Coping With Stress Quotes

Denial is a critical part of the human coping mechanism. Without it, we would all wake up terrified every morning about all the ways we could die. Instead, our minds block out our existential fears by focusing on stresses we can handle—like getting to work on time or paying our taxes.

When you have a persistent sense of heartbreak and gutwrench, the physical sensations become intolerable and we will do anything to make those feelings disappear. And that is really the origin of what happens in human pathology. People take drugs to make it disappear, and they cut themselves to make it disappear, and they starve themselves to make it disappear, and they have sex with anyone who comes along to make it disappear and once you have these horrible sensations in your body, you’ll do anything to make it go away.

I am not "cured"--I know I never will be. I will always crave that pain to keep me centered. I will always be just a little astounded when I get through a crisis without putting a blade to my flesh.

...repeated trauma in childhood forms and deforms the personality. The child trapped in an abusive environment is faced with formidable tasks of adaptation. She must find a way to preserve a sense of trust in people who are untrustworthy, safety in a situation that is unsafe, control in a situation that is terrifyingly unpredictable, power in a situation of helplessness. Unable to care for or protect herself, she must compensate for the failures of adult care and protection with the only means at her disposal, an immature system of psychological defenses.

Traumatic events, by definition, overwhelm our ability to cope. When the mind becomes flooded with emotion, a circuit breaker is thrown that allows us to survive the experience fairly intact, that is, without becoming psychotic or frying out one of the brain centers. The cost of this blown circuit is emotion frozen within the body. In other words, we often unconsciously stop feeling our trauma partway into it, like a movie that is still going after the sound has been turned off. We cannot heal until we move fully through that trauma, including all the feelings of the event.

Medicine is a social science, and politics nothing but medicine on a large scale,

One very important domain of our lives and experience that we tend to miss, ignore, abuse, or lose control of as a result of being in the automatic pilot mode is our own body.

A large percentage of what we think of when we talk about stress-related diseases are disorders of excessive stress-responses.

In a world of stressful lack of control, an amazing source of control we all have is the ability to make the world a better place, one act at a time.

The most common emotional defense is avoidance (an ineffective coping skill for any stressor) as expressed through denial (e.g., "That wasn't really bad, I barely remember it").

Mental health, contemporary psychiatrists tell us, consists of the ability to adapt to the inevitable stresses and misfortunes of life. It does not mean freedom from anxiety and depression, but only the ability to cope with these afflictions in a healthy way.

It takes surprisingly little in terms of uncontrollable unpleasantness to make humans give up and become helpless in a generalized way.

Humans have various ways of coping with extended stress, and one is the anticipation of a better time. Here, as with retribution, there is often a kind of symmetry: the more intense the stress and the more hopeless the situation, the more fabulous the coming times that are anticipated.

Procrastination is not a form of laziness at all. It’s a coping mechanism for stress.

Something roughly akin to love is needed for proper biological development, and its absence is among the most aching, distorting stressors that we can suffer.

If there is one thing developmental psychologists have learned over the years, it is that parents don’t have to be brilliant psychologists to succeed. They don’t have to be supremely gifted teachers. Most of the stuff parents do with flashcards and special drills and tutorials to hone their kids into perfect achievement machines don’t have any effect at all. Instead, parents just have to be good enough. They have to provide their kids with stable and predictable rhythms. They need to be able to fall in tune with their kids’ needs, combining warmth and discipline. They need to establish the secure emotional bonds that kids can fall back upon in the face of stress. They need to be there to provide living examples of how to cope with the problems of the world so that their children can develop unconscious models in their heads.

Denial is a critical part of the human coping mechanism. Without it, we would all wake up terrified every morning about all the ways we could die. Instead, our minds block out our existential fears by focusing on stresses we can handle—like getting to work on time or paying our taxes. If we have wider, existential fears, we jettison them very quickly, refocusing on simple tasks and daily trivialities.

Blame is a Defense Against Powerlessness Betrayal trauma changes you. You have endured a life-altering shock, and are likely living with PTSD symptoms— hypervigilance, flashbacks and bewilderment—with broken trust, with the inability to cope with many situations, and with the complete shut down of parts of your mind, including your ability to focus and regulate your emotions. Nevertheless, if you are unable to recognize the higher purpose in your pain, to forgive and forget and move on, you clearly have chosen to be addicted to your pain and must enjoy playing the victim. And the worst is, we are only too ready to agree with this assessment! Trauma victims commonly blame themselves. Blaming oneself for the shame of being a victim is recognized by trauma specialists as a defense against the extreme powerlessness we feel in the wake of a traumatic event. Self-blame continues the illusion of control shock destroys, but prevents us from the necessary working through of the traumatic feelings and memories to heal and recover.

Subjected to enough uncontrollable stress, we learn to be helpless—we lack the motivation to try to live because we assume the worst; we lack the cognitive clarity to perceive when things are actually going fine, and we feel an aching lack of pleasure in everything.

Then I resolved that I would go back out there and somehow cope with the situation, despite the fact that I lacked a strategy and was frightened to the pit of my being.

Packing all of your belongings into a U-Haul and then transporting them across several states is nearly as stressful and futile as trying to run away from lava in swim fins.

The traditional techniques used in getting sleep aren’t much effective any longer and our sleep techniques need to evolve as rapidly as our life style has, in order to cope with it.

Because of this inner busyness, which is going on almost all the time, we are liable either to miss a lot of the texture of our life experience or to discount its value and meaning.

The defining feature of a major depression is loss of pleasure. If I had to define a major depression in a single sentence, I would describe it as a “genetic/neurochemical disorder requiring a strong environmental trigger whose characteristic manifestation is an inability to appreciate sunsets.

It would not be hard to imagine that a happy hermit, living in isolation, might feel connected to everything in nature and all people on the planet and not be at all affected by a dearth of human neighbors.

Knowing what you are doing while you are doing it is the essence of mindfulness practice.

You might notice yourself checking things, picking at things, thinking obsessive thoughts, or fiddling with your own body in a routinized kind of way. These are signs that the stress has overwhelmed your brain’s ability to cope rationally with the stressor.

Natalie was going to stay at home, cooking meals, baking pies, and making sure their life together was comfortable. When Zach came home from a hard day's work, she wanted to be there for him, not coping with her own stress and fatigue. She knew some women would object to her decision, but this was her life, and she was going to live it as she chose.

AFTER ALL, ONE OF THE DEFINING elements of a traumatic experience—particularly one that is so traumatic that one dissociates because there is no other way to escape from it—is a complete loss of control and a sense of utter powerlessness. As a result, regaining control is an important aspect of coping with traumatic stress.

Alterations in regulation of affect (emotion) and impulse: Almost all people who are seriously traumatized have problems in tolerating and regulating their emotions and surges or impulses. However, those with complex PTSD and dissociative disorders tend to have more difficulties than those with PTSD because disruptions in early development have inhibited their ability to regulate themselves. The fact that you have a dissociative organization of your personality makes you highly vulnerable to rapid and unexpected changes in emotions and sudden impulses. Various parts of the personality intrude on each other either through passive influence or switching when your under stress, resulting in dysregulation. Merely having an emotion, such as anger, may evoke other parts of you to feel fear or shame, and to engage in impulsive behaviors to stop avoid the feelings.

