Trauma and Substance Use: How to think about addiction as an attachment disorder

I have spent my professional career immersing myself in understanding addiction through a mental health lens, and the farther along I go in this path I have come to agree with several professionals, innovators, and visionaries in the field that addiction is primarily a symptom, and specifically a symptom of trauma. As Dr. Gabor Maté stated at a conference, “Addiction is only a symptom, it is not the fundamental problem. The fundamental problem is trauma.” Now when I say trauma, most of us generally think of the big “T’s” of trauma, such as abuse, neglect, witnessing violence, feeling our life is in danger, and all of the criteria A of in the DMS 5 of Posttraumatic Stress Disorder; however, what about the little “t’s” which happen to people consistently. When I think of the little “t’s” of trauma, such as not feeling an attachment to our caregivers and experiencing toxic stress I tend to think of the saying, “death by a thousand cuts,” which are adverse childhood experiences and need to be acknowledged. The reason it is imperative to really understand how addiction is a symptom is before we can ask how to treat something, we have to understand what we are treating. When we understand addiction comes back to trauma people have experienced in their life and understand this, treatment can happen. To paraphrase Maté, most in the medical profession and the legal system do not understand addiction and treatment is not helpful and can in fact be harmful. The type of trauma I am going to speak of involves early childhood adversity and how when certain factors are present insecure attachment becomes a breeding ground for addiction to become a “substitute” relationship for individuals and attachment-sensitive counseling can be fundamental in the healing process for individuals diagnosed with a substance use disorder.

So, let’s talk about this. One model I love when understanding addiction is the biopsychosocial model of addiction—but what exactly does this mean? In my understanding, it means addiction is not always what it seems. There are hidden drivers, influences and motivations at work and underlying the disorder. Stress-specifically toxic stress, adversity, and trauma become the covert engines underneath many of the social, medical, and psychiatric crises we face. When we start to see this one thing becomes frightfully clear: trauma and addictive disorders are two of the most underdiagnosed disorders and this can be because most clinicians shy away from asking about sexual or emotional abuse, as well as substance use disorders. Oliver Morgan stated, “Perhaps the most powerful barrier confronting counselors and those struggling with trauma and addiction is the experience of shame and discomfort, of blame and societal judgment that surrounds both conditions. Safety to speak and inquire must precede honest truth-telling, and clinicians need to adopt making safety a priority.” One solution? Universal screening. After years of working in this field I am still shocked by how often trauma-related disorders are not even assessed. It is imperative to realize, as well, that both substance use disorders and diagnoses associated with trauma exist on a spectrum, and this perspective does not deny other factors--It does challenge, however, all the health and wellness-related fields to consider a new impact of stress and coping on living. When we understand that people who are addicted are traumatized people, we can take an approach that will help them heal that trauma rather than make it worse.

When it comes to different definitions about addiction, the DSM 5 evolved from the DSM IV by defining addiction as a spectrum disorder with specific emphasis on the substance taking over the person’s life. I don’t think this definition tells the whole story. My favorite definition of addiction has been from the Seeking Safety treatment manual stating addiction is the “chronic neglect of the self,” and with this definition it segues into the understanding addiction is an adaptive functioning to cope with the symptoms of trauma. I LOVE that. Substance use disorders have such a stigma and are still (wrongly) viewed as a choice or a morale defect; however, substance use is actually adaptive for individuals. Specifically, individuals that never learned how to regulate learn to regulate with substances; or if they have had adversity and insecure attachments, they finally find comfort in something, which tends to be a substance. Due to the fact substance use is adaptive it is essential to know when the substance is gone, they have taken away their biggest and most effective coping skill. For people whom have experienced trauma, substance use can have many meanings. Substance use can be a way of getting to sleep, numbing the pain, giving them control, helping them feel accepted by people, committing slow suicide, getting back at an abuser, crying out for help, showing others how much pain they feel, blotting out memories, accessing memories… and many more. The reason I like the definition about a chronic neglect of the self can be clients do not know how to care for themselves because they were never taught or they do not think they deserve to nurture themselves. Attachment-sensitive counselors can work with clients to explore how addiction evolved into a substitute relationship, and potentially how clients can learn to re-parent themselves.        

Some alarming facts about trauma co-occurring with addiction are individuals diagnosed with both have statistically poorer treatment outcomes and higher rates of relapse. So how common are both disorders? Here are some statistics to shed some light on this?

