Seattle Part 6: the HMO

October, 2014

On my first day, it took me nearly an hour to get to my new job, though it was only about 8 miles distance from my residence. I had to drive down a long, narrow, busy Seattle street through traffic and stoplights, then get on a congested freeway. Traffic moved very slowly across the lake, and there was no other way to get there.

I worked on the top floor of a medical clinic, the local face of a busy HMO (Health Maintenance Organization). The mental health clinic employed around ten therapists, and we were all kept significantly busy. Clients who held a particular insurance were given good rates to see a doctor or a counselor at the HMO, and they were charged a lot of out-of-pocket expenses to see anyone else, thus we always had a long list of people waiting to be seen by a provider. Someone might call in in some sort of crisis and then not be able to see a counselor for six weeks afterward, based on current openings.

I had worked at community health centers before, so I understood the medical model of therapy. I was a clinical social worker, or LCSW, meaning I could get higher than standard reimbursement rates through various insurances, including Medicare and Medicaid, and the company seemed happy to have me there. But this place worked at a much higher pace than anything I had ever experienced before.

First of all, consider therapy itself. A counseling session requires the therapist’s all. There can be no distractions, no phones or music or computers. It’s just the therapist and the patient. There can’t be errant thoughts, or outside stressors, or headaches, or upset stomachs, or sleepiness. The therapist can’t yawn, or stretch, or eat a snack. The client requires one hundred per cent of the therapist’s focus, as well as their clear memories of past therapy sessions, like names of loved ones and therapeutic goals. On top of that, therapists are often dealing with clients who have extreme trauma issues. They hear stories about combat, suicide, rape, abuse, grief, and pain. And when one client leaves, the next is generally waiting, and the therapist can’t still be thinking about the first or she won’t be able to focus on the second.

Doing three or four therapy sessions in a row requires a tremendous effort; doing seven or eight becomes downright exhausting if not impossible. The HMO required more. And doing that day after day, well, it’s not for the faint-hearted. In standard clinics, even busy ones, I became accustomed to doing four therapy sessions, having an hour lunch, then doing three more, with the last hour of the day being reserved for case and progress notes, treatment plans, and correspondence. It was already at a taxing schedule.

But at the HMO, the expectations were much higher. They had competitive wages (about 45 dollars per hour, consistently, on salary) and a great benefits package. But they had their therapists on a very rigid schedule, seeing a patient basically every forty minutes with no time for case notes built in.

A standard schedule might go like this, for one day:

8 am: ten minute staff check-in

8:15: first patient (let’s say an elderly woman with Alzheimer’s whose husband just died)

9: second patient (a teenage girl who recently attempted suicide)

9:45 third patient (a refugee worried about her loved ones in her home country)

10:30: fourth patient (a couple going through extreme marital issues)

11:15: fifth patient (a veteran struggling with PTSD issues)

12: thirty minutes for lunch

12:30: sixth patient (a single mother of four processing stress)

1:15: seventh patient (a woman with a new baby, struggling with postpartum)

2: eighth patient (a mother processing stress over her son coming out of the closet)

2:45: ninth patient (a man referred by his boss for losing his temper at work)

3:30: tenth patient (a ten-year old boy whose parents recently divorced)

4:15: eleventh patient (a woman with borderline personality disorder, recently out of the state hospital following a suicide attempt).

Then, after that, once your notes were finished, you could go home for the day. Every other week or so, there would be a staff meeting of some kind. And every second or third day, a client might cancel or not show up, giving a chance to catch up. But that many patients per day, every day, four days per week, generally meant between 36 and 45 people seen per week. Sessions had to be shorter and more goal-directed, and a failure to adhere to the schedule meant knocking multiple clients back. If a client came in in crisis, very little could be done to manage it without having to cancel another session afterwards completely, and openings after that became hard to find.

I came into the job with boundless enthusiasm. The team of people I worked with were amazing, funny, friendly, and supportive. The agency had great diversity representation, several gay therapists, and a good camaraderie. But as I finished my first week of work, beaten down, grey, and bitter, I began to realize how tired everyone was. It was like working in an emergency room, without breaks, day after day, every day. With an hour’s drive each way.