Laborsaving devices do not necessarily save time, but they increase our expectactations of what mothers should accomplish

I’ve been married but I’m not anymore. And I still believe in love.

Part of the ingenuity of any addictive drug is to fool you into believing that life without it won’t be as enjoyable, and/or that you’ll be less able to cope with stress.

cultivating mindfulness is not unlike the process of eating. It would be absurd to propose that someone else eat for you. And when you go to a restaurant, you don’t eat the menu, mistaking it for the meal, nor are you nourished by listening to the waiter describe the food. You have to actually eat the food for it to nourish you. In the same way, you have to actually practice mindfulness, by which I mean cultivate it systematically in your own life, in order to reap its benefits and come to understand why it is so valuable.

What ever happened to mental hygiene?” he asked rhetorically. “It doesn’t exist—and never did. When you went through high school, you were never taught how to deal with stress, how to deal with trauma, how to deal with tension and anxiety—with the whole list of mood impairments. There’s no preventive maintenance. We know how to prevent cavities. But we don’t teach children how to be resilient, how to cope with stress on a daily basis.

The way you choose to cope with stress can change not only how you feel, but also how it transforms the brain. If you react passively or if there is simply no way out, stress can become damaging.

Everything in physiology follows the rule that too much can be as bad as too little. There are optimal points of allostatic balance. For example, while a moderate amount of exercise generally increases bone mass, thirty-year-old athletes who run 40 to 50 miles a week can wind up with decalcified bones, decreased bone mass, increased risk of stress fractures and scoliosis (sideways curvature of the spine)—their skeletons look like those of seventy-year-olds. To put exercise in perspective, imagine this: sit with a group of hunter-gatherers from the African grasslands and explain to them that in our world we have so much food and so much free time that some of us run 26 miles in a day, simply for the sheer pleasure of it. They are likely to say, “Are you crazy? That’s stressful.” Throughout hominid history, if you’re running 26 miles in a day, you’re either very intent on eating someone or someone’s very intent on eating you.

Somatic Symptoms: People with Complex PTSD often have medical unexplained physical symptoms such as abdominal pains, headaches, joint and muscle pain, stomach problems, and elimination problems. These people are sometimes most unfortunately mislabeled as hypochondriacs or as exaggerating their physical problems. But these problems are real, even though they may not be related to a specific physical diagnosis. Some dissociative parts are stuck in the past experiences that involved pain may intrude such that a person experiences unexplained pain or other physical symptoms. And more generally, chronic stress affects the body in all kinds of ways, just as it does the mind. In fact, the mind and body cannot be separated. Unfortunately, the connection between current physical symptoms and past traumatizing events is not always so clear to either the individual or the physician, at least for a while. At the same time we know that people who have suffered from serious medical, problems. It is therefore very important that you have physical problems checked out, to make sure you do not have a problem from which you need medical help.

[When under stress I thought of] the books I had read [and applied] them to myself. I [imagined I was] one of the characters [and soon found myself] in made-up circumstances which were most agreeable to my inclinations.

Coping with any death is traumatic; suicide compounds the anguish because we are forced to deal with two traumatic events at the same time. According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, the level of stress resulting from the suicide of a loved one is ranked as catastrophic–equivalent to that of a concentration camp experience.

The best advice I ever received came from my mother: “Do at least one fun thing every day.

The simplest description I have ever come across is that stress is our brain’s reaction to a perception of threat.

The traffic was real, but it was your own beliefs, values, and expectations that made the situation into one that you found stressful.

When I was talking to a reporter, she said, “Oh, you mean to live for the moment.” I said, “No, it isn’t that. That has a hedonistic ring to it. I mean to live in the moment.

Fear is the vigilance and the need to escape from something real. Anxiety is about dread and foreboding and your imagination running away with you. Much as with depression, anxiety is rooted in a cognitive distortion. In this case, people prone toward anxiety overestimate risks and the likelihood of a bad outcome.

This is the critical point of this book: if you are that zebra running for your life, or that lion sprinting for your meal, your body’s physiological response mechanisms are superbly adapted for dealing with such short-term physical emergencies. For the vast majority of beasts on this planet, stress is about a short-term crisis, after which it’s either over with or you’re over with. When we sit around and worry about stressful things, we turn on the same physiological responses—but they are potentially a disaster when provoked chronically. A large body of evidence suggests that stress-related disease emerges, predominantly, out of the fact that we so often activate a physiological system that has evolved for responding to acute physical emergencies, but we turn it on for months on end, worrying about mortgages, relationships, and promotions.

Instead, parents just have to be good enough. They have to provide their kids with stable and predictable rhythms. They need to be able to fall in tune with their kids’ needs, combining warmth and discipline. They need to establish the secure emotional bonds that kids can fall back upon in the face of stress. They need to be there to provide living examples of how to cope with the problems of the world so that their children can develop unconscious models in their heads.

Males who do extreme amounts of exercise, such as professional soccer players and runners who cover more than 40 or 50 miles a week, have less LHRH, LH, and testosterone in their circulation, smaller testes, less functional sperm. They also have higher levels of glucocorticoids in their bloodstreams, even in the absence of stress. (A similar decline in reproductive function is found in men who are addicted to opiate drugs.)

Whenever you inhale, you turn on the sympathetic nervous system slightly, minutely speeding up your heart. And when you exhale, the parasympathetic half turns on, activating your vagus nerve in order to slow things down (this is why many forms of meditation are built around extended exhalations).

One is compulsive overeating. In layman’s terms, an addiction to food. Using food and eating to hide from emotion. To fill a void and cope with stress and the problems that occur in everyday life. Compulsive overeaters are most times fully aware that their eating habits aren’t normal but get little support, other than being told to get some willpower and go on a diet. It’s just as damaging to their self-esteem as telling an anorexic to just eat.

the average level of happiness increases in old age; fewer negative emotions occur and, when they do, they don’t persist as long. Connected to this, brain-imaging studies show that negative images have less of an impact, and positive images have more of an impact on brain metabolism in older people, as compared to young.

Dissociative identity disorder is conceptualized as a childhood onset, posttraumatic developmental disorder in which the child is unable to consolidate a unified sense of self. Detachment from emotional and physical pain during trauma can result in alterations in memory encoding and storage. In turn, this leads to fragmentation and compartmentalization of memory and impairments in retrieving memory.2,4,19 Exposure to early, usually repeated trauma results in the creation of discrete behavioral states that can persist and, over later development, become elaborated, ultimately developing into the alternate identities of dissociative identity disorder.

Most dissociative parts influence your experience from the inside rather than exert complete control, that is, through passive influence. * In fact, many parts never take complete control of a person, but are only experienced internally. * Frequent switching may be a sign of severe stress and inner conflict in most individuals.