·      A Massachusetts study of adolescents and children in CD inpatient and intensive residential treatment found 82% had a history of trauma.

·      Adolescents with alcohol dependence are 6-12 times more likely to have a childhood history of physical abuse and 18-21 times more likely to have a history of sexual abuse than those without substance abuse problems.

·      In one study of juvenile detainees, 93.2% of males and 84% of females reported a traumatic experience with 18% of females and 11% of males meeting full criteria for PTSD. Males were most likely to report witnessing violence, while females were most likely to report being victims of violence.

·      Individuals with histories of violence, abuse, and neglect from childhood onward make up the majority of clients served by public mental health and substance abuse service systems

·      90% of public health clients have been exposed to (and most have actually experienced) multiple experiences of trauma.

·      97% of homeless women with mental illness experience severe physical and/or sexual abuse, 87% experienced this abuse as children and as adults.  

The reason why these statistics are so important is to dissect and understand the previously accepted theories of addiction are woefully inept in getting the whole picture. For example, the disease model speaks of the brain being hijacked, the choice model only speaks of it being a voluntary choice, and the learning model talks about what we see-because we are social creatures and we learn from modeling. And while there is validity in parts of the models, they do not tell the whole story. Oliver Morgan argues, “Why not view addiction as an attachment disorder?” This perspective does tell the entire story, and it removes stigma from addiction and increases empathy and understanding for clinicians and society as a whole.

Early childhood trauma, and again I am not necessarily speaking of the big “T’s” which are important to consider—such as emotional abuse, chronic neglect, caregiver substance use or mental illness, exposure to violence; but the little ones. The chronic little “t’s” can add up very quickly without adequate adult support and it creates toxic stress. Toxic stress becomes a response when a child experiences frequent, prolonged adversity. Children do not yet know how to emotionally regulate and they need an adult caregiver to “co-regulate” with them, and often they do not receive the kind of support they need to learn this fundamental skill.

Why does toxic stress then lead to substance use? Individuals reach for substances as comforts when they do not get comforts in the “normal” places. We as humans seek to be soothed, and it is human nature to reach for other things to support us in times of trouble. When there is not a relationship present, we settle for something else. This then becomes the beginning of “substitute relationships.” When we are diagnosing trauma, it is important to consider several factors which impact how an individual experiences trauma. Such as:

·      Age of the person

• Developmental and psychological history

• Timing of traumatic occurrences

• Temperament

• Source of the trauma

• Previous exposures

• Length of the exposure

• Perceived sense of control

• Perception of the event’s meaning

• Level of perceived life threat

• Availability and use of supports

  • All of these together equate to the symptoms we see

Again, speaking of trauma, these incidents are too large to discuss in the scope of this blog; however, I’m including these to consider in the screening process to be considered:

• Acute childhood illness, medical intervention, and extended hospitalization

• Motor Vehicle, occupational, and household accidents

• Repeated traumatic exposure

• Unrecognized societal traumas (preverbal or neonatal trauma)

• Delayed on-set trauma

• Cultural trauma

When we talk about trauma, the real issue we are discussing is adversity. I found this quote striking: “It is easier to build strong children than to repair broken men.” Transitioning to adversity, which is a form of trauma: Adversity can affect the individual who grows up in a toxic family environment with childhood or teenager maltreatment that can predispose for poor health outcomes and addiction susceptibility, or co-occurrence with mental disorders.

• Evidence from a wide variety of sources indicates that America’s addiction health crisis—and specifically its current prescription drug and opioid crisis—has roots in childhood and later adversity.

• Childhood adversity is a premier predisposing risk factor for vulnerability to substance-related addictive disorders.

• Individuals with a history of adversity do not approach involvement with substances and compulsive behaviors from a neutral position. Those living with significant stress bring that history. Those who experience later adversities can use addictive relationships for coping and comfort. Those relationships can be difficult to renounce.

With that being said, who here has heard of the ACE’s study? Evidence from a wide variety of sources indicates that America’s addiction health crisis—and specifically its current prescription drug and opioid crisis—has roots in childhood and later adversity. This insight does not deny that other factors, such as genetics, temperament, or comorbid mental illness, are important, but it does insist that developmental trauma, toxic stress, and social ecology are major players in public health. The evidence also indicates that improvements in the nation’s health and addiction crisis must involve intervention and prevention regarding adverse childhood experiences. Childhood adversity is a premier predisposing risk factor for vulnerability to substance-related addictive disorders.

