FAT SHAMING: WORSE THAN JUST RUDE

Posted on January 23, 2024January 24, 2024 by vlaw759

According to Harvard University School of Public Health, 33% of adults in the U.S. are overweight and 36% are ob⁶ese. Although percentages vary, several sources claim two thirds of American adults are overweight or obese.

With these numbers, one might expect a certain amount of heft to be perceived as acceptable, perhaps even desirable. But not so. Instead, in the United States, labels like fupa, lard, chunker, fatso, and jelly belly are slapped on. And how is this for humor? A collective noun for a group of overweight/obese people: A blubber of fat lads.

Even people who are trying to be polite or helpful say things that sting:

It’s easy to lose weight …
You have such a pretty face …
You’d be so pretty if you lost weight …
I don’t see you as fat …
You look great! …
I’m so fat (when the speaker isn’t) …
It’s not like you’re obese …
That (food) looks healthy …
I’ve always wanted a bum like yours! …

Where Did the Body Mass Index Come From?

*Lambert Adolphe Jacques Quetelet, the man responsible for the obesity epidemic (in a way).*

Lambert Adolphe Jacques Quetelet, a Belgian mathemetician, developed Quetelet’s Index (later called the Body Mass Index or BMI) in the 1842 as a method of determining the average measurements of French and Scottish men. Quetelet prized homogeneity and thought that the ideal person should be as close to the center of the statistical bell curve as possible. At the time of its creation, Quetelet was very clear that “Quetelet’s Index” was useful solely as a means of predicting the average body size of a population, not to measure or predict anything for an individual, including health.

In 1867, Mutual Life Insurance of New York started using an adaptation of Quetelet’s BMI tables to determine how much to charge policy holders. Within a few years, every insurance company in the market was using different BMI tables with wildly varying numbers to define “healthy” weights, which they then used to set prices for clients.

Even when Ancel Keyes adapted Quetelet’s original findings as a way for doctors to use during medical consultations, he admitted that the BMI was only accurate as measure of obesity about half the time. He also included data only from men, almost entirely white men from relatively wealthy countries.

These early limitations of the BMI calculator continue to cause serious challenges for those trying to use it as a diagnostic tool. Women’s bodies store fat differently than men’s bodies. The cut-offs for defining someone as overweight or obese vary widely among ethnic groups. Scientists created the BMI for children by simply extending downward the existing trend lines for small adults, which makes the data for children particularly unreliable. Older adults have different metabolic needs and may benefit from having a higher BMI altogether.

In 1995, the World Health Organization change the definitions of overweight and obese according to BMI. The American National Insitute of Health (NIH) adopted those standards in 1998; overnight, millions of people became overweight or obese without gaining a pound. This marked the start of the “obesity epidemic” and the “war on obesity” (which has not really had any effect on actual health.)

Obesity Today

Today, the NIH classifies about 1 in 11 adults (9.2%) as having severe obesity.

As a rule of thumb, you are likely morbidly obese if you are more than 100 lbs. over your ideal body weight or have a BMI of over 40.

Women had a higher prevalence of severe obesity (11.5%) than men (6.9%). The prevalence was highest among adults aged 40–59 (11.5%), followed by adults aged 20–39 (9.1%), and adults aged 60 and over (5.8%).

Other obesity data reflect much of the data on other health issues.

Recent national data show that 54.8 percent of Black women and 50.6 percent of Hispanic women are obese compared to 38.0 percent of White women. Rates of obesity are also higher for Hispanic men, in the South and Midwest, in nonmetropolitan counties, and tend to increase with age. However, as discussed above, inherent problems in calculating BMI may misrepresent actual health of people in these populations.

Who Is Fat? Who Is Obese?

Kimberly Truesdale and June Stevens found that perception of one’s own weight may be skewed. Surprisingly, to me, only 22.2% of obese women and 6.7% of obese men correctly classified themselves as obese.

How can this be? Fat people have all kinds of euphemisms for fat. (Curvy, plump, voluptuous, plus-size, zaftig, heavyset, Rubenesque, queen-size, large, thick, plush, stout, hefty, buxom, portly, ample-bodied, curvaceous, puffy, fluffy, etc.)

In the Media

As I reported in an earlier blog (September, 2020) Greenberg et al. reported on their findings of television actors’ BMI after analyzing 5 episodes of the top 10 prime time shows.

In comparing television actors’ BMI to that of the American public, they found that only 25 percent of men on television were overweight or obese, compared to almost 60 percent of American men.
Almost 90 percent of women on TV were at or below normal weight, compared to less than 50 percent of American women.

Popular television shows that include people who are obese portray them as comedic, lonely, or freaks. Rarely if ever are they romantic leads, successful lawyers or doctors, or action stars.

In addition, shows like The Biggest Loser promote the perception that obesity is caused by individual failure rather than a mixture of individual, environmental, and genetic sources.

Weight and Mental Health

*“Do these feathers make my bum look big?”*

Defensive self-labeling aside, the results of fat shaming are apparent in many correlates of mental health. Societal stigmas and biases mean that carrying extra weight is hard on one’s mental health.

Late-onset or chronic overweight/obesity predicted low general, social, and academic/school-related self-esteem.

Socially competent people using better strategies for solving interpersonal problems are more readily accepted by peers and valued by adults. Obese individuals, especially teenagers, have deficits in several social skills, which lead to damage to relationships, lower self-esteem and devaluation by social agents.

Children with lower social skills are also at a greater risk of becoming overweight or obese.

Many individuals who are obese also struggle with issues related to their mood, self-esteem, quality of life, and body image. This emotional distress likely plays a role in treatment seeking but also can impact successful treatment.

Weight Stigma

“Anti-fat bias kind of turns up the volume on existing systems of oppression,” says Aubrey Gordon, author of You Just Need to Lose Weight” and 19 Other Myths About Fat People.

Obesity is associated with a higher risk of having certain mental health disorders, including anxiety, depression, bipolar disorder, and eating disorders. Often, this relationship is due to the effects of weight discrimination.

People with a weight problem are more likely to feel alone and describe themselves as lonely. They may feel they might not ever meet the ‘right person’, feel uncomfortable with intimacy, feel they are being judged for their weight, and just want to hide sometimes.

Obesity contributes to negative mental health and poor psychological well-being. Society also highly stigmatizes obesity, which negatively affects social and relational health, as well as inhibiting communication about the topic.

Medical professionals are often guilty of fat-shaming. Patients seeking treatment for problems that have nothing to do with size are instead lectured about why they need to lose weight. As Aubrey Gordon says, “It is one of the great fears of my life, that I will die of a totally treatable or preventable thing because my doctor can’t conceive of me having any other health problem than just being a fat person. That is a fear that follows me every time I go into a doctor’s office.”

The vast majority of people who are overweight or obese according to BMI also have some form of eating disorder, according to Dr. Erin Harrop at Denver University. However, because these patients don’t fit the common perception of looking dangerously thin, the medical establishment classifies thesm as having “atypical anorexia.” This distinction makes it much more difficult to receive an accurate diagnosis. Not only are doctors more reluctant to treat overweight patients with disordered eating, insurance companies are reluctant to cover those treatments.

The social and emotional effects of obesity include discrimination, lower wages, lower quality of life and a likely susceptibility to depression.

To be clear, the mental health issues that are correlated with being overweight or obese are caused by our fat-shaming culture. In societies where people value weight, these stigmas are not prevalent.

Does Personality Cause Obesity?

Who are these overweight and obese people?

In analyses of separate personality traits, openness and conscientiousness were significantly associated with obesity in men, and only agreeableness was associated with obesity in women.

Introverts are more likely to be at a healthy weight. They have lower rates of obesity. In one study of nearly 2,000 people over a span of 50 years, extroverts were heavier than introverts, with more body fat, larger waists, and bigger hips.

The BIH has found positive associations between obesity and the personality traits neuroticism (OR: 1.02) and extraversion (OR: 1.01), and negative associations between obesity and openness to experience (OR: 0.97) and agreeableness (OR: 0.98). (Recall, a positive association means as one goes up, so does the other; a negative association means as one goes up, the other goes down.)