In Utah, my therapy work had almost exclusively been with LGBT people who were struggling to align their sexuality with their Mormonism. Here, I was seeing people from every walk of life, all struggling with their own sets of problems. The word Mormon wasn’t being brought up anymore, but there was constant depression, anxiety, trauma, grief, and emotional pain. And within two weeks, I found myself unable to offer my client’s my all any longer. Instead of being an incredible therapist, I was becoming a mediocre one, simply to survive the rigorous page.

And with the reality of the new job settling in, Seattle didn’t feel quite so magical. It felt wearying, and expensive. Some cracks in the foundation of my dream life began to show.

And every night, there was the phone call to my sons, who remained far away, and who I missed very, very much.

Bank Robbers

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The scariest bank robber I ever came across wore a mask and carried a gun. I never met him personally, but I saw the pictures. He wore a Halloween mask (not unlike the one in the picture above, which was worn by an actual bank robber in Pennsylvania a few years back) and he entered the bank aggressively, brandishing his weapon.

The man in this particular robbery hit at least two banks in Salt Lake City, a few years ago. He walked into both banks arrogantly, careful not to touch anything, and he pointed the gun at the helpless tellers, demanding money. He knew what he was doing. He asked for cash from secondary drawers, knew to demand no trackers, and brought in his own bags. He climbed behind the counter and pointed his gun at people’s heads, even into their mouths, promising to come back and hurt them if he was caught. He was gone in less than a few minutes and fled.

Of course, the police caught him, but it took them a little bit of time. The aggression of his actions, with a weapon and threats, escalated the crime to the highest levels with nearly maximum sentences. Bank-robbing is federal crime automatically, but using a weapon and delivering threats escalate the crime, though taking hostages, or hurting or killing someone, would obviously result in a more severe sentencing.

As a clinical social worker, I’ve worked the last 15 years doing crisis response work, on the side from my professional business. Though I’m self-employed, I make myself available to businesses who have been impacted by crises. Tragic employee deaths, suicides, corporate downsizings, industrial accidents, and, yes, bank robberies. Bank robberies, over the years, have been the most frequent crisis I get called out to. At this point, I’ve been to the sites of dozens of them (they happen more often than what people think), and I usually arrive just after the FBI has left). All of them are traumatic in their own way, and it is impossible to walk out of one of them emotionally unscathed.

But this man, this selfish, scary, arrogant man in a mask, he spent two minutes trying to get some quick cash, and then he lost everything, facing decades in jail. But for those he hurt, those half dozen people that he threatened and frightened, for them, this experience lasts forever. He never saw them, he only aimed the gun and then ran. He didn’t see them as humans. He didn’t realize that one of tellers would later break off her relationship with her fiancee because she couldn’t handle the nightmares, that one of the men would turn to alcohol to avoid the flashbacks he was having from the war, that an older single mother would quit her job because it was too scary to return, or the young man who suddenly couldn’t get the image out of his head about how his father used to beat him. The robber didn’t realize that some of them would be forever altered by this.

Most bank robberies aren’t this abrupt or violent. Often the robber is quiet, quick, or even apologetic. They are sometimes under the influence of drugs, or mentally ill, or just plain desperate. They might stand in line like a regular customer, walk up to the counter, calmly, and pass a note. They may or may not imply that they have a weapon in their pockets, a gun up their sleeve, or even, as one robber pretended, a bomb strapped to his chest under his shirt. They might simply rush out of the store as quickly as possible. One robber I’m aware of hung out in the bank branch for nearly thirty minutes, stating he was waiting for someone, before he finally handed his note over.

Bank robbery notes themselves are fascinating. Some are short and direct. “THIS IS A ROBBERY! PUT ALL THE MONEY IN A BAG AND DON’T SAY ANYTHING TO ANYONE!” Some are apologetic. “I’m so sorry to have to do this, but my family is starving. Please give me $2000 in twenties and tens as fast as possible. And don’t call the police!” And some fill an entire page with detailed instructions. “This is a robbery. Do not call the police. Do not signal anyone for help. There is a gun in my left pocket. Before you read any further, raise your left hand in the air to indicate understanding, but do not look up at me. After raising your hand, I want you to take the bag I am placing on the counter and then…” The notes might be legible in lined blue ink, monstrous scrawls in black marker, or even pre-typed on carbon paper.