• Early childhood adversity, abuse, neglect are capable of impairing the function of reward and stress response systems.

• Long-term treatment of addiction must consider any underlying psychological dimensions that a person in distress was attempting to ameliorate when they started on the road to addiction.

• “…without exception, people who have had extraordinarily difficult lives. And the commonality is childhood abuse. In other words, these people all enter life under extremely adverse circumstances. Not only did they not get what they need for healthy development, they actually got negative circumstances of neglect…that’s what sets up the brain biology of addiction”

And for someone much more knowledgeable and articulate than me, please watch this TED talk:

https://www.ted.com/talks/nadine_burke_harris_how_childhood_trauma_affects_health_across_a_lifetime?language=en

With all of this being said—what would it be like to think about addiction as an attachment disorder? When we think about attachment to caregivers: Attachment is a fundamental mainspring driving human development. When all goes well, the individual becomes securely attachment and capable of moving out into the world on his or her own. But things do not always go so well. When a child, primed and ready for connection, encounters indifference, neglect, preoccupied caregivers, a lack of adequate care--or worse, hostility, manipulation, relationship challenges, or outright victimization, then she or he becomes burdened with deficits and imperatives to cope in any way possible or crumble.

• Substance-related and addictive disorders may be seen as potential outcomes when attachment processes go awry or attachment needs remain unmet (Fishbane, 2007; Flores, 2004).

• Disconnection creates fertile ground for the emergence of addiction and other troubles later in life.

• Unfulfilled interpersonal needs can be shifted toward bonding and relationship-building with a drug, an activity, or a behavior that partially fulfilled the role of a substitute (Morgan, 2019, P. 104).

Daniel Seigal spoke of attachment as a “feeling felt,” and when it is absent, there can become rupture. Before I go too far down the rabbit hole, I have been in several trainings where parents can quickly become frightened of harm they have caused, but just know it is not about the rupture of the attachment so much as the repair, and there has been significant research on “good enough parenting.” With that being said: Mary Main identified disorganized/unresolved attachment and while this group makes up to maybe 15-25% of the population, they tend to be 80% of individuals diagnosed with substance use disorders.

Children that are raised in challenging homes and toxic environments learn to anticipate stress, danger, and the need for protection. They wake up every morning with neural fists raised and ready. When this happens, something happens to the brain where the individual cannot think long-term. They cannot active the pro-con list most of us do before making a decision.  I have seen this with clients so frequently. They are constantly in survival mode and their brain literally does not function the same way as those not growing up in an adverse environment. When it comes to treatment: Attachment-based deficits help us to understand the prevalence of a number of contemporary social and clinical dysfunction from divorce to child maltreatment, from physical illness to addictions.

I know a lot was just covered and I am going to leave you on a cliff hanger… stay tuned for the next blog about what attachment-sensitive counseling means and why EMDR is so effective in treating both trauma-related diagnoses and substance use disorders.

Why are Boundaries so Important?

Boundaries. First of all, why are they always talked about and why are they so important? Why does it matter to have boundaries? I can say one thing, for those reading this that have healthy boundaries because you were pushed to your limit by others violating and crossing your boundaries—you know why they are so important. Most of the time boundaries are finally set when we are pushed to our limit, and then it is almost too late because it is so much easier to set high boundaries and lower them over time then setting low boundaries and having to raise them after they have been crossed or violated. A big misconception people have about boundaries is other people in our lives should know our boundaries without us having to say them; however, if we do not state what our boundaries are people naturally treat us within the guidelines of their own boundaries. Thus, it is important to know for ourselves what is and what is not okay. What we will and what we will not tolerate—because what we tolerate teaches people how to treat us. The most essential thing to explore is, what kind of boundaries do I set for the different people in my life—because truly, not everyone in our lives should have the same boundaries. A way to think about setting different boundaries for different people in our lives is to think about our life and everyone in our life as a concert where we are the show. If we are on the stage—some people are on the stage with us, some people are in the front row, some are in line at will call, some people are waiting for a ticket, and some people cannot enter because it is now sold out. Prior to allowing someone to “buy a ticket,” we want to explore the concept of consistency over time. Is this person who they say they are? How long have I known this person? Is this person safe? Do I trust this person? Anyone can seem awesome the first five minutes we know them, but people need to treat us with reciprocity, respect, and be consistent over time to have the honor of sitting in our front row.