We also need to recognize that not all stress is bad, that children require challenges and risk as well as safety. It is natural to want to protect our children, but we need to ask ourselves when the desire for risk-free childhoods has gone too far. The safest playground, after all, would have no swings, no steep slides, no rough surfaces, no trees, no other children—and no fun. Children’s brains are shaped by what they do slowly and repeatedly over time. If they don’t have the chance to practice coping with small risks and dealing with the consequences of those choices, they won’t be well prepared for making larger and far more consequential decisions.

The core lessons these children have taught me are relevant for us all. Because in order to understand trauma we need to understand memory. In order to appreciate how children heal we need to understand how they learn to love, how they cope with challenge, how stress affects them. And by recognizing the destructive impact that violence and threat can have on the capacity to love and work, we can come to better understand ourselves and to nurture the people in our lives, especially the children.

Too often the survivor is seen by [himself or] herself and others as "nuts," "crazy," or "weird." Unless her responses are understood within the context of trauma. A traumatic stress reaction consists of *natural* emotions and behaviors in response to a catastrophe, its immediate aftermath, or memories of it. These reactions can occur anytime after the trauma, even decades later. The coping strategies that victims use can be understood only within the context of the abuse of a child. The importance of context was made very clear many years ago when I was visiting the home of a Holocaust survivor. The woman's home was within the city limits of a large metropolitan area. Every time a police or ambulance siren sounded, she became terrified and ran and hid in a closet or under the bed. To put yourself in a closet at the sound of a far-off siren is strange behavior indeed—outside of the context of possibly being sent to a death camp. Within that context, it makes perfect sense. Unless we as therapists have a good grasp of the context of trauma, we run the risk of misunderstanding the symptoms our clients present and, hence, responding inappropriately or in damaging ways.

Genes are rarely about inevitability, especially when it comes to humans, the brain, or behavior. They’re about vulnerability, propensities, tendencies

Sport can teach us how to set and achieve goals, solve problems, cope with stress, manage our emotions, refocus after mistakes, and build self-confidence.

When you really understand that God will accept you on the basis of what Christ did, you don’t have to prove to the world how important you really are.

Releasing contracted thoughts through insight is completely natural. When a child is scared of monsters in the dark, you don’t teach him to relax, breathe, or cope. You turn on the lights.

Memory can be dramatically disrupted if you force something that’s implicit into explicit channels. Here’s an example that will finally make reading this book worth your while—how to make neurobiology work to your competitive advantage at sports. You’re playing tennis against someone who is beating the pants off of you. Wait until your adversary has pulled off some amazing backhand, then offer a warm smile and say, “You are a fabulous tennis player. I mean it; you’re terrific. Look at that shot you just made. How did you do that? When you do a backhand like that, do you hold your thumb this way or that, and what about your other fingers? And how about your butt, do you scrunch up the left side of it and put your weight on your right toes, or the other way around?” Do it right, and the next time that shot is called for, your opponent/victim will make the mistake of thinking about it explicitly, and the stroke won’t be anywhere near as effective. As Yogi Berra once said, “You can’t think and hit at the same time.

As Beck and other cognitive therapists have emphasized, much of what constitutes a depression is centered around responding to one awful thing and overgeneralizing from it—cognitively distorting how the world works.

Studies on the phenomenon indicate that a person with a high tolerance for pain is likely to also have above-average capacity to cope with the stress of a job layoff or a cancer diagnosis, and this same person is more likely as well to have experienced a moderate amount of psychological trauma in his or her past. It would appear that a certain amount of misfortune is needed to toughen the mind against suffering and hardship, but excessive trauma leaves scar tissue.

If…an infant, especially one born with a genetically-encoded altered neurophysiologic reactivity, does not have adequate experiences of being part of an open dynamic system with an emotionally responsive adult human, its corticolimbic organization will be poorly capable of coping with the stressful chaotic dynamics that are inherent in all human relationships. Such a system tends to become static and closed, and invested in defensive structures to guard against anticipated interactive assaults that potentially trigger disorganizing and emotionally painful psychobiological states. Due to its avoidance of novel situations and diminished capacity to cope with challenging situations, it does not expose itself to new socioemotional learning experiences that are required for the continuing experience-dependent growth of the right brain. This structural limitation, in turn, negatively impacts the future trajectory of self-organization.

It turns out that how you think about stress is also one of those core beliefs that can affect your health, happiness, and success. As we’ll see, your stress mindset shapes everything from the emotions you feel during a stressful situation to the way you cope with stressful events. That, in turn, can determine whether you thrive under stress or end up burned out and depressed. The good news is, even if you are firmly convinced that stress is harmful, you can still cultivate a mindset that helps you thrive.

Catastrophe here does not mean disaster. Rather, it means the poignant enormity of our life experience. It includes crisis and disaster, the unthinkable and the unacceptable, but it also includes all the little things that go wrong and that add up. The phrase reminds us that life is always in flux, that everything we think is permanent is actually only temporary and constantly changing. This includes our ideas, our opinions, our relationships, our jobs, our possessions, our creations, our bodies, everything.

In the end, what I love most about contemporary yoga is its ability to synthesize the everyday with the extraordinary, the practical with the visionary, the mundane with the sacred. I love that yoga can work to release my tense muscles, negative emotions, and psychic detritus at the same time. That it can connect me to my body in ways that create new neural pathways in my brain. That it offers a practical tool for coping with everyday stress, as well as an intuitive opening to the hidden magic of everyday life.