Although there is no single personality type characteristic of the morbidly obese, they differ from the general population as their self-esteem and impulse control is lower. They have passive dependent and passive aggressive personality traits, as well as a trend for somatization and problem denial.

Over-eating may be the result of self-sabotage. A person gets into a cycle of low self-worth and shame, using food to soothe. Obesity can also be seen as a way of showing the world ‘I am worth nothing, stay away, because I am bad.’

Researchers have found four characteristics that typify the ”overweight personality.” You may have low self-esteem, poor self-control (or even eat compulsively), experience mood swings, or be prone to depression and anxiety.

Physical Causes of Obesity

Genes contribute to the causes of obesity in many ways, by affecting appetite, satiety (the sense of fullness), metabolism, food cravings, body-fat distribution, and the tendency to use eating as a way to cope with stress. Some researchers believe they may have identified “missing” genes that potentially contribute to obesity.

It’s important to remember that obesity is a disease, and we shouldn’t blame individuals for it because the causes are not always something they can control. In other words, it’s not your fault if you are obese.

Obese and Healthy

Obesity is definitely a physical health hazard, but poor health is not necessarily inevitable. In a database at McGill University, about 15% or slightly over half a million people were categorized as being obese and metabolically healthy.

If a person is 300 pounds and does not have any other diseases or health complications, then that person is considered healthy. However, the chances of staying healthy with 300 pounds weight are low. Around 99% of individuals weighing this much suffer from several other health complications.

“There is a lot of data that says that fat people generally and fat women in particular postpone care because they know that they are going to be overtly, directly judged by their health care providers and they know that they will get substandard care because of that judgement.”

Aubrey Gordon

Essentially, people with obesity can still be healthy. However, what a McGill University study, and prior research, shows is that obesity even on its own carries a certain cardiovascular risk even in metabolically healthy individuals.

Some People Do Manage to Lose Weight

The annual probability of achieving normal body weight was 1 in 210 for men and 1 in 124 for women with simple obesity. The probability declined with increasing BMI category. In patients with morbid obesity, the annual probability of achieving normal weight was 1 in 1290 for men and 1 in 677 for women.

Good news! Children who successfully reduced weight may have equal levels of self-esteem or even better social self-esteem than those being always underweight/normal weight.

The disease of obesity, no matter what it means for your physical body, is not your whole self or your whole life. Obesity does not define you as a person.

Bottom Line: For many people, too much weight is a fact of life. Be aware of the possible (probable) effects of fat shaming on your mental wellbeing!

Self-Soothing

Posted on November 21, 2023November 21, 2023 by vlaw759

“Self-soothing” refers to behaviors people use to regulate their emotional state by themselves. It’s a strategy used to regain equilibrium after an upsetting event, or when facing a stressful situation. (For example, when a child’s parents argue, or an older person has to make a public presentation.)

Self-soothing behaviors are often apparent early in life, and are calming or comforting for a child or adolescent. Infants, for example, may be seen repeatedly sucking fingers or thumbs, hugging a toy or blanket. These habits may continue for years.

Self-soothing behaviors are repetitive/habitual in nature—and are often not consciously applied. Do you touch your hair, twist a ring, straighten your tie, etc.? Noticing when you engage in such behaviors can help you recognize mildly tense or stressful situations. It’s another form of self-awareness.

Following a shock, a traumatic or upsetting event, all people need soothing. In these more intense situations, two common self-soothing behaviors include reaching for an alcoholic drink or a tub of ice cream or other emotional eating. However—as you no doubt know—these kinds of self-soothing behaviors can cause additional problems.

Several self-soothing behaviors can lead to other problems: binge-watching TV, compulsive gaming, or internet surfing. Many superheroes have unhealthy self-soothing behaviors, including Jessica Jones and Iron Man.

Constructive Methods of Self-Soothing

Positive Psychology published an article suggesting several more positive strategies: “24 Best Self-Soothing Techniques and Strategies for Adults.” The following 7 suggestions quoted below are included in that article.

1. Change the Environment

If possible, just change the environment for a few minutes. Go outside and focus on greenery or find a soothing indoor space with a pleasant view or ambiance.

(The origin of the “Green Room” in theaters may stem from Elizabethan actors resting “on the green” between scenes to calm their eyes and their nerves. As the wavelength of green light causes the least strain on the human eye, those Elizabethans may have been on to something!)

2. Stretch for Five Minutes to Move Any Blocked Energy

*For best results, try to put your chin between your heels.*

Often, after upsetting news or a shock, our bodies respond by freezing and energy gets blocked. A few simple trunk twists, neck rotations, or bends at the hip to touch the toes can help shift stagnant energy.

(Even without a shock, our bodies tend to store tension and stress in our backs, shoulders, and necks. Stretching these areas can prevent headaches and improve circulation.)

3. Take a Warm Shower or Bath

Treat yourself with soothing body wash or bubbles and a fresh, soft towel afterward.

(For best results, do not use overly hot water and avoid scrubbing too hard. If hot water is not available, you can turn to oil, smoke, some types of mud, or simple cold water to achieve cleanliness and promote peace of mind.)

4. Soothing Imagery

Find soothing things to look at such as a burning candle, soft lights, pictures of loved ones, favorite places, or perhaps some framed inspirational resilience quotes or affirmations.

(The color green is most restful to the human eye, but some evidence suggests that other colors may have a calming effect on stress and mood. According to the principles of chromotherapy, surrounding oneself with blue, purple, or white can calm, soothe, and relax the central nervous system.)

5. Soothing Music

Listen to favorite tracks that have a calming effect or one of the many relaxing music videos for stress relief that are available online.

(Harp music in particular has a soothing effect on the body as well as the mind. Research has shown that listening to harp music improves pain management, blood pressure, and heart rate regularity.)

6. Soothing Smells

Create pleasant smells by using an essential oil diffuser, scented candle, or incense. Also, try using scented hand lotion.

7. Self-Compassion

Speak compassionately to yourself aloud. Talk to yourself like a good friend would. Give yourself the grace to be off-balance and the space to just be as you are for a while.

Soothing Every Sense

When people experience high levels of stress or discomfort often, some therapists recommend making a self-soothing box that includes objects or reminders of how to soothe all five senses:

Comforting smells such as scented candles, essential oils, or body lotion
Pleasant tastes such as herbal teas or favorite snacks
Soothing things to touch such as a favorite sweater, wrap, or stress ball
Comforting sights such as photos of loved ones, pets, or favorite places
Soothing sounds such as a favorite piece of music or guided meditation track

Most of us are familiar with people soothing other people—a hug, a back-rub, a shoulder to cry on. During COVID, when interpersonal soothing was less available, researchers studied the benefits of self-touching (Dreisoerner et al., 2021). They found that both self-soothing touch (in this study, most participants chose to place their right hand on their heart and their left on their abdomen while focusing on the rising and falling of their breath) and receiving a hug from another person were equally effective at lowering stress levels.

When adults are distressed, it’s difficult to regulate potentially disruptive emotions like anger, fear, and sadness, especially in a public space such as the workplace. If you want to explore self-soothing further, just look online. You will find lists of techniques from 8 to 100. Surely there’s something there for everyone.

Bottom Line: Everyone experiences distress of various sorts and at various levels. Self-soothing is a life skill worth learning.

Hygiene and Mental Health

Posted on October 10, 2023October 10, 2023 by vlaw759

mental health hygiene — *Today’s guest blog post was written by Kathleen Corcoran.*

Mental health and cognitive decline can have a serious impact on a person’s ability to maintain regular hygiene and grooming routines. At the same time, changes or lack of regular hygiene and grooming routines can seriously impact a person’s mental health. Today is World Mental Health Day, a good day to consider how hygiene and mental health are woven together.

You’ve probably heard the saying “cleanliness is next to godliness” at some point. Many people subconsciously apply this moral judgement to the personal hygiene of those around them. As society’s standards of hygiene and grooming have changed over the centuries, so have the judgements on those who do not meet those standards.

This can have deleterious impacts on people already struggling with mental health or cognitive ability. Social stigma can deter people from reaching out for help, whether to mention their struggle to a therapist or ask for physical assistance. Self-consciousness about grooming standards may then contribute to isolation and loneliness.