How then do you figure out what your own boundaries are? There are many types of boundaries, which I will discuss later, but how do you know what you will and will not tolerate? It is usually much easier to answer what an unhealthy boundary is or what an unhealthy person and/or relationship looks like, but what about the everyday interactions we have with others? We might be so used to focusing on the needs of others, afraid to say no and say yes to everything we do not even know what are boundaries are. When this happens, we often have porous boundaries. With porous boundaries we might overshare information; not be able to say no; are overally invested in the problems and lives of others; tolerate abuse and disrespect; fear rejection if we assert ourselves and our own needs; or are dependent on the opinions of others without trusting our own judgment. Having porous boundaries can depreciate and destroy self-respect, self-compassion, self-esteem, and perception of self-worth overtime. We lose our sense of empowerment and lose trust in ourselves because we allow everyone on the stage. Not only is everyone else on our stage but they completely take over the concert so it is all about them and there is no balance or reciprocity and mutuality in the relationship. On the complete opposite side of the spectrum there are rigid boundaries, which can be just as dangerous because they prevent meaningful relationships from occurring—no one can buy a ticket to see our show. This is dangerous because humans are social creatures—we are literally wired for connection and rigid boundaries prevent connection. When someone has rigid boundaries, they are unlikely to ask for help; avoid intimacy and deep relationships; very protective of personal information; has few close relationships, if any; keeps others at a distance and may appear detached.

What then are healthy boundaries and how do you figure it what your boundaries are and how to set them? This is one of the hardest questions to answer because we have to truly know ourselves, which is a lifelong process causing our boundaries to change over time as we learn what we will and will not tolerate. First, healthy boundaries are basically in the middle of porous and rigid boundaries. They are the “just right” porridge in the Goldilocks story of boundaries. When someone has healthy boundaries they value their own opinions; does not compromise their values for others; shares personal information in appropriate ways; knows their personal wants and needs and can communicate them (it is one thing to know our needs but another huge skill to learn to be able to communicate them); and accepts when others say no to them. In order to learn what our boundaries are and how to be able to communicate them in a healthy way we first need to tune into our emotions. As I have said in previous posts, emotions communicate to ourselves, communicate to others, and motivate us for action. When we feel uncomfortable and uneasy our emotions are communicating to us something does not feel right and we are not currently comfortable with these boundaries for this interaction. When trying to explore and identify our own boundaries, we want to ask ourselves what we are feeling and what our emotions are trying to tell us. Emotions will communicate what we need to attend to—like what interactions need higher boundaries, and what we enjoy—so what boundaries we need to continue to set. Additionally, tuning into our thoughts is key to understanding our boundaries. What are we telling ourselves after spending time with someone? Are they decreasing our self-worth? Making us doubt our judgement? Noticing and tuning into our thoughts can help us discern our boundaries. We can also ask others—we can become investigators into how others set and understand their own boundaries in order to get an idea of how we can set ours. Lastly, one of the most important factors to understanding what our boundaries revolves around our values. We want to get a clear understanding of our own values because values are highly correlated with healthy boundaries and we want to aim for our values to be congruent with the kind of boundaries we set when they are healthy. When we start to learn our own values more, we can set boundaries which honor our values. A word of caution: if we have had porous boundaries in the past and begin to set healthier boundaries, expect resentment and resistance from others. However, remember they will adapt and we are not harming anyone by saying no and taking care of ourselves and our needs by setting healthy boundaries. Moreover, if individuals do not respect our boundaries, they do not deserve to buy a ticket or even see our show.