Freud was fascinated with depression and focused on the issue that we began with—why is it that most of us can have occasional terrible experiences, feel depressed, and then recover, while a few of us collapse into major depression (melancholia)? In his classic essay “Mourning and Melancholia” (1917), Freud began with what the two have in common. In both cases, he felt, there is the loss of a love object. (In Freudian terms, such an “object” is usually a person, but can also be a goal or an ideal.) In Freud’s formulation, in every loving relationship there is ambivalence, mixed feelings—elements of hatred as well as love. In the case of a small, reactive depression—mourning—you are able to deal with those mixed feelings in a healthy manner: you lose, you grieve, and then you recover. In the case of a major melancholic depression, you have become obsessed with the ambivalence—the simultaneity, the irreconcilable nature of the intense love alongside the intense hatred. Melancholia—a major depression—Freud theorized, is the internal conflict generated by this ambivalence. This can begin to explain the intensity of grief experienced in a major depression. If you are obsessed with the intensely mixed feelings, you grieve doubly after a loss—for your loss of the loved individual and for the loss of any chance now to ever resolve the difficulties. “If only I had said the things I needed to, if only we could have worked things out”—for all of time, you have lost the chance to purge yourself of the ambivalence. For the rest of your life, you will be reaching for the door to let you into a place of pure, unsullied love, and you can never reach that door. It also explains the intensity of the guilt often experienced in major depression. If you truly harbored intense anger toward the person along with love, in the aftermath of your loss there must be some facet of you that is celebrating, alongside the grieving. “He’s gone; that’s terrible but…thank god, I can finally live, I can finally grow up, no more of this or that.” Inevitably, a metaphorical instant later, there must come a paralyzing belief that you have become a horrible monster to feel any sense of relief or pleasure at a time like this. Incapacitating guilt. This theory also explains the tendency of major depressives in such circumstances to, oddly, begin to take on some of the traits of the lost loved/hated one—and not just any traits, but invariably the ones that the survivor found most irritating. Psychodynamically, this is wonderfully logical. By taking on a trait, you are being loyal to your lost, beloved opponent. By picking an irritating trait, you are still trying to convince the world you were right to be irritated—you see how you hate it when I do it; can you imagine what it was like to have to put up with that for years? And by picking a trait that, most of all, you find irritating, you are not only still trying to score points in your argument with the departed, but you are punishing yourself for arguing as well. Out of the Freudian school of thought has come one of the more apt descriptions of depression—“aggression turned inward.” Suddenly the loss of pleasure, the psychomotor retardation, the impulse to suicide all make sense. As do the elevated glucocorticoid levels. This does not describe someone too lethargic to function; it is more like the actual state of a patient in depression, exhausted from the most draining emotional conflict of his or her life—one going on entirely within. If that doesn’t count as psychologically stressful, I don’t know what does.

Research consistently shows that tougher individuals are able to perceive stressful situations as challenges instead of threats. A challenge is something that’s difficult, but manageable. On the other hand, a threat is something we’re just trying to survive, to get through. This difference in appraisals isn’t because of an unshakable confidence or because tougher individuals downplay the difficulty. Rather, those who can see situations as a challenge developed the ability to quickly and accurately assess the situation and their ability to cope with it.

Society reaps what it sows in the way it nurtures its children, because stress sculpts the brain to exhibit several antisocial behaviors. Stress can set off a ripple of hormonal changes that permanently wire a child's brain to cope with a malevolent world. Through this chain of events, violence and abuse pass from generation to generation as well as from one society to the next. Many world leaders who have been disciplined through anger and cruelty go in to treat their own people abominably, or to bully other nations. As long as we continue to discipline children like this, we will continue to have terrible wars on both the family and the world stage. One very powerful study illustrates the point. Researchers tracked down Germans who, in World War II, risked their own lives by hiding a Jewish person in their house. When interviewed, the researchers found one common feature of all these people. They had all been socialized in ways that respected their personal dignity.

Now we have hundreds of carefully engineered, designed, and marketed commercial foods filled with rapidly absorbed processed sugars that cause a burst of sensation that can’t be matched by some lowly natural food. Once, we had lives that, amid considerable privation and negatives, also offered a huge array of subtle and often hard-won pleasures. And now we have drugs that cause spasms of pleasure and dopamine a thousand-fold higher than anything stimulated in our drug-free world.

CONSENSUS PROPOSED CRITERIA FOR DEVELOPMENTAL TRAUMA DISORDER A. Exposure. The child or adolescent has experienced or witnessed multiple or prolonged adverse events over a period of at least one year beginning in childhood or early adolescence, including: A. 1. Direct experience or witnessing of repeated and severe episodes of interpersonal violence; and A. 2. Significant disruptions of protective caregiving as the result of repeated changes in primary caregiver; repeated separation from the primary caregiver; or exposure to severe and persistent emotional abuse B. Affective and Physiological Dysregulation. The child exhibits impaired normative developmental competencies related to arousal regulation, including at least two of the following: B. 1. Inability to modulate, tolerate, or recover from extreme affect states (e.g., fear, anger, shame), including prolonged and extreme tantrums, or immobilization B. 2. Disturbances in regulation in bodily functions (e.g. persistent disturbances in sleeping, eating, and elimination; over-reactivity or under-reactivity to touch and sounds; disorganization during routine transitions) B. 3. Diminished awareness/dissociation of sensations, emotions and bodily states B. 4. Impaired capacity to describe emotions or bodily states C. Attentional and Behavioral Dysregulation: The child exhibits impaired normative developmental competencies related to sustained attention, learning, or coping with stress, including at least three of the following: C. 1. Preoccupation with threat, or impaired capacity to perceive threat, including misreading of safety and danger cues C. 2. Impaired capacity for self-protection, including extreme risk-taking or thrill-seeking C. 3. Maladaptive attempts at self-soothing (e.g., rocking and other rhythmical movements, compulsive masturbation) C. 4. Habitual (intentional or automatic) or reactive self-harm C. 5. Inability to initiate or sustain goal-directed behavior D. Self and Relational Dysregulation. The child exhibits impaired normative developmental competencies in their sense of personal identity and involvement in relationships, including at least three of the following: D. 1. Intense preoccupation with safety of the caregiver or other loved ones (including precocious caregiving) or difficulty tolerating reunion with them after separation D. 2. Persistent negative sense of self, including self-loathing, helplessness, worthlessness, ineffectiveness, or defectiveness D. 3. Extreme and persistent distrust, defiance or lack of reciprocal behavior in close relationships with adults or peers D. 4. Reactive physical or verbal aggression toward peers, caregivers, or other adults D. 5. Inappropriate (excessive or promiscuous) attempts to get intimate contact (including but not limited to sexual or physical intimacy) or excessive reliance on peers or adults for safety and reassurance D. 6. Impaired capacity to regulate empathic arousal as evidenced by lack of empathy for, or intolerance of, expressions of distress of others, or excessive responsiveness to the distress of others E. Posttraumatic Spectrum Symptoms. The child exhibits at least one symptom in at least two of the three PTSD symptom clusters B, C, & D. F. Duration of disturbance (symptoms in DTD Criteria B, C, D, and E) at least 6 months. G. Functional Impairment. The disturbance causes clinically significant distress or impairment in at least two of the following areas of functioning: Scholastic Familial Peer Group Legal Health Vocational (for youth involved in, seeking or referred for employment, volunteer work or job training)

Perhaps the best way to begin is by making a mental list of the sorts of things we find stressful. No doubt you would immediately come up with some obvious examples—traffic, deadlines, family relationships, money worries. But what if I said, “You’re thinking like a speciocentric human. Think like a zebra for a second.” Suddenly, new items might appear at the top of your list—serious physical injury, predators, starvation. The need for that prompting illustrates something critical—you and I are more likely to get an ulcer than a zebra is.

We must always remember that the healing will happen in the way that God knows is best for us. Sometimes we may not recognize that healing has occurred as it may not have been the healing we asked for—it may be emotional or spiritual healing rather than physical. We need to watch out for healing and recognize when it has been granted. Often healing can seem small—perhaps somebody who has been depressed for a long time smiles or laughs; maybe someone who was in a lot of physical distress feels a lot better; or maybe a mother who has been stressed out and unable to cope suddenly feels happiness and joy.