“Unfortunately, at both ends of the spectrum, a lack of personal hygiene or an obsession with personal hygiene create additional stress and anxiety for the sufferer,” says Carla Manly, PhD, a clinical psychologist and author.

Depression

*Maybe chicken flavored toothpaste makes oral hygiene easier?*

The fatigue and lack of motivation that often characterize depression make otherwise routine tasks monumentally impossible. Executive dysfunction can be paralyzing in the face of all the minor steps needed to shower or bathe.

Additionally, depression sometimes causes sensory issues that make bathing physically painful. The temperature changes, scents, or lights can be overwhelming for someone with severe depression.

Instead of traditional bathing practices, those with mental health challenges might turn to alternative methods of hygiene. Dry shampoo, mouthwash, and wipes can enable someone with depression to stay clean when everything is difficult.

Alzheimers and Dementia

People with cognitive decline issues, such as Alzheimer’s and dementia, often have trouble maintaining regular bathing and grooming routines. They may bathe repeatedly, forgetting that they have already done so. Or they may forget to bathe entirely. Alternatively, they may have physical issues that prevent them from bathing. Issues with regular bathing can lead to health complications, such as skin infections or gum disease.

People who can live alone may be able to address this by setting alarms or writing reminders. Maintaining a routine for daily grooming and hygiene can help it become automatic rather than something to remember. Adjustments like hose attachments and rubber mats can remove some of the physical impediments to routine bathing.

Nurses, caregivers, and health aides can help patients who need more assistance with bathing. Keeping up habits established over the course of a lifetime can make assisted bathing easier. Bathing at the same time, using the same products or scents, might make a patient less agitated. Focusing on hygiene rather than grooming can help eliminate stress.

Ablutophobia

Many young children fear taking a bath or shower, but they generally grow out of it as they become more familiar with the routine or associate the bath with pleasant sensations. However, some people develop ablutophobia, an extreme fear of bathing or washing. This may be due to a sensory processing disorder, a traumatic experience, changes in brain function, or an underlying anxiety disorder.

When people with ablutophobia try to perform routine hygiene or grooming rituals, they may experience the symptoms of a panic attack or dissociation.

In the short term, people with ablutophobia can use alternative forms of cleaning, such as wipes or dry shampoo. However, treating ablutophobia will ultimately require psychotherapy or medication, which may allow a patient to uncover and address an underlying cause.

PTSD and Anxiety Disorders

Both post traumatic stress disorder (PTSD) and anxiety disorders can cause difficulties with regular standards of cleanliness. These mental health challenges can cause people to go to either extreme of hygiene and grooming. Sometimes people avoid bathing entirely because it triggers traumatic memories or causes a spike in anxiety. At other times, people fixate on removing dirt, performing ritualized grooming behaviors, controlling elements of their environment, or perfecting their outward appearance.

At either extreme, a person will likely feel an increased sense of social stigma and isolation, compounding the pain from mental illness.

*Some people may prefer to take dust baths rather than water baths.*

Short-term solutions may include changing the method of bathing, such as cleaning body parts individually to limit vulnerability, or switching from baths to showers. Changes to the bathing environment may also help, such as removing or installing locks on doors, turning down the temperature of the water heater in the home, or removing harsh scrubbers.

“The ultimate goals with such behaviors are to reduce a sense of being violated and ‘dirty’ and to increase a sense of safety,” says Carla Manly.

Schizophrenia

People struggling with schizophrenia often have difficulty maintaining regular routines and lose interest in daily activities. This includes habits like showering, brushing teeth, or changing into clean clothes.

Additionally, many medications to treat schizophrenia have side effects that contribute to problems with hygiene or grooming. Antipsychotic drugs often cause dry mouth, which can lead to gum disease, cavities, and halitosis. These medicines may also cause incontinence, which makes maintaining hygiene very difficult.

Some people find written reminders or alarms helpful to encourage regular hygiene or grooming rituals. Adjusting medications or dosages may help with side effects. Chewing gum and drinking lots of water can help with dry mouth, improving oral hygiene.

Bottom Line: Hygiene and grooming serve two different functions in our lives. When mental health issues make everything more difficult, focus on hygiene rather than grooming.

YOUR TOXIC ENVIRONMENT

Posted on May 23, 2023May 23, 2023 by vlaw759

Not the air you breathe, not the water you drink, not asbestos in your house or lead based paint. I’m talking about toxic people in your life! As part of Mental Health Awareness Month, let’s talk a bit about how to recognize the toxic people in your life and what to do about them.

Toxic People

A toxic person is anyone whose behavior adds negativity and upset to your life. Lillian Glass first used the term in her 1995 book Toxic People: 10 Ways of Dealing With People Who Make You Miserable.

I’m not the first to recognize the threat toxic people pose to one’s well-being. Clinical psychologists and other counselors frequently see people struggling with toxic people in their lives. And there are a ton of self-help books out there.

In 2018 Oxford Dictionaries named “toxic” as its Word of the Year, citing a 45% increase in look-ups of the word and an expansion in the scope of its application.

Toxic people are more common than you may think.

Researchers suggest that toxic people represent possibly 5-10% of the population and maybe cause 95% of the damage to humans. Toxic friendships are all too common: 84% of women and 75% of men report having a toxic friend at some point.

A 2015 study suggests that, though men and women may display toxic personality traits differently, toxic personality shows up equally across the entire population.

Identifying Toxic People

Your own gut reaction to toxic people will likely warn you to limit interactions with them. From WebMD, here are some warning signs that you’re dealing with a toxic person:

You feel like you’re being manipulated into something you don’t want to do.
You’re constantly confused by the person’s behavior.
You feel like you deserve an apology that never comes.
You always have to defend yourself to this person.
You never feel fully comfortable around them.
You continually feel bad about yourself in their presence.
You consistently dread spending time in this person’s company.

Just like there are signs you’re around a toxic person because of how the person makes you feel, there are signs you might see in toxic people themselves that highlight their toxicity.

**The Covert Passive-Aggressive Narcissist** by Debbie Mirza

The most common signs include:

Toxic people are often controlling, wanting his/her way in matters large and small. They often say, “You should….”
They are unwilling to compromise, even on seemingly minor issues.
Toxic people are typically highly critical.
Their mood toward you seems to run hot and cold, i.e., they are inconsistent.
Their “wounded ego” constantly needs bolstering.
Toxic people are often narcissistic, focusing mostly on themselves.
They tend to exaggerate.
They are preoccupied with projecting an idealized image, whether that’s of a perfect family, a benevolent philanthropist, or simple physical attractiveness.
They have a negative attitude about other people and about life in general.
They often abuse alcohol or other substances.
They don’t respect the boundaries of others, sometimes physically, more often psychologically; i.e., making plans on others’ behalf, not keeping secrets, bringing up hurtful topics.
They expect others to “know” or guess what they need without actually asking for it (and then take offense when those needs are not met).
They’ll use non-toxic words but in a toxic tone of voice.
They will never admit to their own wrong-doing.
Through all their stories, they are always the victim.
They’re judgmental and not afraid to share.

So How Do These People Get into Your Life?

Friend by History:
- This is a person whom you have known forever.
  - Maybe you went to elementary school together, or you were neighbors growing up.
- Now you feel guilty ending the relationship.

Friend by Proximity:
- This is a person who comes as a package with someone else in your life.
  - Maybe it’s your partner’s best friend, or your friend’s brother who always tags along, or your best friend’s childhood friend.
- You feel guilty because you don’t want to put “your” person in an awkward situation.

Friend by Context:
- This is a person who you see all the time in a specific area of your life
  - Someone you work with everyday, maybe someone on your flag football team or someone who lives across the hall, perhaps someone in your bridge group.
- You feel guilty brushing them off because you see them all the dang time.

How Toxic People Negatively Impact You?

The negative effect toxic people can have on those around them goes both deep and far. And it’s not just personal: a toxic employee or manager can negatively impact their entire business.