Bank employees go through a rigorous training in order to work in banking institutions. They learn protocols for how to handle it. They are taught to remember as much as possible, to comply with all possible requests, to focus on safety first, and to get the robber out of there as fast as possible. They are told not to argue, to keep their voices calm, and to call the police in a calm manner afterward, giving them all the details possible. But no amount of training can prepare you for the moment a man (they are almost always men) comes in with a note, an implied weapon, and a threat. Adrenaline kicks in, trauma is triggered, and the heart rises in the throat, and sticking to the training is not always easy.

Immediately after the robbery takes place, the bank tellers have to notify the police and authorities, check on the customers who have been impacted, shut down the branch, and then write down everything they remember. They have to be interviewed by the FBI agents who arrive, provide descriptions and details, make camera footage available. This can take hours, and generally they don’t have a chance to even call their families before that is over. Regardless of whether they are angry, scared, anxious, panicked, numb, or triggered, they have to follow these protocols. And then they have to deal with the trauma for the following days.

Imagine going home to your car after a robbery and having to drive home. Imagine getting home and facing your family. Imagine closing your eyes for sleep that night, images flashing in your brain as you wonder if you locked the door or not. Imagine having to walk back into the bank branch the next morning to start the new shift, all over again. Imagine checking the news repeatedly to see if the police have caught the guy yet. Imagine worrying every time that you leave your branch that your coworkers might get robbed while you are gone.

I enter banks differently now. I view the tellers, young and old, with new respect. They aren’t paid well, and often don’t have a lot of support, yet the put themselves into these dangerous situations generally because they love customer service and they are dedicated employees. Sitting with them in the roughest moments, after their traumas, is difficult, but it is my supreme honor.

just another mass shooting…

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Yesterday, I got word about another mass shooting. This one, in a Christian church. In a small unincorporated township in rural Texas. Eight members of the same family died. The pastor and his wife were on vacation, and their 14 year old daughter was killed. A one year old child is among the victims. A pregnant mother and three of her children are among the victims. The grandmother of the killer’s wife is among the victims. The shooter was an angry white man with a history of domestic violence and mental illness, with military training and mysterious motives.

It wasn’t the first shooting this month. It wasn’t the first shooting with victims in the dozens in the past few months. It wasn’t the first shooting in a church. It wasn’t the first murder of children. It was just… another shooting. And somehow, this time, that’s all that I’m able to process.

Weeks ago, when that man opened fire on the country concert in Las Vegas, I spent three days obsessively searching for information about the victims, wanting to honor them. I felt duty bound to remember them, and to not click on a single headline about the killer. I posted over 50 photos with synopses about their lives, and I took detailed notes. I even wrote a blog about holding vigil about them.

But this time, I’m numb. Again. (Still?) Vegas hit me more personally. It’s closer to home. It’s a place I have spent lots of time in, on the streets of. Virginia Tech, years ago, and Columbine before that, they hurt be deeply. Though they were places I’d never been, they are academic environments, a college and a high school, and I know the culture there. Sandy Hook hurt me more. As a father, the idea of waiting helplessly there to see if my child is among the living, the images of artwork and bulletin boards and school lunch menus and tiny desks, the idea of that becoming a place that is no longer safe, it hurt me on a primal level.

And the Pulse shootings. They haunted me for weeks. I’ve been in so many clubs in so many cities, there for a relaxing drink, some music, and some conversation and dancing, or entertainment. The idea of someone with that much hate.

I just, I’m numb. Today, I’m out of outrage. I’m out of fear. I’m out of pain. I’m out of hurt. I’m out of anger. I eek clicking back on the news website to see an update, and then not clicking on it. I don’t want to feel it again.

I don’t want to jump on social media and see the Conservative/Liberal debate over gun control laws (we need them!) and how the media is biased toward whites by calling them misunderstood and mentally ill while railing against people of color by calling for immigration bans. I don’t want to read posts about the corruption of America. I don’t want to see the statistics of how gun violence is increasing. I don’t want to see the charts with pink and blue and red lines that grow up and up and up. I don’t want to talk to relatives about how humans have always been bloody and vile, with their atomic bombs and concentration camps and war machines, and how assault rifles and rented trucks and car bombs are just the latest worries of our generation, not the most corrupt just the most current. I don’t want to realize that social media and news outlets will be outraged and titillated by this for about 72 hours, until the next horrible news drops.