The act of consciously and purposefully paying attention to symptoms and their antecedents and consequences makes the symptoms more an objective target for thoughtful observation than an intolerable source of subjective anxiety, dysphoria, and frustration. In ACT, the act of accepting the symptoms as an expectable feature of a disorder or illness, has been shown to be associated with relief rather than increased distress (Hayes et al., 2006). From a traumatic stress perspective, any symptom can be reframed as an understandable, albeit unpleasant and difficult to cope with, reaction or survival skill (Ford, 2009b, 2009c). In this way, monitoring symptoms and their environmental or experiential/body state "triggers" can enhance client's willingness and ability to reflectively observe them without feeling overwhelmed, terrified, or powerless. This is not only beneficial for personal and life stabilization but is also essential to the successful processing of traumatic events and reactions that occur in the next phase of therapy (Ford & Russo, 2006).

Because in order to understand trauma we need to understand memory. In order to appreciate how children heal we need to understand how they learn to love, how they cope with challenge, how stress affects them. And by recognizing the destructive impact that violence and threat can have on the capacity to love and work, we can come to better understand ourselves and to nurture the people in our lives, especially the children.

Emotionally mature people are comfortable and honest about their own feelings and get along well with other people, thanks to their well-developed empathy, impulse control, and emotional intelligence (Goleman 1995). They’re interested in other people’s inner lives and enjoy opening up and sharing with others in an emotionally intimate way. When there’s a problem, they deal with others directly to smooth out differences (Bowen 1978). Emotionally mature people cope with stress in a realistic, forward-looking way, while consciously processing their thoughts and feelings. They can control their emotions when necessary, anticipate the future, adapt to reality, and use empathy and humor to ease difficult situations and strengthen bonds with others (Vaillant 2000). They enjoy being objective and know themselves well enough to admit their weaknesses (Siebert 1996).

Nature’s ultimate goal is to foster the growth of the individual from absolute dependence to independence — or, more exactly, to the interdependence of mature adults living in community. Development is a process of moving from complete external regulation to self-regulation, as far as our genetic programming allows. Well-self-regulated people are the most capable of interacting fruitfully with others in a community and of nurturing children who will also grow into self-regulated adults. Anything that interferes with that natural agenda threatens the organism’s chances for long-term survival. Almost from the beginning of life we see a tension between the complementary needs for security and for autonomy. Development requires a gradual and ageappropriate shift from security needs toward the drive for autonomy, from attachment to individuation. Neither is ever completely lost, and neither is meant to predominate at the expense of the other. With an increased capacity for self-regulation in adulthood comes also a heightened need for autonomy — for the freedom to make genuine choices. Whatever undermines autonomy will be experienced as a source of stress. Stress is magnified whenever the power to respond effectively to the social or physical environment is lacking or when the tested animal or human being feels helpless, without meaningful choices — in other words, when autonomy is undermined. Autonomy, however, needs to be exercised in a way that does not disrupt the social relationships on which survival also depends, whether with emotional intimates or with important others—employers, fellow workers, social authority figures. The less the emotional capacity for self-regulation develops during infancy and childhood, the more the adult depends on relationships to maintain homeostasis. The greater the dependence, the greater the threat when those relationships are lost or become insecure. Thus, the vulnerability to subjective and physiological stress will be proportionate to the degree of emotional dependence. To minimize the stress from threatened relationships, a person may give up some part of his autonomy. However, this is not a formula for health, since the loss of autonomy is itself a cause of stress. The surrender of autonomy raises the stress level, even if on the surface it appears to be necessary for the sake of “security” in a relationship, and even if we subjectively feel relief when we gain “security” in this manner. If I chronically repress my emotional needs in order to make myself “acceptable” to other people, I increase my risks of having to pay the price in the form of illness. The other way of protecting oneself from the stress of threatened relationships is emotional shutdown. To feel safe, the vulnerable person withdraws from others and closes against intimacy. This coping style may avoid anxiety and block the subjective experience of stress but not the physiology of it. Emotional intimacy is a psychological and biological necessity. Those who build walls against intimacy are not self-regulated, just emotionally frozen. Their stress from having unmet needs will be high.

New evidence (2002) indicates that reparative adult experiences enable those with attachment traumas to increase their ability to cope with stress and restore a sense of security. Healing through new relationships occurs frequently, and makes a person who has experienced trauma increase the ability to cope with stress and negative affect. Religious or 12-step experiences, therapeutic experiences, and intimate relationships all offer possibilities for repair.

The off-drug patients also suffered less from depression, blunted emotions, and retarded movements. Indeed, they told Carpenter and McGlashan that they had found it "gratifying and informative" to have gone through their psychotic episodes without having their feelings numbed by the drugs. Medicated patients didn't have that same learning experience, and as a result Carpenter and McGlashan concluded, over the long term they "are less able to cope with subsequent life stresses.

Science provides us with some of the most elegant, stimulating puzzles that life has to offer. It throws some of the most provocative ideas into our arenas of moral debate. Occasionally, it improves our lives. I love science, and it pains me to think that so many are terrified of the subject or feel that choosing science means that you cannot also choose compassion, or the arts, or be awed by nature. Science is not meant to cure us of mystery, but to reinvent and reinvigorate it.

Another study that winds up in half the textbooks makes the same point, if more subtly. The subjects of the “experiment” were children reared in two different orphanages in Germany after World War II. Both orphanages were run by the government; thus there were important controls in place—the kids in both had the same general diet, the same frequency of doctors’ visits, and so on. The main identifiable difference in their care was the two women who ran the orphanages. The scientists even checked them, and their description sounds like a parable. In one orphanage was Fräulein Grun, the warm, nurturing mother figure who played with the children, comforted them, and spent all day singing and laughing. In the other was Fräulein Schwarz, a woman who was clearly in the wrong profession. She discharged her professional obligations, but minimized her contact with the children; she frequently criticized and berated them, typically among their assembled peers. The growth rates at the two orphanages were entirely different. Fräulein Schwarz’s kids grew in height and weight at a slower pace than the kids in the other orphanage. Then, in an elaboration that couldn’t have been more useful if it had been planned by a scientist, Fräulein Grun moved on to greener pastures and, for some bureaucratic reason, Fräulein Schwarz was transferred to the other orphanage. Growth rates in her former orphanage promptly increased; those in her new one decreased.

Looking at your own experience of abuse, many factors can influence the degree of traumatic impact you experience. Howe we handle stress in our lives varies; some of us have learned better coping strategies than others. The severity, intensity, frequency, and length of time the abusive episodes have lasted all strongly impact your response as well. Other powerful influences include the length of time your personal traumatic reaction lasts after your partner's abuse stops and your history, before you ever met your partner.