**Emotional Vampires: Dealing with People Who Drain You Dry** by Dr Albert Bernstein

As Babita Spinelli, L.P., J.D. explains, toxic people will find ways to blame you for everything, control you, suffocate you, and invalidate you, which can lead you to abandon yourself.
When a toxic person has a hold on you, you’ll find yourself accommodating them, making poor choices, and getting caught in drama. This all leads to an overall diminishing of self-esteem and self-worth, and even anxiety and depression, says Spinelli.
A more insidious effect of toxic people is that they’re energy vampires, meaning they seem to drain the very life out of people around them just with their presence. “They cause you a lot of distress that you may even justify because you can’t understand why it’s affecting you so badly,” Perpetua Neo, DClinPsy notes, adding that toxic people will often make you question your reality.
Children with toxic parents can develop a variety of mental traumas as they grow up, including depression, anxiety, eating disorders, hypochondria, and Post Traumatic Stress Disorders.
Children surrounded by toxic adults may grow up to be toxic adults themselves.
Teachers with toxic personalities can harm students’ academic performance, interest in school, and self-esteem.
Toxic employees can cost a company revenue and hurt an organization’s reputation both with customers and within an industry.
Toxic bosses decrease employee productivity, increase employee absenteeism and turnover, and have an overall negative impact on the entire organization where they work.

Are You a Toxic Person?

Could you be a toxic person? Take this quick test from Truity:

It is simply a fact that I am smarter than the average person.

Inaccurate				Accurate
1	2	3	4	5

People who want to get close to me need to understand that I have strong emotions and that I must be true to myself.

Inaccurate				Accurate
1	2	3	4	5

Most people spend too much time and energy trying to achieve goals that don’t really matter.

Inaccurate				Accurate
1	2	3	4	5

Everyone lies—I’m just better at it than most.

Inaccurate				Accurate
1	2	3	4	5

The best way to avoid being disappointed is to expect the worst.

Inaccurate				Accurate
1	2	3	4	5

I often have to push people to do things in a way that meets my high standards.

Inaccurate				Accurate
1	2	3	4	5

I do not like to be treated like one of the crowd.

Inaccurate				Accurate
1	2	3	4	5

**The Highly Sensitive Person’s Guide to Dealing with Toxic People** by Shahida Arabi

If any of this sounds like you, don’t despair! Most people do not have a permanent, entrenched personality disorder; they may be simply going through particularly toxic phases. The first step to fixing a problem is generally admitting that the problem exists. Deliberate efforts on your part to shift your perspective and your responses to those around you can help you break toxic patterns of behavior.

As Hannah Baer writes, “Research demonstrates that believing others have fixed traits which don’t change (including, say, “toxic” personality pathology) yields defensiveness, failure to listen, and failure to set boundaries (because what good can it do if they can’t change?).”

On the other hand, you might recognize someone you know in this quiz. Many times, people who are toxic are dealing with their own stresses and traumas. To do this, they act in ways that don’t present them in the best light and usually upset others along the way. Or maybe it’s just the alcohol! But you are not the therapist for such family members, friends, coworkers, neighbors… Attend to your own well-being first.

How to Deal with Toxic People

**In Sheep’s Clothing: Understanding and Dealing with Manipulative People** by Dr George Simon

Paracelsus, a 16th century Swiss physician and philosopher, famously said, “Dosis sola facit venenum (Only the dose makes the poison).” Though his claim that poisons can cause harm only if ingested in a high enough concentration may not be entirely true for toxic chemicals, it is a good guiding principle when dealing with toxic people.

There is a chance that the person is not genuinely toxic and is just reacting to particularly high levels of stress in their own life. In this case, you might be able to bring their toxic behavior to light, leading them to change on their own.

Confront the person about the toxic behavior. This is best done in a calm, non-argumentative way. For example, “When you do/say X, I feel Y.”
In the case of someone you’ve known for a while, ask yourself if their behavior has always been problematic or if it has become more toxic over time. If the person has become more toxic, you may be able to have a discussion about what has changed, when it changed, and whether it might change back.
Discuss the negative behavior you’ve noticed, including specifics.
Often, a person displays toxic behavior in response to power imbalances in a relationship, such as a work supervisor or a parent. In such cases, addressing the unequal power in the relationship might remove the trigger for toxic behavior.

If you realize that you are unlikely to cause a genuinely toxic person to change their personality in any fundamental way, your best option may be to minimize your “dose” of exposure.

**Whole Again: Healing Your Heart and Rediscovering Your True Self After Toxic Relationships and Emotional Abuse** by Jackson MacKenzie

Set and enforce clear boundaries.
Spend as little time as possible with the person.
Change the subject when they bring up problematic conversation topics.
Limit conversation to relevant topics. For example, only talk to a toxic coworker about work-related topics. With a problematic bridge partner, only discuss future bridge games or strategies.
Leave yourself options for escaping bad encounters if necessary.
If your boundaries aren’t respected, follow through with concrete actions, including breaking off contact.

It may be best to break off all contact with a toxic person, preserving your own sanity and peace of mind.

Stop all meet-ups, phone calls, messages, social media connections, etc.
Avoid reminiscing about the “good times” or reliving painful memories.
Don’t give in to the urge to look them up online or ask mutual acquaintances about them.
Focus on personal healing and self-care.
Maintain healthy and supportive relationships with others.

Bottom Line: Purge your life of toxic people. You know who they are!

BETTER KNOW YOUR CHARACTER: GRIEF

Posted on July 27, 2021July 27, 2021 by vlaw759

Funeral for a victim of the Siege of Sarajevo
photo by Mikhail Estafiev

Grief, deep sorrow at the loss of someone/something important, comes to everyone in one form or another, at some time or another. According to healthline.com, grief is personal, not necessarily linear, and doesn’t follow timelines or schedules. Everyone grieves in his or her own way.

People usually recognize when someone is grieving the death of a loved one. But other deaths—other losses—any change that alters life as one knows it—can cause grief. What might cause your character(s) to grieve? Loss of . . .

Job/career
Marriage
A love relationship
A child
Loss of child custody
A pet (or pet custody)
A close friend
One’s home
Reputation
Faith
Physical ability
One’s youth
Treasured object
…and others?

How Would Your Character(s) Grieve?

In 1969, Elizabeth Kübler-Ross published On Death and Dying, based on her years of work with terminally ill people. Subsequently, it was applied to other losses as well. Because grief is so complex and personal, various numbers of stages—from two to seven—have been posited. The original model had five stages:

*Robert Plutchik’s **Wheel of Emotions** is another model of possible progressions of grief.*

Denial
Anger
Bargaining
Depression
Acceptance

Models with seven stages include the following three after depression:

Upward turn
Reconstruction and working through
Acceptance and hope

Important to note: Stages can vary in order, can overlap, or can be skipped altogether. The duration of any given stage can vary widely, from days to months to years.

What Would Your Character(s) Grief Cycle Look Like?

Straight line?
Bowl of spaghetti?
Immediate start?
Delayed?

Expressions of Grief Reflect One’s Personality

For example, people who express anger physically will continue to do so while grieving, very different from those who express anger verbally. Grieving can be self-destructive, triggering harmful eating, drinking, or risk-taking behaviors. Some might grieve by intellectualizing (finding out everything possible about the causes, prognosis, etc.) or compartmentalizing (confining conscious grieving to certain times or places).

Mass expressions of grief, such as at public funerals, can turn into a feedback loop among the crowd bordering on hysteria. This is particularly true when the person mourned was the subject of a “Cult of Personality,” such as Joseph Stalin or Kim Jong-Il.

BOTTOM LINE: What causes feelings of loss and how your character(s) respond are rich sources of adding depth and feeling to your plot.

“THE MOST WONDERFUL TIME OF THE YEAR.” REALLY?

Posted on December 18, 2020December 19, 2020 by vlaw759

CONSIDER THE DOWNSIDE OF CHRISTMAS.

Part of the downside of Christmas is this myth that everything and everyone is merry and bright, and if you aren’t, you must be a Scrooge. Or a Grinch. Or Burgemeister Meister Burgher. Indeed, much of what follows also applies to Hanukkah, Kwanzaa, Ōmisoka, and other holidays too numerous to mention. Almost everyone (every character?) suffers one or more of these downsides of typical celebrations.