I don’t want to explain to my children why there are people in the world who might hurt them, who might be so full of anger that they went to inflict as much pain on them and the world as possible before they remove themselves from it. I don’t know how to tell them to be afraid enough, nor do I want them to be afraid. I don’t want them to walk around in perpetual fear that someone could speed at them with a car or enter their school with a gun.

Yesterday afternoon, I went to hear a choir sing. In Latin. About death and remembrance. I sat on a hard wooden bench. There were easily 75 people in the room. As a male baritone sang words that I didn’t understand, his beautiful voice hit my heart, and I wondered what would happen if that man entered this room. Would there be warning? Who would be hit first? Where were the exits? Would I scream, fall to the floor, play dead, shield my loved ones, rush toward the exit, try to disarm him? Would my loved ones be among the dead? After the service, I crossed a crosswalk and I realized how swift it would be if a car careened toward me, trying to take out civilians.

I don’t know how to feel these feelings. I do grief for a living, yet I can’t process my own. I’m desensitized. I’m exhausted. I’m wounded and it can’t stop bleeding. Words like ‘massacre’ and ‘bloodbath’ and ‘terrorist’ and ‘mass casualties’ leave my fingertips and my lips far too frequently now.

And so, I’ll do what all humans do, what I would tell others to do, what I am growing accustomed to doing myself. I survive. I wake up and I make my coffee. I read my book. I see my clients. I process through how I’m feeling. I walk and feel the cool air and the warm sun. I exercise. I buy a T-shirt. I open my computer and I blog about being numb. And soon, another day has passed, and I’m still here, and I keep finding ways to fight for a world that I refuse to lose hope in.

That’s what the families of the victims have to do. And the law enforcement officers who responded. And even the loved ones of the killers themselves. And if they can get up, so can I. I’ll fight for a better world for me, and for my sons.

 

Repressed Memories

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“So I have this client who thinks that something might have happened to her when she was a kid. She wonders if she might have been abused or something, but she doesn’t have any specific memories.”

I nodded. “Okay, and is that something you are exploring in therapy?”

The clinician I was supervising tapped his pen against the pad of paper, collecting his thoughts. “I’ve been looking into it some. If there are repressed memories, it seems there are a number of ways to discover them and heal from them. Hypnosis can work, dream journals seem to help, regular meditation. I’m just not sure that I’m all that equipped to help her. I’m brand new in this field.”

“The operative word in your previous paragraph? If.”

I watched him write the word IF on his paper. “If. If there are repressed memories.”

“Right. She doesn’t know if there are or not. If there are repressed memories then hypnosis and those other methods might help. If there aren’t?”

“Then there wouldn’t necessarily be anything there. Okay, interesting.”

I let him collect his thoughts, then began asking questions. “So the first thing to wonder, why does she think she might have repressed memories?”

He smiled, enthusiastic. “I actually asked her that question. She had a decent childhood, so far as she remembers, but some traumatic stuff happened to her later on. Now she is realizing there are blank patches in her childhood memories, so that leads her to wonder if something bad happened and her subconscious mind blanked it out.”

“Okay, good job exploring that with her. There certainly could be repressed memories. In times of trauma, for adults or kids but particularly for kids, the brain can enter a mode where the person shuts down for a while or where they kind of leave their own body in order to survive. There are also times when the brain can hide or omit memories from the consciousness as they would be too disturbing to the person. When those memories show up, it can be in the form of flashbacks or panic attacks, and it usually happens after something triggers the trauma memories, or, ironically, the memories can show up during times of safety, when everything feels comfortable and okay for once so the memories are able to finally come to the surface.

“But the key here is she doesn’t know if she has repressed memories. She might and she might not. She’s simply wondering at this point if there might be. During the 1990s, there was a lot of repressed memories topics showing up on talk shows and soap operas, and suddenly everyone was coming forward as having repressed memories. It became kind of a craze. But wondering if something bad might have happened in childhood, or even wondering if more memories should be there where there aren’t any, that doesn’t mean there is any evidence of repression.

“Of course, it also doesn’t mean that there isn’t.”

The clinician clicked his pen in frustration. “So what do I tell her to do?”

I smiled, knowing this would annoy him. “What’s the first question we always ask ourselves?”

He rolled his eyes. “‘What is my role here?'”