If the sleep disruption is repeated night after night, the actual measured impairments do not remain constant. Instead, there is an escalating accumulation of sleepiness that produces in adults continuing increases in headaches, gastrointestinal complaints, forgetfulness, reduced concentration, fatigue, emotional ups and downs, difficulty in staying awake during the daytime, irritability, and difficulty awakening. Not only do the adults describe themselves as more sleepy and mentally exhausted, they also feel more stressed. The stress may be a direct consequence of partial sleep deprivation or it may result from the challenge of coping with increasing amounts of daytime sleepiness. Think how hard it would be to concentrate or be motivated if you were struggling every day to stay awake. If children have

Physiological stress, then, is the link between personality traits and disease. Certain traits — otherwise known as coping styles — magnify the risk for illness by increasing the likelihood of chronic stress. Common to them all is a diminished capacity for emotional communication. Emotional experiences are translated into potentially damaging biological events when human beings are prevented from learning how to express their feelings effectively. That learning occurs — or fails to occur — during childhood. The way people grow up shapes their relationship with their own bodies and psyches. The emotional contexts of childhood interact with inborn temperament to give rise to personality traits. Much of what we call personality is not a fixed set of traits, only coping mechanisms a person acquired in childhood. There is an important distinction between an inherent characteristic, rooted in an individual without regard to his environment, and a response to the environment, a pattern of behaviours developed to ensure survival. What we see as indelible traits may be no more than habitual defensive techniques, unconsciously adopted. People often identify with these habituated patterns, believing them to be an indispensable part of the self. They may even harbour self-loathing for certain traits — for example, when a person describes herself as “a control freak.” In reality, there is no innate human inclination to be controlling. What there is in a “controlling” personality is deep anxiety. The infant and child who perceives that his needs are unmet may develop an obsessive coping style, anxious about each detail. When such a person fears that he is unable to control events, he experiences great stress. Unconsciously he believes that only by controlling every aspect of his life and environment will he be able to ensure the satisfaction of his needs. As he grows older, others will resent him and he will come to dislike himself for what was originally a desperate response to emotional deprivation. The drive to control is not an innate trait but a coping style. Emotional repression is also a coping style rather than a personality trait set in stone. Not one of the many adults interviewed for this book could answer in the affirmative when asked the following: When, as a child, you felt sad, upset or angry, was there anyone you could talk to — even when he or she was the one who had triggered your negative emotions? In a quarter century of clinical practice, including a decade of palliative work, I have never heard anyone with cancer or with any chronic illness or condition say yes to that question. Many children are conditioned in this manner not because of any intended harm or abuse, but because the parents themselves are too threatened by the anxiety, anger or sadness they sense in their child — or are simply too busy or too harassed themselves to pay attention. “My mother or father needed me to be happy” is the simple formula that trained many a child — later a stressed and depressed or physically ill adult — into lifelong patterns of repression.

This feeling of stress triggers a cascade of physiological consequences. The hypothalamus and pituitary gland in the brain release hormones that cause the release of cortisol from the adrenal glands located on the kidneys. Cortisol increases heart rate, among other things, readying the body for “fight” or “flight.” Acutely, the release of cortisol is beneficial and helps you cope with whatever is urgently being demanded of you. But if the stress becomes chronic, maladaptive things begin to happen. Normally, the release of cortisol turns the hypothalamus and pituitary off, stopping the release of hormone, which in turn stops the further release of cortisol from the adrenal glands. It’s a nice, clean, negative feedback loop. But in the chronically stressed, the loop breaks. The brain stops reacting to cortisol. Our natural, automatic shutoff valve stops working. The brain keeps releasing hormone, and the adrenal glands keep dumping cortisol into the bloodstream, even when the stressful thing that initially triggered the stress response is no longer around. Chronic, elevated levels of cortisol have been associated with a weakened immune system, deficits in short-term memory, chronic fatigue syndrome, anxiety disorders, and depression.

This is great. But what I’m grasping at is an idea about a subtler goal. This thinking owes a lot to conversations with Manjula Waldron of Ohio State University, an engineering professor who also happens to be a hospital chaplain. This feels embarrassingly Zen-ish for me to spout, being a short, hypomanic guy with a Brooklyn accent, but here goes: Maybe the goal isn’t to maximize the contrast between a low baseline and a high level of activation. Maybe the idea is to have both simultaneously. Huh? Maybe the goal would be for your baseline to be something more than the mere absence of activation, a mere default, but to instead be an energized calm, a proactive choice. And for the ceiling to consist of some sort of equilibrium and equanimity threading through the crazed arousal. I have felt this a few times playing soccer, inept as I am at it, where there’s a moment when, successful outcome or not, every physiological system is going like mad, and my body does something that my mind didn’t even dream of, and the two seconds when that happened seemed to take a lot longer than it should have. But this business about the calm amid the arousal isn’t just another way of talking about “good stress” (a stimulating challenge, as opposed to a threat). Even when the stressor is bad and your heart is racing in crisis, the goal should be to somehow make the fraction of a second between each heartbeat into an instant that expands in time and allows you to regroup. There, I have no idea what I’m talking about, but I think there might be something important lurking there. Enough said.

The subject of one experiment is a rat that receives mild electric shocks (roughly equivalent to the static shock you might get from scuffing your foot on a carpet). Over a series of these, the rat develops a prolonged stress-response: its heart rate and glucocorticoid secretion rate go up, for example. For convenience, we can express the long-term consequences by how likely the rat is to get an ulcer, and in this situation, the probability soars. In the next room, a different rat gets the same series of shocks—identical pattern and intensity; its allostatic balance is challenged to exactly the same extent. But this time, whenever the rat gets a shock, it can run over to a bar of wood and gnaw on it. The rat in this situation is far less likely to get an ulcer. You have given it an outlet for frustration. Other types of outlets work as well—let the stressed rat eat something, drink water, or sprint on a running wheel, and it is less likely to develop an ulcer.

That’s why just about every top professional athlete has been laid low by injury, sometimes a career-ending injury. There was a moment in my career when I seriously wondered whether I’d be able to continue competing at the top level. I play through pain much of the time, but I think all elite sports people do. All except Federer, at any rate. I’ve had to push and mold my body to adapt it to cope with the repetitive muscular stress that tennis forces on you, but he just seems to have been born to play the game. His physique—his DNA—seems perfectly adapted to tennis, rendering him immune to the injuries the rest of us are doomed to put up with.

when it comes to the bread and butter of human misery, try a major depression. It can be life-threatening, it can destroy lives, demolish the families of sufferers. And it is dizzyingly common—the psychologist Martin Seligman has called it the common cold of psychopathology. Best estimates are that from 5 to 20 percent of us will suffer a major, incapacitating depression at some point in our lives, causing us to be hospitalized or medicated or nonfunctional for a significant length of time. Its incidence has been steadily increasing for decades—by the year 2020, depression is projected to be the second leading cause of medical disability on earth.

The transactional view of psychological stress reminds us that we can be more resistant to stress, more resilient, if we build up our resources and enhance our physical and psychological well-being in general (for example, via regular exercise, meditation, adequate sleep, and the deep connectedness of interpersonal intimacy, to name four of the most important ones) during times when we are not particularly taxed or overwhelmed. This is our biological and psychological “bank account” from which we can withdraw needed resources on some occasions, and to which we can make deposits at other times. This is really what the phrase “healthy lifestyle” implies.