Exposure Fatigue

*“Fairytale of New York” by The Pogues reflects the loneliness despair of Christmas.*

Going into a store in October and see “decorations” for Halloween, Thanksgiving, AND Christmas
Christmas music that begins to be played everywhere before Thanksgiving
- Christmas music gets old fast, particularly for people working in retail
Commercials touting the “perfect” gift
The pervasiveness of sappy Christmas movies (and over-exposure to the good ones, such as “It’s a Wonderful Life” and “Miracle on 34th Street”)

Physical Fatigue

Decorating
Food preparation
Package wrapping and/or mailing
Attending celebratory events, especially navigating office/work place parties
Hassles of travel (insane boarding lines, delayed flights, driving clogged highways)
Making gifts or cards by hand
Shopping for presents
- Finding a mall parking space 2 miles from the shops
Tracking down the right present for the right person

Weather

Living in a warm place, one laments the lack of snow
Living in a cold climate, one laments cold and snow that keep people inside
Ice storms that keep one from attending/hosting a holiday event
Combination of extra traffic, stressed drivers, and wintry weather can make every drive a terrifying experience

Family Stresses

Feeling compelled to see family you’d rather not
- Spending time with the family of one’s significant other can be even worse
Conflicts between/among guests
Pretending to like presents you don’t
Taking awkward photos
Kids demands for presents and apply pressure in in terms of values, money, and parenting
Waiting in endless lines for kids to visit Santa at the mall
Bad situations can worsen, and marriages are strained
- Recently divorced parents navigating custody arrangements
- Divorce lawyers have their busiest month in January

Financial Strains

Feeling pressed to give a gift of equivalent value, even when the “gift lists” for giver and recipient aren’t the same
Dealing with a year when one’s gift-giving must be cut/downsized in number and/or expense and it will be obvious
Higher electric bill for huge outdoor displays
Travel, tickets, decorations, food, etc., can drain bank accounts and max out credit cards even without buying gifts

Physical Health

Emergency room visits are up 5-12% around Christmas
- Slips and falls on icy walkways or while putting up decorations
- Sharp object injuries from unfamiliar cooking utensils, new toys, assembling gifts
- Falls from a height
- Workplace accidents
- Abdominal discomfort from overeating
- Psychiatric disorders exacerbated by stress and crowds
- Poisonings
  - Incorrectly prepared food
  - Overconsumption of alcohol

Disruption of healthy patterns
- Abandoning diets or eating irregularly
- Loss of sleep
- Failure to follow doctor’s instructions for treatment and/or medication
A typical Christmas meal is likely to be two-to-three times the recommended daily calorie count
- Indulging in meals, cakes, pies, chocolates, or whatever sweets
- Cookies, biscuits, candy, homemade treats brought in to the workplace or shared by shops for the entire season

Stress levels are almost certain to be higher than usual
- Stress contributes to heart disease, stroke, and cancer
- Stress leading to immune system breakdowns, leading to colds, for example
Mingling with more people exposes them to more infections, especially flu and flu-like symptoms
Falls, cuts, and burns result in tens of thousand of visits to the ER
Alcohol consumption resulting in alcohol poisoning, broken bones from skips and fall, car and home accidents, etc.
Domestic violence is up about one-third compared to an average day

An ambulance driver explained it to me this way:

“It’s like everyone’s on a hurt-yourself schedule, same every year. Early morning starts with the drunk drivers going home from parties, sometimes the homeless with hypothermia, depends on the weather. Then the kids get up way too early and open their presents and start hitting each other with them or falling off anything with wheels and breaking any bone you can think of.

**Even the angels are drinking too much!**

“After that, you get a mix of cooking accidents and alcohol poisonings through the afternoon. Eventually, people hit their limit with family, have too much to drink, and start beating on each other. That’s also about the time ‘lonely hearts’ start calling us, asking to go to the hospital just because they have no place else to go and they don’t want to be alone.

“People eat too much at dinner and get the ‘too-much-macaroni sweats.’ They get heartburn and think they’re having a heart attack. We get more alcohol calls, either people fighting or passing out.

“And then everyone heads home, driving drunk. Better hope your tree doesn’t catch on fire. Happy Holidays.”

Mental Health

There is a MYTH that suicides peak around Christmas – they actually peak in spring
That said, it is breakup season
- The peak breakup time is the two weeks before Christmas
Overall, holiday depression is a real thing
- Family conflicts
- Financial woes
- Expectations of perfection
- Singles watching couples get all mushy
Loneliness is highlighted, especially for older people who live alone and have no one available with whom to celebrate
- People 65 and older are twice as likely to spend Christmas alone, compared to younger people

The loss of a family member—previous or recent—is especially painful
Being/fearing being left out of desirable events
Mistletoe invites unwanted advances
People with birthdays anywhere near Christmas often find the events conflated
Dealing with someone who has problems, like alcoholism or domestic violence
Wishing to skip Christmas because of other events in one’s life
Accessing helpful services that normally help one cope can be more difficult
Finding other religious festivals or holidays fade in comparison to Christmas
Overall, people are more likely to experience anxiety, sleep disturbances, headaches, loss of appetite, and poor concentration
Call rates to help hotlines spike on Christmas Eve

*The original lyrics were a lot more depressing.*

Environmental Downside

*It’s after midnight! Wake up! Time for presents and sugar highs!*

Massive amounts of trash going to landfills
- Decorations
- Single-use wrapping paper
Food waste
- Imported foods enlarging your carbon footprint
Energy consumption
- Traveling burning fossil fuels
- Turning up the heat
- Electric lights inside and outside

The End

Taking down/storing items for next year
Missing the buzz and activity
Realizing that nothing can be done about many things now regretted

*Queen Elizabeth doesn’t take down her Christmas decorations until early February, in memory of her father’s death.*

Bottom line: These are all for typical Christmases. Consider which might be eased and which might be exacerbated in the year of COVID?

NIGHT TERRORS: MORE THAN DREAMS, MORE THAN NIGHTMARES

Posted on September 25, 2020September 25, 2020 by vlaw759

The Pooka (or Poukha or Puca), an Irish nightmare

A character’s “night life” can provide depth to the characterization and understanding for the reader. Nightmares and night terrors are both frightening, but the two sleep disorders are frightening in different ways to very different audiences. Knowing the distinctions will help you use them effectively in your writing.

Adequate sleep, with all the different stages and cycles, is a crucial part of overall physical and mental well-being. Dreaming is absolutely necessary to good mental health. There is far too much detail to get into here, but research is clear. Indeed, repeatedly waking someone to prevent dreaming is a well-known form of torture.

What Are Nightmares?

Depiction of the **Nightly Parade of 100 Demons**
*Japanese Folklore*

Nightmares are vividly realistic, disturbing dreams that rattle a person awake from a deep sleep. They often affect the body in the same way waking danger does. Adrenaline spikes, heart rate and respiration rate increase, and the body increases sweat production.

**Rakshasa**, a Hindu demon causing nightmares

Nightmares tend to occur most often during rapid eye movement (REM) sleep, when most dreaming takes place. Because periods of REM sleep become progressively longer as the night progresses, people experience nightmares most often in the early morning hours.

**A Dream of Crime & Punishment** (1847) by JJ Grandville

Some people wake from nightmares crying, while others may wake shaking from fear. After a nightmare, people often have trouble falling back to sleep. The combination of the stress hormones flooding through the body with whatever lingering images from the nightmare are stuck in the mind make it very difficult to relax enough to fall back asleep. Particularly disturbing nightmares can cause sleep disruptions for days and stick around in the brain for years.

What are Night Terrors?

Night terrors are recurring nighttime episodes that happen while a person remains asleep. They’re also commonly known as sleep terrors. When a night terror begins, a sleeper will appear to wake up. They might call out, cry, move around, or show other signs of fear and agitation.

**Lady Macbeth Sleepwalking** *by Artus Scheiner*

Other common reactions:

Screaming or crying
Staring blankly
Flailing or thrashing in bed
Breathing rapidly
Having an increased heart rate
Becoming flushed and sweaty
Seeming confused
Getting up, jumping on the bed, or running around the room

A sleeper may become aggressive if a partner or family member tries to restrain them or keep them quiet. The episode can last for a few seconds or up to several minutes, though the sleeper typically doesn’t wake up. Most people fall right back to quiet sleep after a night terror.