“And your role in this case?”

“Is as her therapist.”

“So what is your job regarding this?”

“My job is to help her meet her goals. We are working on getting through depression and PTSD.”

“Right. So your job is to help her talk about it. Which you are already doing. Help her talk about her trauma, about why she thinks she might have oppressed memories, about her actual childhood memories. Then explore with her the options of other treatment methods if she feels they can help. There is hypnosis, there are mindfulness groups, there are dream journals. All of those take effort, time, and money, and she can pursue any of them that she wants to. But regardless, your job is to be there with her, week to week, whenever she is in front of you and needs help.”

“Okay, right, but are repressed memories an actual thing? Is that something you have come across?”

I moved my tongue along the inside of my cheek for a moment, thinking of the best way to answer. “Well, yeah. But it isn’t as simple as all that. Trauma can impact a person in a myriad of ways. It can show up as anxiety, as depression, as apathy. It can result in withdrawing from relationships, in sexual promiscuity, or in crippling fear. We can research trauma for years, but we can never have a clear mapped path that shows its results on a particular person. Even if we understand how a trauma effects someone, that effect can change with age or time or stress. Someone can live with trauma unseen for years and then have it show up much later in life.

“Here, I’ll use a personal example. When I was a kid, I went through a period of sexual abuse at the hands of a family member. For years, I didn’t understand how serious that was. As a kid, I also knew I was different from other kids, but didn’t know what that meant. As an adolescent, when I began to realize I was attracted to boys and not girls, I didn’t have any context to understand this, so in the beginning I automatically assumed that the abuse was causing the attractions, when in fact there were no direct correlations.

“When I was 20, and on my Mormon mission, I hit a slump of pretty low depression. Life was very much routine. I was mugged and knocked unconscious one day, which was its own separate trauma. But something about that particular incident seemed to knock something loose, pun intended. I began getting flashbacks after that back to the abuse from when I was a kid. Full on trauma flashbacks. Like in my brain I was the young kid for a while, then I would come back into my own adult skin. I wrote down everything that was happening, in detail, to get it out of my system, and after a couple of weeks, the flashbacks went away.

“So using that example, we can see the impact of trauma on development, and we could run down the list of trauma symptoms. Yet those symptoms showed up differently in childhood and adolescence than they did in adulthood. And a separate trauma caused me to have flashbacks of my childhood trauma.”

The clinician was scribbling notes. “So would you call those flashbacks that you experienced repressed memories?”

“I wouldn’t, actually. But some could. They were memories that, for whatever reason, I had to relive in order to move on. And they were repressed. But they weren’t forgotten, or omitted by my subconscious. I had no sense that parts of my childhood were missing, yet they were also memories that I avoided completely because they caused me discomfort.”

“Okay, okay.” He underlined something on his paper. “I get it. It’s complicated. We can study the topic, but it’s gonna show up for the individual person in different ways at different times. And my job is to be there with them, talk it over, help them meet their goals and explore their options.”

“Right.”

He gave a deep sigh. “What we do isn’t easy, is it?”

“It most certainly isn’t. But we get to help people who ask for help. And that makes it worth it.”

EMDR

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“Chad, listen, I’m thinking of becoming certified in EMDR therapy. What do you think about that?”

I looked out across the room full of new social workers I was supervising and nodded, thoughtfully. “I think it’s a great idea. Why do you want to?”

“Well, it’s new and people seem excited about it. It seems to be getting good results for a lot of people.” Several of the others agreed, showing new interest in a potential certification. “What do you think about it?”

I felt a bit nostalgic, remembering when EMDR had first been introduced in a class I was taking back at Boise State University in 2003. My teacher back then, an eccentric woman named Alberta, had sung its praises.

“EMDR stands for Eye Movement Desensitization and Reprocessing,” she’d explained as I’d taken notes. “It was developed by Francine Shapiro. Basically, after a human undergoes trauma, there are altered memories and pathways in the brain that form, and the trauma memories then cause symptoms to show forth generally in the form of PTSD, which can include anxiety, depression, flashbacks, depersonalization and derealization, anger, unhealthy relationships, and on and on. EMDR is designed to alter and heal the pathways in the brain that were negatively impacted by the trauma.”

