. You won’t know what to say and you will find it too painful to keep looking. You’ll look away, hoping that such a horror never befalls you; but somewhere inside you are thinking that there but for the grace of God, goes your teenager and you.

Many of our teens are in danger of falling through the cracks of a “too busy to care” world. If you’re worried that your child has something dark and troublesome on his mind, he probably does. If you’re too busy to take the time to break through to your child, make the time. If your child pushes you away, remember you don’t need his permission to protect him from anything that could hurt him or his future.

In fact it’s your most important job as a parent. If you don’t know how to communicate with your defiant teen, learn to. If you’re that teen who is having despairing thoughts and the following letter and poem relate to you, send it! If you’re a parent worrying about what’s going on inside your teen and you think the letter and poem may relate to him or her, give it to them and ask. Then put everything else aside and take the time to listen to and talk with your teenager.

Dear Mom and Dad,

I’m writing you this letter, because I’m afraid if I tell you how unhappy I am, you’ll become angry or frightened, or even worse, you’ll tell me I’m just trying to make excuses or trying to get attention. Then I’ll have to take it back and reassure you that it’s nothing and I’m okay— when I’m really not. I really don’t know what’s wrong, and I know I don’t deserve to feel as bad as I do because other people have it much worse. But I can’t help it, I do feel as bad as I do. I feel very alone and that nobody in the world knows me— and I’m so confused, that I couldn’t even tell anyone what I want them to know about me. Read this enclosed poem and it might help you to know how I’m feeling. I’m really sorry if I’m a big disappointment to you. Please don’t be angry at me for being so ashamed of me. Can you please help me?

Love,

REACHING OUT FOR HELP

Don’t be fooled by me.
Don’t be fooled by the face I wear.
For I wear a thousand masks, masks that I’m afraid to take off.
And none of them are me.
Pretending is an art that’s second nature to me.
But don’t be fooled, for God’s sake, don’t be fooled.
I give the impression that I’m secure,
That all is sunny and unruffled with me,
Within as well as without,
That confidence is my name and coolness my game,
That the water’s calm and I’m in command,
And that I need no one.
But don’t believe me, please.
My surface may seem smooth, but my surface is my mask.
Beneath this lies no complacence.
Beneath dwells the real me in confusion, in fear, and aloneness.
But I hide this. I don’t want anybody to know it.
I panic at the thought of my weakness and fear of being exposed.
That’s why I frantically create a mask to hide behind,
A nonchalant, sophisticated façade,
To help me pretend, to shield me from the glance that knows.
But such a glance is precisely my salvation. My only salvation.
And I know it.
That is if it’s followed by acceptance, if it’s followed by love.
It’s the only think that will assure me of what I can’t assure myself…
That I am worth something.
But I don’t dare tell you this. I don’t dare. I’m afraid to.
I’m afraid your glance will not be followed by acceptance and love.
I’m afraid you’ll think less of me, that you’ll laugh at me,
And your laugh would kill me.
I’m afraid that deep down I’m nothing, that I’m no good.
And that you will see this and reject me.
So I play my game. My desperate game.
With a façade of assurance without and a trembling child within.
And so begins the parade of masks. And my life becomes a front.
I idly chatter to you in the suave tones of surface talk.
I tell you everything that is really nothing.
And nothing of what’s everything,
Of what’s crying within me.
So when I’m going through my routine, do not be fooled by what I’m saying.
What I’d like to be able to say,
What for survival I need to say, but what I can’t say,
I dislike hiding, honestly.
I dislike the superficial game I’m playing, the phony game.
I’d really like to be genuine and spontaneous and me.
But you’ve got to help me. You’ve got to hold out your hand,
Even when that’s the last thing I seem to want.
Only you can wipe away from my eyes the blank stare of breathing death,
Only you can call me into aliveness.
Each time you’re kind and gentle and encouraging.
Each time you try to understand because you really care,
My heart begins to grow wings, very small wings, very feeble wings,
But wings.
With your sensitivity and sympathy, and your power of understanding
You can breath life into me, I want you to know that.
I want you to know how important you are to me.
How you can be the creator of the person that is me, if you choose to.
Please choose to.
You alone can break down the wall behind which I tremble.
You alone can remove my mask.
You alone can release me from my shaking world of panic and uncertainty.
Please…do not pass me by.
It will not be easy for you.
A long conviction of worthlessness builds strong walls.
The nearer you approach me, the blinder I strike back.
I fight against the very thing I cry out for.
But I am told that love is stronger than walls,
And in that lies my hope.
Please try to beat down those walls with firm hands,
But with gentle hands…for a child is sensitive…
Who am I, you may wonder. I am someone you know very well.
For I am every man you meet and I am every woman you meet.
I am you and I am me.
- Charles C. Finn

To Think About:

• Trying to understand your teenager is more important than what you understand. One of the most exasperating experiences for any teenager is dealing with someone who instead of trying to understand, acts as if they already know. You accomplish trying to understand by keeping your teenager talking and expressing his or her thoughts and by asking questions like: what happened next, what did you feel when that happened, what did you do when that happened, and what did you think when all that happened. Keep asking these questions and alternate the order so you might talk about feelings first, thoughts second, actions third and then changing the order. Don’t worry about arriving at the correct solution. The more your teenager is able to express his thoughts, feelings, and actions into your undivided attention, the more he’ll feel known and felt, the less he’ll feel alone, and the less his despair will be.
• Teenagers have a great sense of despair about how angry they feel towards their parents. They’re so furious with their parents, but still are so dependent upon them that they don’t know what to do with their destructive thoughts other than direct them back at themselves. Helping them to talk about this conflict with you (and not becoming defensive when they vent their hostility at you) will lessen the pain it inflicts on both them and you. As awful as it might be to have them aim their anger at you, it’s much better than having them aim it at themselves.