I suspect that self-deception is similar to its cousins, overconfidence and optimism, and as with these other biases, it has both benefits and disadvantages. On the positive side, an unjustifiably elevated belief in ourselves can increase our general well-being by helping us cope with stress; it can increase our persistence while doing difficult or tedious tasks; and it can get us to try new and different experiences. We persist in deceiving ourselves in part to maintain a positive self-image. We gloss over our failures, highlight our successes (even when they’re not entirely our own), and love to blame other people and outside circumstances when our failures are undeniable. Like our friend the crab, we can use self-deception to boost our confidence when we might not otherwise feel bold. Positioning ourselves on the basis of our finer points can help us snag a date, finish a big project, or land a job. (I am not suggesting that you puff up your résumé, of course, but a little extra confidence can often work in our favor.) On the negative side, to the extent that an overly optimistic view of ourselves can form the basis of our actions, we may wrongly assume that things will turn out for the best and as a consequence not actively make the best decisions. Self-deception can also cause us to “enhance” our life stories with, say, a degree from a prestigious university, which can lead us to suffer a great deal when the truth is ultimately revealed. And, of course, there is the general cost of deception. When we and those around us are dishonest, we start suspecting everyone, and without trust our lives become more difficult in almost every way.

One last bit of bad news. We’ve been focusing on the stress-related consequences of activating the cardiovascular system too often. What about turning it off at the end of each psychological stressor? As noted earlier, your heart slows down as a result of activation of the vagus nerve by the parasympathetic nervous system. Back to the autonomic nervous system never letting you put your foot on the gas and brake at the same time—by definition, if you are turning on the sympathetic nervous system all the time, you’re chronically shutting off the parasympathetic. And this makes it harder to slow things down, even during those rare moments when you’re not feeling stressed about something. How can you diagnose a vagus nerve that’s not doing its part to calm down the cardiovascular system at the end of a stressor? A clinician could put someone through a stressor, say, run the person on a treadmill, and then monitor the speed of recovery afterward. It turns out that there is a subtler but easier way of detecting a problem. Whenever you inhale, you turn on the sympathetic nervous system slightly, minutely speeding up your heart. And when you exhale, the parasympathetic half turns on, activating your vagus nerve in order to slow things down (this is why many forms of meditation are built around extended exhalations). Therefore, the length of time between heartbeats tends to be shorter when you’re inhaling than exhaling. But what if chronic stress has blunted the ability of your parasympathetic nervous system to kick the vagus nerve into action? When you exhale, your heart won’t slow down, won’t increase the time intervals between beats. Cardiologists use sensitive monitors to measure interbeat intervals. Large amounts of variability (that is to say, short interbeat intervals during inhalation, long during exhalation) mean you have strong parasympathetic tone counteracting your sympathetic tone, a good thing. Minimal variability means a parasympathetic component that has trouble putting its foot on the brake. This is the marker of someone who not only turns on the cardiovascular stress-response too often but, by now, has trouble turning it off.

I am having nightmares about sitting my exams naked,’ Franz said with an earnest expression as he sat down across from them. ‘Most disturbing.’ ‘If it’s any consolation I have nightmares about Franz sitting exams naked too,’ Shelby whispered to Laura. ‘One’s where I’m sat at the desk right behind his.’ ‘Oh, thanks very much for that mental image. Especially when I’m trying to concentrate,’ Laura said. ‘Thing is,’ Shelby whispered, ‘in the dream he’s really nervous because of the exam and so he’s sweating a lot.’ ‘OK, I am really not listening to you any more,’ Laura said, grimacing. ‘It gets worse because then he . . .’ Shelby leant over and whispered something in Laura’s ear. ‘Is Laura OK?’ Wing asked Otto quietly on the other side of the cluster of desks. ‘She appears to have suddenly gone quite pale.’ Otto looked over at Laura who was now repeatedly hitting Shelby with one of her notepads. Shelby meanwhile was laughing uncontrollably at the look of pure disgust on Laura’s face. ‘Shelby Trinity, there is something seriously wrong with you,’ Laura said, shaking her head. ‘You know, I am thinking Laura is struggling to be coping with the stress of the exams,’ Franz said sadly as he watched Laura rubbing at her temples as if desperately trying to erase something from her brain.

Feeling stressed and feeling overwhelmed seem to be related to our perception of how we are coping with our current situation and our ability to handle the accompanying emotions: Am I coping? Can I handle this? Am I inching toward the quicksand? Jon Kabat-Zinn describes overwhelm as the all-too-common feeling “that our lives are somehow unfolding faster than the human nervous system and psyche are able to manage well.” This really resonates with me: It’s all unfolding faster than my nervous system and psyche can manage it. When I read that Kabat-Zinn suggests that mindful play, or no-agenda, non-doing time, is the cure for overwhelm, it made sense to me why, when we were blown at the restaurant, we weren’t asked to help problem-solve the situation. We were just asked to engage in non-doing. I’m sure experience taught the managers that doing nothing was the only way back for someone totally overwhelmed. The non-doing also makes sense—there is a body of research that indicates that we don’t process other emotional information accurately when we feel overwhelmed, and this can result in poor decision making. In fact, researcher Carol Gohm used the term “overwhelmed” to describe an experience where our emotions are intense, our focus on them is moderate, and our clarity about exactly what we’re feeling is low enough that we get confused when trying to identify or describe the emotions. In other words: On a scale of 1 to 10, I’m feeling my emotions at about 10, I’m paying attention to them at about 5, and I understand them at about 2. This is not a setup for successful decision making. The big learning here is that feeling both stressed and overwhelmed is about our narrative of emotional and mental depletion—there’s just too much going on to manage effectively.

Here we’ll describe four signs that you have to disengage from your autonomous efforts and seek connection. Each of these emotions is a different form of hunger for connection—that is, they’re all different ways of feeling lonely: When you have been gaslit. When you’re asking yourself, “Am I crazy, or is there something completely unacceptable happening right now?” turn to someone who can relate; let them give you the reality check that yes, the gaslights are flickering. When you feel “not enough.” No individual can meet all the needs of the world. Humans are not built to do big things alone. We are built to do them together. When you experience the empty-handed feeling that you are just one person, unable to meet all the demands the world makes on you, helpless in the face of the endless, yawning need you see around you, recognize that emotion for what it is: a form of loneliness. ... When you’re sad. In the animated film Inside Out, the emotions in the head of a tween girl, Riley, struggle to cope with the exigencies of growing up.... When you are boiling with rage. Rage has a special place in women’s lives and a special role in the Bubble of Love. More, even, than sadness, many of us have been taught to swallow our rage, hide it even from ourselves. We have been taught to fear rage—our own, as well as others’—because its power can be used as a weapon. Can be. A chef’s knife can be used as a weapon. And it can help you prepare a feast. It’s all in how you use it. We don’t want to hurt anyone, and rage is indeed very, very powerful. Bring your rage into the Bubble with your loved ones’ permission, and complete the stress response cycle with them. If your Bubble is a rugby team, you can leverage your rage in a match or practice. If your Bubble is a knitting circle, you might need to get creative. Use your body. Jump up and down, get noisy, release all that energy, share it with others. “Yes!” say the people in your Bubble. “That was some bullshit you dealt with!” Rage gives you strength and energy and the urge to fight, and sharing that energy in the Bubble changes it from something potentially dangerous to something safe and potentially transformative.