She went into much more detail before describing how EMDR itself would work. Basically, in a period of therapy sessions, the survivor of trauma would sit before a trained therapist and discuss specific trauma memories and events in a safe environment. Then, wearing headphones that pulsed soothing sounds from left ear to right ear, or left brain to right brain, the therapist would do trauma recovery work while tapping the left and right sides of the survivor’s body, and have them alter the disturbing memories to more safe spaces, allowing the trauma symptoms and triggers to diminish over time. While the therapy itself was highly controversial in some spaces, it had proven extremely effective among those who had utilized EMDR for healing, with long term healing results reported and great reductions in their PTSD symptoms.

I turned back to the group. “What do I think about it? I think it can be very helpful. There are lots of studies that show it’s valid.”

One of the group members smiled. “I sense a but coming.”

“But… I think it is like any kind of therapy. It’s going to be super-effective with those who utilize it well and who are ready for it. It’s like the gym or nutrition analogy. You can develop the knowledge on how to work out and eat right, and even show up at the gym, but that doesn’t mean you are working out effectively to achieve results. I think EMDR can be very effective for those who are ready for healing and put it into practice. But it isn’t the miracle cure that people often think it is.”

The group had heard my philosophies on therapy many times over and they were familiar with my approach toward healing. I’d seen people viewing EMDR as something magical, but I knew from personal experience that it didn’t always work.

The room grew silent as I formed my thoughts. “I’ve shared a lot of my personal story with you guys in the past. When I was married and Mormon, after the birth of my first son, I got really fat and really depressed. I was working more than full-time as a therapist helping people solve their life problems, but I felt broken inside. This was just a few years before I came out. I had come to think that my being gay was something that was broken inside me, and I had given up on trying to find a cure spiritually because there just wasn’t a cure.

“So I figured it must be something emotionally wrong with me. I read a few books that backed that up. I read in some texts (books that I later learned have absolutely no scientific basis) that homosexuality was caused by unmet emotional needs, and that through therapy and effort ‘heterosexuality could be restored’, as one book put it.

“And I remembered what my teacher had said about EMDR being a healthy treatment for trauma. So I found an EMDR therapist, a really nice woman named Jenelle. She spent the first few sessions (I was paying 100 dollars per session, by the way, and I wasn’t telling my wife about them) taking down my history. I told her pretty much everything, except that I was gay. I simply couldn’t admit it. I told her about stuff from childhood, like abandonment and abuse, but I didn’t tell her the real reason that I was there, to stop being gay.

“So after that, we did six separate sessions of EMDR. In total, I spent almost a thousand dollars on the process, but it didn’t do anything for me. I mean, it was nice to talk to someone, but I wasn’t prepared to discuss my real traumas, and EMDR couldn’t possibly do anything for me. You can’t cure something that can’t be cured.”

There was silence in the room as everyone digested the information, and I smiled. “So learn EMDR. And be prepared to use it. It helps a lot of people who have been through terrible things. Combat veterans, sexual assault survivors, people who have lost loved ones to suicide. But know that any kind of therapy has to be individualized for the person. There is no wonder drug out there, and there is no wonder therapy, that magically will cure all ails.”

Soon, the group ended and everyone walked out. For a moment, I closed my eyes, and I pictured being back there with Jenelle. I had headphones on and the sounds of ocean waves were rushing into my ears through head phones, alternating right and left, right and left, and she sat close and tapped my knees, right and left, right and left. She’d told me to talk about a particular trauma, and I’d chosen a memory from childhood where I’d felt isolated and alone. She’d had me observe the trauma from afar as I talked about it, picturing myself on a train that was rushing by so I could observe the events and leave them behind as the train slowly sped by. Right and left, right and left. Somewhere inside me, the old prayer had still been alive, the one begging God to make me whole. Right and left, right and left, right and left.

What We Survived

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“What is the thing you are lucky to have survived? I want you to turn to the members of your small group and share with them, and later you’ll be writing a paper on the same topic.”

I felt nervous as I turned to the other three members of my group, already feeling like I didn’t fit in. I was 23 years old and, as far as I knew, the only Mormon kid in my college cohort of social work undergraduates. I was here at Boise State University in a room full of mostly white students, but there were only a handful of men. After high school, I had spent two years on a Mormon mission, and then another two years at a Mormon university. Now I was here among students who called themselves feminists and who sometimes drank alcohol and I didn’t know at all where to fit in. I felt constantly judged for being religious, and many of them felt constantly judged by me because I was religious, and both of those things were probably true. On top of it all, I was hiding the fact that I was gay, way deep down inside, not daring to tell anyone about my terrible shame.