(c) 2010 Mark Goulston

Reaching Out for Help (click to download PDF of letter and poem)

The Road Back from Hell: A Breakthrough Moment for Us Both

About Teenage Violence: It’s the Rage

Road Back from Hell is meant to be hopeful and helpful to people who might currently be in a dark place in their life and who might find comfort, inspiration and solutions from hearing the stories of others. It is meant for people to share their stories of being in dark places and how they made it back and for visitors to read those stories and take comfort and find solutions to try. It is not a substitute for psychiatric or psychological care. We are not able or staffed to respond to requests for treatment, referrals or to make medical, psychiatric or psychological recommendations.

• Every community has some sort of Mental Health Services- Find Some Help
• Every town has a priest, minister, deacon or elder- Talk to them
• Every school has a Guidance Counselor or Social Worker- Speak to Them
• Every city has a hospital – Go to the E.R. if you are seriously depressed or suicidal or thinking about “ending it all.”
• Every city has a 911 if you are in a dire situation – Call it.

There are resources out there and people who care- Use them.

Des-pair = feeling unpaired in a world where you (mis)perceive that everyone else is paired with intelligence, attractiveness, worth, love and hope.

And when you feel unpaired with anything and all you feel is pain, you begin to pair with death as a way out of the pain. When you’re in that state of mind you fail to realize that “suicide is a permanent solution to a temporary problem.”

For a number of years I used to be a guest lecturer at UCLA in a course entitled: “Death and Suicide” taught by one of my mentors, Dr. Edwin Shneidman. Ed was one of the pioneers in the study and interventions in suicidal thinking and behavior.  He was one of the co-founder of the Suicide Prevention movements in Los Angeles and Washington, D.C.

In my talk at UCLA entitled, “I’m going to kill myself,” I spoke about “Des-pair” and the seven lesses of suicidal thinking:

• helpless
• hopeless
• worthless
• useless
• pointless
• meaningless
• purposeless

I emphasized that what all of these had in common was “-less” as in “without,” without help, without hope, etc.  I also said that the aim of treatment was to give suicidal patients a feeling of “with” to counter the feelings of “without.”  When you do that, they will stop “pairing” with death and may begin to start “pairing” with you, feel less alone and less suicidal.

I did that with one of the most suicidal patients I ever saw in: “The Road Back from Hell”

Suicide Warning Signs:

Here are key suicide warning signs to watch out for, according to the VA:

• Talking about wanting to hurt or kill oneself
• Trying to get pills, guns, or other ways to harm oneself
• Talking or writing about death, dying or suicide
• Hopelessness
• Rage, uncontrolled anger, seeking revenge
• Acting in a reckless or risky way
• Feeling trapped, like there is no way out
• Saying or feeling there’s no reason for living

(AP) Military medical researchers say their efforts to reverse the rising number of suicides among service members are based on “good ideas,” but they don’t know which prevention programs work and which don’t. They launched a $17 million study Wednesday to find out.

None of the current training programs is evidence-based, said Army Col. Carl Castro, director of the Military Operational Medicine Research Program at Fort Detrick, Maryland.

“It’s good ideas — experts think that this is what we need to do — but we do not have any evidence that that training actually in fact prevents suicide,” he said.

I am not a researcher, nor is my work in suicide evidence based, however in the early part of my psychiatric practice I was one of the main psychiatrists that my mentor, Dr. Edwin Shneidman, referred still suicidal, but needing to be discharged, patients from the In Patient Units from what was then UCLA’s Neuropsychiatric Institute (and now The Resnick Neuropsychiatric Hospital).   For 12 years I gave a presentation, “I’m going to kill myself!,” to his UCLA upper division undergraduate class, “Death and Suicide” class. Dr. Shneidman told me that I was always either the top or second to the top rated presentation.

At one time 25 % of my practice were still suicidal patients and I rarely if ever hospitalized them and none of killed themselves (I did hear of one who did years after I was treating him).  My wife still jokes that for ten years I never made it through a movie without being beeped.

I have done some training for the American Foundation for Suicide Prevention when I served on its board and have trained FBI and police in hostage negotiation, suicide by cop and intervening with suicidal police officers.

My challenge is that I am an “outlier” and don’t do well with bureaucracies, so I have turned to other areas where I can be of more help to more people by working with leaders such as executive coaching, leadership training and team building.