So, what are the different types of boundaries? Generally speaking, boundaries are personal rules, limits, or guidelines we set for how others are allowed to treat us. If you are feeling confused by boundaries and how to define them, you are not alone and sometimes it is easier to define boundaries when they are violated or crossed. There are so many types of boundaries: physical boundaries; intellectual boundaries; emotional boundaries; sexual boundaries; material boundaries; and time boundaries. But what the hell does that mean? Physical boundaries feel easy enough to define, and in this particular climate it is respectful to assume everyone’s physical boundary is a six-foot in diameter bubble. The other ones are a bit more complicated. Intellectual boundaries refer to thoughts and ideas. Healthy boundaries allow for respect of different thoughts and ideas and this boundary is violated when our thoughts and ideas are belittled or dismissed. I would additionally argue this boundary is violated when someone repeatedly states they do not feel comfortable discussing certain topics and the person they are talking with continues to bring up those topic completely disrespecting the stated boundary. Emotional boundaries revolve around our own feelings. This boundary is about what we feel comfortable sharing and how we share it, and with who. Often this boundary is violated when others belittle, invalidate, or discount our own emotional experience. Remember, emotions are communicating to us about the environment—so when someone is discounting our own emotional experience we need to investigate where we might need to move this person in our personal boundary concert. Maybe they were in the front row and overtime they continue to violate and cross our emotional boundaries so they need to be put in the backseat, and that is 100% okay to do. We can change our boundaries with people in our life over time.  

When it comes to a healthy romantic relationship, sexual boundaries are imperative to set and maintain and have a transparent dialogue of mutual understanding and respect for each person’s identified sexual boundary. This boundary refers to emotional, physical, and intellectual aspects of sexuality. This boundary is violated when unwanted touch occurs, unwanted pressure to engage in sexual acts, leering, and inappropriate and unwanted sexual comments occur.

Material and time boundaries are often discounted as not as important; however, not having a clear understanding of these boundaries can create significant resentment in our relationships. Material boundaries refer to our money and possessions, and healthy material boundaries involve a clear understanding of who we share our money and possessions with and if it is under our control. For example, it is most likely appropriate for us to lend money to a family member but not someone we just met this morning. This boundary is violated when someone steals or damages something of ours or pressures us into giving them something or lending them something when we do not feel comfortable doing so. The last boundary I will discuss is one of my favorites to set and maintain—it is the boundary of our time. How do we value our time? Are we an introvert who needs to spend more time alone to replenish our energy or do we like being around people more? What are our priorities and how to we manage our time? We know this boundary is being violated when someone is demanding (or making us feel guilty) to have too much of our time and more than we feel comfortable giving. Healthy time boundaries revolve around acknowledging every facet of our live and being able to balance what we give our limited supply of energy in the day to in order to have enough for the things most important to us. This boundary quickly gets violated from those in our lives when we struggle to say no.

The biggest takeaway from this is: Setting and maintaining healthy boundaries is caring for ourselves, valuing our sense of self, valuing our time, learning to say no without making up an excuse because no is a complete sentence, and truly empowering ourselves. Boundaries are self-love, self-compassion, and highly correlated with self-esteem and a high sense of self-worth. AND if someone gets upset when we set a boundary, it is a necessary boundary to set, and they will adapt or we might need to set higher boundaries. Normally when we set a boundary and others become reactive, we can feel guilty. However, if others are truly trying to make us feel guilty, I would argue it constitutes emotional blackmail and gaslighting behavior. We are allowed to say no, we are allowed to value our own opinions, time and judgment—and it is not okay for others in our lives to feel entitled to violate and cross our boundaries.

Anxiety is Exhausting

Anxiety is basically creating conspiracy theories about ourselves all day long, and it is exhausting. I say this only partially joking. Anxiety is worrying about everything and anything for more days than not with difficulty being able to control the worry. Now this is the DSM-5 definition, but what does it feel like? We constantly feel on edge, feel full of apprehension, and mistrust our own instincts. We overthink everything all of the time and can feel completely paralyzed. We feel anxiety in our body and it is more than a feeling of nervousness or not being able to sit still. Our bodies feel restless and keyed up. We have to move, our heart can start racing, our breathing becomes more rapid and shallow, and our entire body can be tense throughout the day. Something does not feel right, and often times because anxiety is in our body—people cannot even identify what they are worrying about, we just know things are not okay.