I boldly agreed to go first, keeping eye contact with my group, hoping to find acceptance there.

“I, uh, went through some pretty tough things as a kid and teenager,” I said, sounding confident even though I wasn’t. I chose not to speak about growing up gay, or about my dad leaving, or about the sexual abuse, and instead focused on more recent events. “Um, when I was 16, I remember coming home one day and finding my 6-lb puppy, just this little black scruffy thing named Sammy, literally broken and lying on the floor in the frozen garage. During the day, my stepfather Kent said she had been causing trouble so he tried to toss her outside in the slow and then he slammed the sliding glass door closed on her on accident. He basically just put her down in the garage to freeze to death. I picked her up and could feel her ribs were broken and I cuddled her underneath the blankets in my bed. Kent came down angry and told me to put her back in the garage and I refused and for some reason he left us alone. He was violent and angry a lot during those years, but somehow that was the worst thing he had done.”

The other students in the group had pained looks on their faces, and they shared in this sadness with me for a moment, then took their turns in sharing their stories. One of the students shared a history of being sexually assaulted and then struggling with eating disorders and suicide attempts afterwards. Another student talked about being in the room when her own mother was murdered. The third talked about a horrific car accident that killed three other people and put her in the hospital, one she nearly didn’t survive.

A moment later, we opened the discussion up to the wider classroom and a handful of people shared their stories. One man had lost friends in combat only to be sent home when he was caught in an explosion, one woman had lost her entire home and everything she owned in a house fire, one had been married to a police officer killed in the line of duty.

I remember sitting there with a sense of emptiness and awe as I looked around this room of brave and incredible people. The only thing we had in common was being here in school at the same time, students in a university program. The professor talked about how humans are powerful and resilient and incredible, how we survive some of the worst things in the world and come out stronger on the other side, although we are forever changed. He talked about how, as social workers, we would be sitting with people in their most vulnerable and tragic spaces and helping them find their strength and their truth. And he talked about how even though we survive painful things, we likely have other painful things to survive in the future.

In many ways, this college experience launched my career in trauma work. Over the following years, I have sat with people in their greatest moments of pain, some of it unfathomable. I’ve sat with the woman who had a gun pointed into her open mouth during a bank robbery, the woman who watched her husband commit suicide with a shotgun right in front of her, the man who found his husband hanging over the breakfast table, the mother who woke up from a coma only to learn her entire family had been killed by a drunk driver, the man who lost his entire family during his 25 years in prison, the man who learned of his sister’s death at the hands of a serial killer, the woman whose husband came out of the closet after 40 years of marriage, the athlete who lost his job and scholarship because of one night of careless drinking, and the mother whose son took his own life because he felt rejected by a church for being gay.

If I were to sit in a group now and talk about what I survived, my answer would be much more recent. I would tell about being a home owner with a child, a pregnant spouse, a business, and major religious responsibilities when I came out of the closet and had to start my life over, rebuilding every relationship and learning how to live.

After I’ve worked in trauma several days in a row, I look at the world differently. I see people as survivors, and there is a weight to my eyes. A few days off with sunshine and fresh air, hugs from my children, laughter with friends, savory food, sweat, sleep, sex, wine, inspiration from history, and chocolate in some form or combination is needed to return the optimism.

It is at times a dark and difficult world. And it is a bright and beautiful one.

And we survive both.

 

President Trump

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Yesterday, a client asked me if I was nervous about the election results. I replied confidently, with spirit and heart and mind all in a line, and with a smile on my face.

“I’m not nervous at all. I believe in my heart that Hillary Clinton will win the presidency. Because she is qualified and competent, because she stands for positive values, because it is long past time in our history when women had a turn, and because all the polls support her triumph. And I cannot conceive of a world where Donald Trump is the President of the United States.”

Then, hours later, I watched with shock as the poll numbers started to roll in. I couldn’t believe even a few states were going for Trump. Then a few more. And over the next few hours, a deep dread and shock settled into my system as I realized the gap was closing. I stayed awake until nearly 2 am, fighting to fall asleep while the television droned on in the background, waiting with all hope that Hillary would pull out a victory at the end. But she didn’t. The American people, as a majority, voted for Donald Trump as President.