However, I did revisit my interest in suicide intervention and treatment of survivors when I wrote PTSD for Dummies and my interest in this area has come back as a result of joining Steele Partners as Vice Chairman along with our Chairman and Founder, Lt. General Marty Steele (USMC ret) and CEO, Colonel Tom Tyrrell (USMC ret).  We had a very successful privately funded Military Civilian Transition Program from 2006-2008 that 500 Marines went through that we have refined and are looking for funding for.

But back to the problem and challenge at hand of soldier and veteran suicide.  What follows is my non-evidence, but experience based “outlier” understanding of the issue and what I believe effective approaches will need to have.

As you can read from “A Breakthrough Moment for Both of Us,” where I essentially went inside the experience of a non-communicative suicidal patient and “Living Through Wanting to Die” where I “got into the listening” of a suicidal athlete and his family, the following is what I think contributes greatly to the increased suicidality of soldiers from “their” inside out.

New recruits come to the Marines, Army and to a lesser but still important extent Navy, Air Force and Coast Guard often with a loosey goosey mindset, a mixed bag of skillsets, often many bad habits that have landed them in trouble and some idea of wanting to become a hero or become all that they can be, or be amongst the few and the proud.

During basic training recruits are taken from an essentially old rickety Ford jalopy, broken down in boot camp, rebuilt and turned into a Porsche.  Along the way of becoming that Porsche they become part of a squadron and mission that overflows with honor, can do empowerment and where they feel purposeful and part of an elite group for the first time in their lives.

Neurologically it’s as if their three loosely connected brains (reptile/fight or flight lower, mammalian/emotional middle, human/rational upper brains) are reconfigured and reconnected so tightly that all through them the feel the way a Porsche door closes instead of a rickety pick up truck.

This is further reinforced through fulfilling a mission towards the most noble of vision, to stop terrorism and tyranny and to let freedom ring.

Skills + squadron + mission (kill the enemy) + purpose (stop terrorism and tyranny) –> Emboldened and Empowered to win at war.

Then they hit the horrors of war.  They are trained that war will be ugly and that there will be enemy deaths, fellow soldier deaths and innocent civilian deaths.  As my partner Lt. General Steele says, “War is not pretty, it’s just necessary.”

But nothing prepares them for what they see with their own eyes and feel sometimes to and through their marrow in spite of all the preparatory training they receive.  War is debasing.  Add to that the continuous concussions, traumatic brain injury and stop loss re-deployments and you have a scenario where their minds begin to fragment.

Their three brains threaten to pull apart, but the even if the mission dims in the face of the horror they confront, their squadron, having each other’s back and training keep them functioning on auto-pilot outwardly even as their humanity is suffering body blows almost daily.

And because of the “don’t ask, don’t tell” code about feeling scared and vulnerable, brittle and even fragile, they individually believe that everyone else is handling it better, not knowing that nearly everyone is experiencing the same sharp and blunt trauma to their psyche, their spirit, their will, their emotions and their humanity.

When their training and squadron is no longer able to keep them together, suicide becomes an option and sometimes the only way to relieve the pain when they are still enlisted.

And when they are finally discharged without a mission, without a fire team and without a way to reacclimate to civilian life to hold them together, they go back to their communities to families they can’t relate to and can’t relate to them, to spouses and siblings and parents they frighten and to a job market that is afraid to hire them, not wanting to take a chance that they will be the one to snap.

All of the above should inform our efforts to help.  All returning soldiers need:

1. A fire team to be part of in transitioning, where a knowing look or nod can foster much more understanding than anything they can say or hear from their families.
2. A “boot camp” that take a badly beated up Porsche, breaks that down, and rebuilds it into –how about a Chevy Volt? –with the mindset, skillset and resources they will need to land on their feet and march to the life they so richly deserve.  This step is the “tipping point,” because like it or not, afraid of falling apart or not, they will need to have a setting in groups to “have the horror heard that will heal the hurt” run by highly skilled and confident therapists and facilitators who can constantly tell them, “No, you are not falling apart.  The way you are built for war is coming apart so that you can be rebuilt from the inside out, reconfigured and repurposed for civilian life.”
3. A new mission and vision for what victory as a civilian looks like
4. A strategy and tactics that they participate in developing to fulfill that mission and realize that vision

So that their new winning formula becomes:

Skills + squadron + mission (to be as effective in civilian life as you were at war) + purpose (support your family and community) –> Emboldened and Empowered to succeed at home and “live happily ever after”… because they have earned it.

When you can’t say, “Yes,”
because you don’t have anything left to give;

When you can’t ask for help,
because you can’t hear someone give another excuse for why they can’t
and because you wouldn’t know what to ask for anyway;

When you deal with the above by withdrawing
and becoming sullen and irritable with your family;

AND when the cycle repeats itself daily
and every day is Groundhog Day;

YOU are depressed.

If this speaks to you, what do you do? If’s it’s about someone you care about, how have you helped them?

Read More at: Are You Anxious or Depressed?

Depression and Suicide see: “I’m going to kill myself”

Don’t isolate, reach out and share your hurt and what you’re doing about it at: Are You Depressed

Resources for Depression:

NIMH
WebMD
NAMI
Mayo Clinic
Wikipedia