**Takagi Umanosuke Confronts the Ghost of a Woman**
*by Tsukioka Yoshitoshi*

Night terrors are more common in young children, but they can disturb adults as well. An estimated 2 percent of adults also experience night terrors. In reality, this number may be higher, since people often don’t remember having night terrors.

Night terrors usually happen earlier in the night, during the first half of the sleeping period. This is when a sleeper is in stages 3 and 4 of non-rapid eye movement (NREM) sleep, also called slow-wave sleep. It’s uncommon to have them twice in one night, though it can happen.

What is the Difference Between Night Terrors and Nightmares?

**Dream-Land** etching (1883) by S.J. Ferris after a painting by C.D. Weldon

Night terrors may might seem similar to nightmares, but the two are different. In addition to the immediate mental and physical effects, the effect on witnesses or other members of a household are very different for night terrors and nightmares.

**The Last Judgment** (detail) by Jan van Eyck

When a sleeper wakes up from a nightmare, they will probably remember at least some of what the dream involved. Come morning, the sleeper is quite likely to remember the episode, though the memory may be vague.

During night terrors, the sleeper remains asleep and usually doesn’t remember what happened when they do wake up in the morning. The sleeper might remember a scene from a dream they had during the night terror episode, but it’s uncommon to recall any other part of the experience.

**The Orphans Dream** (ca. 1900) by James Elliott

A partner, roommate, family member, or other witness to a night terror episode is likely to remember the experience quite well. The daughter of a friend has fairly frequent night terrors, during which she will wander out of the house in her pyjamas or physically attack her partner in his sleep. In the morning, she occasionally has grass on her feet or bruised knuckles but no memory of how she got them.

What Causes Sleep Disorders?

**SPECT Readout of a Sleepwalking Patient**, from the Lancet

Many adults who experience nightmares or night terrors live with mood-related mental health conditions, such as depression, anxiety, or bipolar disorder. Night terrors have also been associated with the experience of trauma and heavy or long-term stress.

Physical factors can also contribute to the frequency of night terrors and nightmares. Sleep apnea is a very common cause of other sleep disorders. Some other possible causes

**Khumbhakarna**, a bringer of nightmares, in a temple in Bali

Travel-related sleep disruptions
Restless leg syndrome
Sleep deprivation
Medications, including stimulants and some antidepressants
Fever or illness
Alcohol use

Frequent disruptions to sleep cycles (such as night terrors or nightmares) cause fatigue and, eventually, sleep deprivation. Fatigue and sleep deprivation increase the likelihood of having night terrors or nightmares. There’s no escape!

**Nightmare** (1810) by Jean Pierre Simon

Bottom Line for Writers: Characters can be just as interesting when they sleep! Why would your character have disrupted sleep, and how would they react? Would the sleep disruption be more effective if experienced by the narrator (nightmare or confusion after night terrors) or by someone close to the narrator (night terror or discussing remembered nightmare)?

**Sleepwalker** a rather odd statue put up in Boston in 2014 by Tony Matelli

ALCOHOL: OTC MEDICATION?

Posted on May 15, 2020May 15, 2020 by vlaw759

Stress and alcohol go together like peanut butter and jelly—a burger and fries, mac and cheese, bread and butter, mashed potatoes and gravy, milk and cookies, or any other iconic duo you can think of. Yes, they can be separated but—oh, so often—you don’t have one without the other.

I started thinking about this when the Richmond Times-Dispatch ran a front page story (above the fold!) about liquor sales in Virginia. You will recall that ABC Stores have remained open as “essential” services. And according to numbers from the Virginia Alcoholic Beverage Control Authority, sales now hover around $22 million a week.

In March, as the social distancing began, the ABC stores had more than $30 million per week. Sales in April 2020 were up about 15% over a year ago. The article goes on to identify the top selling brands for the state and for the Richmond Planning District (City of Richmond, Henrico, Goochland, Hanover, Chesterfield, and Powhatan counties). I was less interested in the rankings than in the sheer volume!

Alcohol consumption is up all over the country. To look at one other location, in Tulsa, OK, one liquor store reported that looking at sales March 15 to April 15, liquor sales were up 56% and beer 48%. Compared to a similar date in April of 2019, one-day sales in April 2020 were up by 100%.

According to one store owner, buying habits are changing in that people are buying more at a time, shopping more during the day and less in the evenings and on weekends.

In order to facilitate buying alcohol, providers are offering digital ordering and delivery, curbside pick-up, hosting, hosting virtual tastings and/or cocktail hours. And some are branching out by stocking hand sanitizers and face masks. Virtual cocktail parties among friends and families are now common.

*If your aim is absolutely perfect, your cocktail parties with neighbors don’t have to be virtual!*

Estimates of the increase in U.S. alcohol consumption from now to the same time last year vary from 25% (WHO) to 55% (Healthcare Home [//healthcare.utah.edu]).

The uptick in alcohol consumption is not solely a U.S. phenomenon. The World Health Organization has issued statements urging countries world-wide to try to curb drinking during the current pandemic. They cite several health reasons to try to control excessive alcohol consumption. No matter how bad a situation is, excess drinking can always make it worse!

*Magic Snowman Tea is guaranteed to be 100% alcohol free.*

Weaken the immune system, actually making people more vulnerable to infection
Exacerbate existing health problems
Increase risk-taking
Increase violence (“a horrifying global surge in domestic violence”)
- As victims of domestic abuse find themselves trapped at home under constant surveillance by their abuser, many have trouble accessing resources. Some organizations are offering discreet assistance for people with no physical or virtual privacy.
  - Circle of 6
  - One Love Foundation
  - Private sellers of make-up or beauty products who will not be listed here as that would defeat their anonymity
- The National Domestic Violence Hotline (1-800-799-7233), Futures Without Violence, National Network to End Domestic Violence, National Coalition Against Domestic Violence, Stronghearts Native Helpline (1−844-762-8483) and other organizations provide more information about available resources during the pandemic.

*There are other substances one can turn to in times of stress. This is one of my favorites.*

Contribute to or worsen mental health problems
- If you are in a crisis, please call (1-800-273-8255).
- The Suicide Prevention Lifeline, Zero Suicide, the Suicide Prevention Resource Center, and the National Alliance on Mental Illness have all updated their websites with information about mental health assistance during the pandemic.

Also according to WHO, alcohol-related deaths number 3 million every year—before the pandemic. And the WHO now has the added difficulty of trying to quash the misinformation that has circulated to the effect that drinking can make someone immune to the COVID-19 virus and/or cure one if infected. The presumed medicinal value of alcohol has a long history (see below), perhaps with roots in the dulling of physical pain.

Jackie Chan is a master of Drunken Fist Kung Fu ( 醉拳 )

The link between stress and alcohol consumption is so well established that it’s actually called “self-medication.” In fact, such self-medication can be pretty effective, at least initially, in relieving anxiety and depression. Alcohol is a “downer” (i.e., a system depressant) so if people are wound up, rapid heart beat, etc., alcohol can definitely make those symptoms of stress go down. But as mentioned above, alcohol also depresses inhibitions, increases risk-taking, decreases logical decision making, increases violence, and — after all that — is still likely to interfere with restful sleep.

*Being home all day with bored and curious toddlers is a very stressful circumstance.*

COVID-19 presents a set of circumstances that are problematic with regard to alcohol consumption.

High levels of anxiety associated with the unknown
Isolation from one’s usual support system
Loneliness
Economic distress/job loss
Food insecurity
Fear of infection/death
Mourning the loss of a loved one
Stress at having to work from home
Stress of having to work in an “essential” job interacting with the public

COVID-19 is dominating today’s headlines, but it is far from unique. Research indicates that alcohol use and abuse increase during and after “violent conflicts”—e.g., wars, periods of martial law, government coups. Other psychotropic substances are also used to deal with psychic strains and trauma, but alcohol is generally the most likely to be readily available, legal, and (at least within limits) socially acceptable.