In two months, Donald Trump will be President. President Trump.

I tossed and turned all night, trying to come up with an optimistic view of our future. I’m not sure I can, I thought. My stomach was upset and my head hurt and I kept getting tears in my eyes. I would drift off to sleep for 15 minutes, exhausted, and then wake up for 45 more, my brain spinning and spinning.

To me, this election felt like all our hard work had paid off. All of our years of screaming to be noticed. So many incredible things happened in the last 8 years to give me hope, to make me trust. It’s like I spent 8 years in college and just knew I was going to get into the medical school I applied for. But the letter came back and I was denied entry. And I didn’t have a back-up plan.

I sat down with my sons last night, ages 8 and 5, and we had a conversation about the election, about how girls make great leaders and about how it isn’t okay to be a bully or to do mean things to people. And I so looked forward to showing them that the principles I am teaching them are corrupt, that the bad guys don’t win in the end. And I laid in bed last night in abject fear, not knowing how to have this conversation with them today, about how the bully won.

As I try to take my brain to the big picture, first I go to history. This country was founded on freedom for white men from oppressive religions and taxes. It was also found on the owning of Black people as slaves, the slaughtering of Native Americans, the denial of rights for women, and the heteronormative idea that there is only one way to love. Our most historic moments in the last 200 plus years have all come out of protest and strength: women picketing for the right to vote, black people marching for Civil Rights. We have survived the Depression and the Civil War, Viet Nam and Iraq, Watergate and the AIDS crisis. And I think the disenfranchised have found a voice, a movement in all of that to latch on to, to demand equality and freedom and a place at the table. And none of that changes today. We must still fight and organize and stand tall and lead our lives and demand equality and respect.

I then take my brain to this election itself. And I realize that I’m not sure there is much I/we could have done differently. The votes were close in those key places that would have made history different, like Florida and Pennsylvania. But the public voted for Trump, ignoring the Access Hollywood tapes and the lack of political experience and the mocking and violent rhetoric and the Twitter account, and they seized on Hillary’s Emails and her untrustworthiness. They equated the competent and professional woman with the billionaire reality television star with the rape allegations. I don’t know if there is a single thing that could have turned out differently.

I’m feeling a lot of things as I type this. In the past 12 hours, I have ranged from outraged to devastated to anxious to horrified to exhausted to crushed to baffled to despondent to numb. I remember September 11, 2001, being a young college student and waking up to the news feed as a reporter stood in front of the Twin Towers. On the live news feed, the second plane struck, and I fell back on the couch with an empty pit in my stomach knowing that everything had changed in that split second. I walked around in a daze for hours afterwards. And that’s how I feel today.

I have a friend who once attended an American-themed party in France. The European guests there dressed in baggy flannel shirts and jeans and Duck Dynasty beards, they carried toy guns, they ate popcorn by the handful and drank cheap beer out of plastic cups. They laugh at Americans, the rural white men with Southern drawls who thump Bibles and shame anyone who doesn’t look like them. This morning, I feel like we are an international joke because this is exactly what we look like today. The new president incited violence at rallies, encouraged revolution, and was endorsed by the Ku Klux Klan. Hillary is going to be fine. America isn’t.

All this said, I always fall back on optimism. I expected to wake up this morning to a sunny beautiful day. Instead, it was a massive snowstorm. And I can spend time railing and screaming at the snow as it continues to blanket the earth. Or I can put on my coat and earmuffs and boots and grab my snow shovel and start putting the back work into clearing the sidewalk, knowing I’ll have to do that same work again in a few hours. I can get snow tires put on the car and I can drive more carefully to get to the places I need to go.

In another harsh reality comparison, imagine getting diagnosed with cancer. That is devastating. There will be grief, emotional and physical pain. But there must be a plan of action. A clear understanding with medical professionals about how to move forward with full knowledge about diet and stress levels and sleep patterns and medication routines and social support. If this is cancer, we need a clear path moving forward.

So today, I’m going to hug my sons, and take gulps of fresh air, and I’m going to put one foot in front of the other and walk forward as I grieve. Because the next four years are going to be the worst reality television show ever made, and I have a life to live.