When I first stopped trying to fix other people, I turned my attention to 'curing' myself. I was in a hurry to get this healing process over. I wanted immediate recovery from the effects of growing up in a family riddled with alcoholism and from being married to an alcoholic. I looked forward to the day I would graduate from Al-Anon and get on with my life. As year two and year three passed, I was still in the program. I began to despair as the character defects I had worked so long to overcome came back to haunt me, particularly during times of stress and during periods when I didn't attend meetings. I have severe arthritis in my joints. To cope with my condition, I have to assess my body each day and patiently respond to its needs. Some days I need a warm bath to get going in the morning. On other days I apply a medicated rub to the painful areas. Yet other days some light stretching and exercise help to loosen me up. I'ave accepted that my arthritis will never go away. It's a condition I manage daily with consistent, on-going care. One day I made a connection between my medical condition and my struggle with recovery. I began to look at myself as having 'arthritis of the personality,' requiring patient, continuous care to keep me from 'stiffening' into old habits and attitudes. This care includes attending meetings, reading Al-Anon literature, calling my sponsor, and engaging in service. Now, as long as I practice patience, recovery is a manageable and adventurous process instead of an arduously sought end point.

Lareau stresses that one style isn’t morally better than the other. The poorer children were, to her mind, often better behaved, less whiny, more creative in making use of their own time, and had a well-developed sense of independence. But in practical terms, concerted cultivation has enormous advantages. The heavily scheduled middle-class child is exposed to a constantly shifting set of experiences. She learns teamwork and how to cope in highly structured settings. She is taught how to interact comfortably with adults, and to speak up when she needs to. In Lareau’s words, the middle-class children learn a sense of “entitlement.” That word, of course, has negative connotations these days. But Lareau means it in the best sense of the term: “They acted as though they had a right to pursue their own individual preferences and to actively manage interactions in institutional settings. They appeared comfortable in those settings; they were open to sharing information and asking for attention…. It was common practice among middle-class children to shift interactions to suit their preferences.” They knew the rules. “Even in fourth grade, middle-class children appeared to be acting on their own behalf to gain advantages. They made special requests of teachers and doctors to adjust procedures to accommodate their desires.” By contrast, the working-class and poor children were characterized by “an emerging sense of distance, distrust, and constraint.” They didn’t know how to get their way, or how to “customize”—using Lareau’s wonderful term—whatever environment they were in, for their best purposes.

Kelly McGonigal, a health psychologist at Stanford University, warned about the dangers of stress for a full decade before she realized that maybe it was her advice, rather than stress itself, that was sending people to their graves faster. “I’m converting a stimulus [stress] that could be strengthening people into a source of disease.” With a breakthrough in her thinking, and some powerful new research, McGonigal made a complete turnaround. Turns out, stress might just be our friend. Just as you put stress on a muscle to make it stronger (by lifting weights or running), emotional stress can make us physically and psychologically stronger too. McGonigal now highlights new research showing that when you change your mind about stress, you can literally change your body’s physical reaction to it. In an eight-year study, adults who experienced a “lot of stress” and who believed stress was harmful to their health had a 43% increase in their risk of dying. (That sure stressed me out.) However, people who experienced an equal amount of stress but did not view stress as harmful were no more likely to die! McGonigal says that physical signs of stress (a pounding heart, faster breathing, breaking out in a sweat) aren’t necessarily physical evidence of anxiety or signs that we aren’t coping well with pressure. Instead, we can interpret them as indications that our body is energized and preparing us to meet the next challenge. The bottom line is, science has now proven that how you think about stress matters—the story you attach to stress. Telling yourself it’s good for you instead of harmful could mean the difference between a stress-induced heart attack at 50 or living well into your 90s.

The first step in retracing our way to health is to abandon our attachment to what is called positive thinking. Too many times in the course of palliative care work I sat with dejected people who expressed their bewilderment at having developed cancer. “I have always been a positive thinker,” one man in his late forties told me. “I have never given in to pessimistic thoughts. Why should I get cancer?” As an antidote to terminal optimism, I have recommended the power of negative thinking. “Tongue in cheek, of course,” I quickly add. “What I really believe in is the power of thinking.” As soon as we qualify the word thinking with the adjective positive, we exclude those parts of reality that strike us as “negative.” That is how most people who espouse positive thinking seem to operate. Genuine positive thinking begins by including all our reality. It is guided by the confidence that we can trust ourselves to face the full truth, whatever that full truth may turn out to be. As Dr. Michael Kerr points out, compulsive optimism is one of the ways we bind our anxiety to avoid confronting it. That form of positive thinking is the coping mechanism of the hurt child. The adult who remains hurt without being aware of it makes this residual defence of the child into a life principle. The onset of symptoms or the diagnosis of a disease should prompt a two-pronged inquiry: what is this illness saying about the past and present, and what will help in the future? Many approaches focus only on the second half of that healing dyad without considering fully what led to the manifestation of illness in the first place. Such “positive” methods fill the bookshelves and the airwaves. In order to heal, it is essential to gather the strength to think negatively. Negative thinking is not a doleful, pessimistic view that masquerades as “realism.” Rather, it is a willingness to consider what is not working. What is not in balance? What have I ignored? What is my body saying no to? Without these questions, the stresses responsible for our lack of balance will remain hidden. Even more fundamentally, not posing those questions is itself a source of stress. First, “positive thinking” is based on an unconscious belief that we are not strong enough to handle reality. Allowing this fear to dominate engenders a state of childhood apprehension. Whether or not the apprehension is conscious, it is a state of stress. Second, lack of essential information about ourselves and our situation is one of the major sources of stress and one of the potent activators of the hypothalamicpituitary-adrenal (HPA) stress response. Third, stress wanes as independent, autonomous control increases. One cannot be autonomous as long as one is driven by relationship dynamics, by guilt or attachment needs, by hunger for success, by the fear of the boss or by the fear of boredom. The reason is simple: autonomy is impossible as long as one is driven by anything. Like a leaf blown by the wind, the driven person is controlled by forces more powerful than he is. His autonomous will is not engaged, even if he believes that he has “chosen” his stressed lifestyle and even if he enjoys his activities. The choices he makes are attached to invisible strings. He is still unable to say no, even if it is only to his own drivenness. When he finally wakes up, he shakes his head, Pinocchio-like, and says, “How foolish I was when I was a puppet.