During the 1918 Influenza Pandemic, bootleg whiskey was viewed as a respectable medicine. At the time, more than half the states in the U.S. had passed Prohibition laws and thus were “dry.” But for medicinal purposes, some officials decided to tap the vast stores of liquor that had been confiscated initially to aid the military, although the Army mostly remained silent about using it. In Richmond, Virginia—reportedly—two railroad cars of confiscated whiskey arrived for the benefit of Camp Lee. Over time, confiscated whiskey was distributed to civilian hospitals, too.

Medical isopropyl alcohol is now available at vending machines in Moscow.

The United States Pharmacopeia dropped whiskey, brandy, and wine from its listing of therapeutics in 1916. In 1917, the American Medical Association resolved that “the use of alcohol as a therapeutic agent should be discouraged.” Even so, more than half of physicians believed it was “a necessary therapeutic agent.” It continued to be available by prescription in dry states. To this day, strong alcohol is prescribed for medicinal purposes in some areas, even by doctors!

Besides the demand for alcohol, the Spanish Flu pandemic shared other characteristics with COVID-19:

Wearing masks
Social isolation
Use of disinfectants
Limiting group gatherings, including churches
Hospitals and funeral homes were overwhelmed
During Spanish Flu the treatment of choice was aspirin, up to 30 grams daily which is a toxic dose; currently, think ingesting bleach or disinfectants.

*Bootlegger tunnels in Miami during Prohibition*

Bottom line for writers: people use alcohol to self-medicate for stress. The current stressor is COVID-19 BUT consider all the other stressors out there, which might occur alone or in combination with COVID-19: death of a loved one, job loss, divorce, physical illness, mental illness, physical disability, too little money, going hungry, being homeless… Do you have a character who does—who could—self-medicate with alcohol?

WRITING ISOLATION

Posted on May 1, 2020May 1, 2020 by vlaw759

There is a whole cadre—Heidegger (1889-1976) arguably the most famous—who argue that being-with-others is part of the “structure of human existence.” In other words, we are hard-wired to socialize. Whether you believe that or not, there are a gazillion (by actual count) studies that have found isolation to be harmful to humans, both physically and psychologically.

(Editor’s note: Including photographs of isolated and lonely people was too depressing, so I invite you to enjoy these photos of animals not social distancing instead.)

For writers, bad is good

How bad is it? Some researchers posit that social isolation and loneliness are twice as harmful as obesity. Others compare the effects on mortality to be equal to smoking 15 cigarettes per day. Others say the magnitude of risk is right up there with physical inactivity and lack of access to health care.

N.B. Degrees or levels of isolation are difficult to define and measure. Perceived isolation is what produces feelings of loneliness. In many ways, it is easier to study social isolation, though they are closely linked.

As a writer, the first question is, “Why is your character isolated?” Your options may be more numerous than you think. Here are a few examples.

Death of a loved one
Divorce
Move to a new place
Researcher in isolated places, like Antarctica
Mission/mission training, e.g., astronauts
Immune compromised

A child/infant in understaffed orphanage
Being shunned for any reason
- Behavior
- Appearance
- Membership in a marginalized subgroup
Medical quarantine
As a form of torture
- Solitary confinement in prison (currently about 80,000 in the U.S. each year)

The second set of questions for a writer:

How complete is the isolation?
How long does it last?
Is it repeated?
In general, the more complete the isolation, the longer it lasts, and repetition all increase the number and seriousness of the effects.

The third question is, which effects will your character display?

Fatigue
Insomnia
Headaches
Sweaty palms
Heart palpitations
Lowered immunity
Increased inflammation
Trembling
Diarrhea
Stomach pains
Lack of appetite
Drastic weight loss

Muscle pains (esp. neck and back)
Oversensitivity to sensory stimuli
Difficulty concentrating
Dizziness
Distorted sense of time
Severe boredom
Impaired memory
Inability to think coherently
Apathy

Anxiety
Panic
Feelings of inadequacy
Feelings of inferiority
Irritability
Withdrawal
Rage/anger/aggression
Confusion
Paranoia
Depression
Suicidal thoughts
Hallucinations

Many of these effects mimic PTSD and, like PTSD, can last for years after the event.

In the last couple of months, researchers are finding that COVID-19 isolation tends to evoke one of two responses.

Those who hunker down and enjoy it—take it as a time to relax, read, bake, pursue a hobby, accomplish things around the house. In short, they’re getting along fine.

But for others—especially extroverts—the isolation can be harmful to both mind and body.

Not surprisingly, the effects of COVID-19 isolation are many of the same effects as other reasons for isolation.

Boredom
Lethargy
Anxiety
Depression
Distorted sense of time
Poor sleep quality
Develop or increase unhealthy habits

Dr. Samantha Brooks wrote in The Lancet: “A huge factor in the negative psychological impact [of isolation] seems to be confusion about what’s going on, not having clear guidelines, or getting different messages from different organizations.” In addition, not knowing how long isolation will last exacerbates the negative effects of isolation. Think of the current differences within the U.S. and how similar circumstances could be applied to a fictional setting.

People who are at increased risk from COVID-19 isolation are those at heightened risk for social isolation in the first place:

Older adults, especially with physical limitations and/or poor family support
Men who didn’t develop social networks outside work
Being non-white is a bigger risk factor than sex
Lower income people who may not afford the technology for distance socializing
Anyone who is marginalized (LGBTQ, survivor of domestic abuse, living in an isolated rural area)
People incarcerated for any reason

Evidence of stress is apparent in the increased number of calls to suicide prevention (1-800-273-8255) and addiction (1-844-289-0879) hotlines.

Bottom line for writers: consider isolating your character and/or increasing his/her loneliness. You can take it almost anywhere.

INSIDE A MIND WITH PTSD

Posted on December 3, 2019December 3, 2019 by vlaw759

Today’s blog is written by a fellow writer who wishes to remain anonymous for privacy reasons.

Among the many odd things I’ve done in my life, one that has had the most lasting impact is being a linguistic and cultural ambassador posted to a country that shall remain nameless here. Because of various regional disputes, a massive prison outbreak, less-than-polite national elections and regime changes, and a general culture of aggressiveness, I found myself living in conditions that were much more dangerous than I’d been led to expect.

When I eventually returned home, among the souvenirs and keepsakes I brought back with me, I found in my luggage a serious case of PTSD (post traumatic stress disorder). As Vivian’s blog is for writers and writing, I thought perhaps a guided tour inside the warped and broken mind of a person with PTSD might be of interest to you all.

Please keep hands and arms inside the cart at all times, and don’t feed the negativity gremlins as we go past.

Very Important Disclaimer: Neither Vivian Lawry nor this guest author are psychiatric professionals or are qualified to provide medical assistance. The information contained herein is not intended to be used for diagnostic or treatment purposes in any way, shape, or form.

This is basically what the inside of my mind looks like.
(It’s actually the Soul Cairn from the Dawnstar plug-in to *Elder Scrolls IV: Skyri*m by Bethesda.)

Before the ride begins in earnest, you can look to your left for some basic information about PTSD. The most common association people have with PTSD is of veterans of military combat, but it can result from many different experiences, including natural disasters, abusive relationships, assault (sexual or otherwise), prolonged insecurity, traffic collisions, and so on. People can even develop second-hand PTSD from witnessing these events in other people’s lives. A patient may develop PTSD immediately after an event, but sometimes symptoms don’t appear until well after the event itself.

Common symptoms of PTSD. As soon as I can cultivate a substance abuse problem, I’ll have BINGO! (That’s how it works, right?)

With all of these possibilities, there are loads of ways in which the inclusion of a character experiencing PTSD can enrich, complicate, drive, or drive, or even resolve your writing. There is a lot of information available about the causes and effects of PTSD, but remember that each case is different. Every person will have different triggers, coping mechanisms, involuntary reactions, etc.

You may notice the cart shaking violently as we enter the tunnel; this is simply the result of uneven neural pathways, nothing to be alarmed about.

As a writer and a reader, I’ve found myself thinking of ways in which my warped thoughts and behaviors could fit in with other common narrative techniques. I have also found some absolutely infuriating stories out there in which a character has a traumatic experience (usually rape or sexual assault) simply so the hero can come to the rescue or to establish a villain as a villain… and victimized character goes right back to skipping through the tulips. Don’t be that writer!

If you look out on either side of the cart, you may be able to make out (through the erratic strobe lights and general gloom) a few of the ways common behaviors of characters with PTSD could be very useful in your writing. Please remember that these are only glimpses from one mind and do not necessarily reflect every patient. Also, hold on to the lap bar as there are some sharp curves coming up.

Unreliable Narrator: What I see and hear is always filtered through the PTSD in my mind. If a story is told from the point of view of a character with PTSD, this is a good way to demonstrate the disconnect from reality. If another character is getting information from a character with PTSD, it could skew everyone’s opinions and affect the plot moving forward.

What it feels like to walk down the street.

Social interactions are a minefield of side-stepping physical attacks (handshakes, hugs, pats on the back).
Random strangers only ever approach me with violent intentions, such as petting my dog, asking me to reach something off a high shelf, or walking past me on a narrow sidewalk.
People waiting in parked cars are obviously armed, most likely on the lookout for potential victims.
Anyone who stands in a doorway must be trying to block the exit or prevent escape.
An approach from behind must be someone trying to sneak up on me, and anyone who surprises me from behind is an attacker and will be punched.
This isn’t helped by chronic sleep deprivation giving me the same symptoms as early-onset Alzheimer’s: How can I be trusted to provide accurate information when I lose time and forget everything?

Mistaken Motivations: Objectively, I know there is nothing wrong with mental illness, nor should there be any shame attached. Still, I try to hide it or play it off as no big deal. As a result, family, friends, and strangers all have reason to assume my coping behaviors are something very different. Having a character reveal midway through or near the end of a story that their actions were motivated by coping mechanisms could be a plot twist, a clue for investigators, a reset of other characters’ attitudes, or plenty of other ways of adding narrative interest.

Friends frequently ask if I’m cold because I can’t stop shaking.
Constantly scanning for threats and possible exits sometimes makes me look like I’m trying to find someone or looking for an excuse to leave a boring conversation.
Being hyper-vigilant in general makes me look twitchy, itchy, over-caffeinated, or paranoid, depending on who is providing their opinion.
My brother thought he’d done something to offend me when I repeatedly moved away from him or left the room when he entered.
After I repeatedly panicked and cancelled plans at the last minute, many friends thought I was just blowing them off.
Arriving late to social gatherings, hiding in the corner, and leaving early have all led acquaintances to assume I’m too stuck-up to mingle.
To make it through particularly important events that I cannot miss, I’ve sometimes taken extra doses of anti-anxiety medication. My slurred speech, unfocused gaze, less than ideal balance, and inability to follow conversation looks an awful lot like I’ve shown up to the baptism or wedding drunk as a skunk.
I escape to the bathroom a lot when things get overwhelming, sometimes for extended periods of time. Most of my family now thinks I have severe digestive issues.

Affects in My Life: In order to be diagnosed as a disorder (the D in PTSD) a patient must have symptoms severe enough to disrupt their ability to live a normal life. A character who develops PTSD midway through a narrative would almost certainly show changes in behaviors. These are some of mine.

Chronic insomnia and nightmares: Years later, I still sleep in a separate room from my spouse, with the lights on, with distracting or soothing music playing… and I still manage to wake the household at least once a month by screaming in my sleep.
My ability to concentrate and complete tasks on time severely impacted my job. Twice, I responded to a coworker trying to get my attention by panicking and attacking them. Going into the office grew increasingly difficult as it became harder to leave the house. I am now unemployed.
Weeks at a time go by when I cannot leave my house, even to go into the backyard. I feel threatened every time I open the door.
Side effects from different medications I’ve tried have included weight gain, headaches, heartburn, memory loss, drowsiness, etc. etc. etc. ad nauseam. These could also be examples of mistaken motivations!
I no longer participate in hobbies I once did, especially anything that involves leaving the house or interacting with other people.
Suicide and suicide attempts are very common among patients with PTSD.
- Don’t do it.

Anxiety Attacks, Panic Attacks, and Flashbacks: These can be triggered by almost anything, depending on the person and the situation. Smelling cigarette smoke, walking on an icy sidewalk, being in a room of people speaking another language I only halfway understand… any of these can send me spiraling. Being under stress increases the chance that something will hit that switch.

Ladies and Gentlemen, we’d like to remind you at this time that motion sickness bags can be found under your seats and to hold on tightly.

It doesn’t look quite as cute when I do it.

Anxiety or Panic Attack: It’s really bizarre to be terrified and not know why. Why is my heart racing? Why can’t I breathe? Why can I not stop screaming? When I have an anxiety attack, I don’t think rationally but I can speak and respond to people around me. When I have a panic attack, it feels like I’m about to die. I can’t feel anything but the absolute terror that completely takes over my body. Usually, I am able to leave a situation when I feel one of these about to happen so that I can mentally implode in the peace and quiet of a public urinal.
Flashback: These are even more bizarre. Anxiety attacks often segue into flashbacks. I am completely unaware of my surroundings and respond to threats that are long gone. I’ll switch languages to talk to people who aren’t there; I’ll be able to smell the food or feel the cold from specific memories. Sometimes, I have flashbacks that aren’t tied to precise events, more an amalgamation of similar threats that get lumped together in my head. It’s very embarrassing to come out of it and realize that I’m hiding behind a clothes rack in Target, desperately fighting off the attack of a stiff coat sleeve.

Treatment Options: There are many different types of treatments for PTSD, with varying degrees of accessibility, cost, success, and side effects. I’ve tried just about everything: some worked, some did not, some worked at first and then stopped. I can’t stress enough that every person will respond differently to different treatments. The information here is simply what undergoing the treatments felt like for me.

He still can’t change the printer cartridges.

Therapy Animal: My dog trained himself to be a therapy dog because he was just that awesome. Before I was eventually laid off, my boss let me bring my dog into the office with me. He learned to impose himself between me and anyone getting too close to my personal space. When I had anxiety attacks, he’d put his head in my lap and nudge my hand until I pet him. Focusing on the feeling of his fur, his cold nose, his super stinky breath worked to calm me down and remind me that I was safe. He passed away in April, and it felt like going through all the trauma again.
TMS (Trans-Cranial Magnetic Stimulation): It felt a bit like sitting in the dentist’s chair while a woodpecker tapped on my head. I went every day for three months, and the only side effect was a minor headache when I first started.
EMDR (Eye Movement Desensitization and Reprocessing): My eyesight is so bad that I couldn’t do the actual eye movement part of it; I held a buzzer in each hand and felt the vibrations in alternating hands at different speeds. In each session, I relived particularly traumatic events over and over while the therapist guided me through sense memories and varied the speed of the buzzing. By the time the hour was up, I was usually an exhausted, damp, shaking mess running to the bathroom to vomit.
Medication: I think by now I’ve tried every different medication type on the market. I can’t even pronounce most of them and have to stutter and hope at the pharmacy. Most gave some relief for a little while and then stopped working.
- There is now a way in which doctors can send a sample of your DNA to a lab, where people in white coats and shiny goggles can magically determine which medicines will or won’t work for you. I have no idea how they do it; I assume it involves cauldrons and eyes or tails of newts.
Ketamine: I was very hesitant to try this method because there have been so few long-term studies. When I started, I went in every day for a week and a half. After that, I went in every three to four weeks depending on how the doctor thinks I’m doing. Ketamine treatment is available through aerosol or intravenously. I sit in a comfy chair with a needle in my arm for about an hour while geometry loses all meaning and everything becomes either fascinating or hilarious. Everything in the universe swirls in front of my face, and the feeling of my hair is the most amazing sensation I can remember. According to the nurse, I tend to wax rhapsodic about how much I love every person who comes through the door. For some reason, they won’t let me drive afterwards!
Healing Crystals/ Salt Lamps/ Essential Oils: I had a lumpy pillow, a pink wall, and everything tasted like lavender.
PTSD is expensive!

I hope you’ve enjoyed this tour through the mess inside my head. Please wait for the ride to come to a complete stop before unbuckling safety harnesses. Be sure to gather all personal items and take them with you as you exit down the ramp to your right. Don’t forget to check the photo booth for a hilarious souvenir memento of your trip. You can also find resources for actual help; as I’m sure you remember, this has just been an example of some personal experiences for your writing toolbox.