Evolutionarily it makes complete sense why we developed this emotion. We needed to be able to sense something was not right in our environment so we could either run or avoid it. Anxiety creates fear and apprehension, which significantly contributed to survival and safety. Anxiety triggers activate the fight-flight-freeze system which releases hormones in order to help us engage appropriately with our environment. How, then do we know when what we are feeling is a reaction to our environment or something more? What is the key to understanding when anxiety is “normal,” which I hate the word normal, or when does it become excessive and not a response to our environment? I think the word extreme can be helpful in navigating anxiety. When it becomes a disorder, our responses to our internal and external stimuli are extreme. We have intense fear and worry which cannot be easily decreased with just recognizing nothing in our immediate environment is threatening. When anxiety is extreme our entire functioning is impacted: being around people can be exhausting; starting a task can cause complete debilitation; sleep is impacted; relationships are affected; work is affected; and our emotional well-being is in jeopardy.

For those around us, what does anxiety look like? It looks like a friend constantly cancelling plans because the idea of being with other people can sound exhausting. But then, cancelling the plans can cause more anxiety because we become so worried and create stories about the cancelling of plans the person hates us and we have lost the relationship. For our partners, we can come across as incredibly irritable because the thoughts and worries in our head prevent our ability to communicate effectively. Most people can become pretty annoyed with us because when we are worrying so much, we need constant validation about what we are worrying about is in fact, not reality. We avoid, but then when we actually do take the risk and speak up about what we are feeling, we second guess if we should have done it for so long it causes us to avoid again in the future.

Anxiety has been shamed and stigmatized, like most mental health disorders and symptoms are, as being something wrong with people and something they can and “should” control. Telling someone not to worry about something is about effective as telling an irate person to “just relax” or “clam down.” It is not helpful and when this emotion is shamed it creates even more anxiety for those struggling with it. What people with anxiety hear is, “Your emotion is making me uncomfortable, so you need to change it,” which only makes people more anxious because then we ruminate how much we are bothering others!

What can we do about it? There are actually several useful strategies, such as paced breathing and progressive muscle relaxation during heightened anxiety episodes. Keep in mind anxiety and worry are rooted in the emotion of fear, and fear motivates us to run or move. Thus, acting on our emotional urge, like exercising or going for a walk can be extremely beneficial. Therapeutic modalities, such as cognitive behavioral therapy and dialectical behavioral therapy have been shown to be incredibly effective. However, I would argue the most beneficial strategy for combatting anxiety is education. We need to educate ourselves how we experience anxiety in our bodies so we can feel it rather than stuff it; learn how to communicate what we are feeling so those close to us know when we are suffering; and talk about it. Shame causes us to stay quiet which increases our feeling of anxiety, and speaking out about our experience is the only anecdote to shame.  

What is Acceptance Anyway?

Working as a therapist I have often experienced significant push-back and anger from clients when exploring the concept of acceptance. This is so understandable! I often approach this with curiosity and ask clients to define acceptance and what it means to them. More often than not I hear clients describing acceptance as a form of approval, passivity, or even going so far to say acceptance means love or compassion. When people define acceptance this way it makes complete sense they get angry at the concept—as they should! Additionally, I hear the word being used in the sense of telling someone to “just get over it.” Whatever the “it” may be. However, the idea of acceptance being equated to approval is not only wrong, it can be extremely invalidating and harmful. The last thing a survivor of trauma wants to hear is they “have to accept” the behavior of the abuser when they equate acceptance with either compassion and love or approval. Moreover, being told we need to “accept” someone is an asshole, or, “accept” social injustice can be infuriating when we believe acceptance means approval or perhaps believing accepting is something we need to do for someone else. Thus, while I validate the client’s emotional reaction and spend time processing past experiences they have had with the word; I spend a great deal of time discussing how the word is not pejorative; explain what it truly means; explore how healing it can be; describe how courageous the action of acceptance is; and emphasize it is one of the most difficult things in life to do. Seriously.

This leads me to describe what is acceptance is not. I think understanding what it is not creates a path to understanding what it is. Even more so, learning what has to be accepted in our lives. Let’s start with what acceptance is not. It is not approval (I know, I know, I’ve said this. But it is worth repeating extensively). It is not love. It is not compassion. It is not giving up. This is what I constantly hear people think it is; so no wonder it pisses us off when we are told to accept something we truly believe should not be accepted!

What acceptance actually means is actively participating in life and seeing what is truly happening in the present moment. With this definition… what has to be accepted? Life and reality. Life and reality have to be accepted as it is happening. This does not mean once we accept it everything is fantastic—NOT AT ALL! By accepting facts about the present and past (and reasonable probabilities about the future) we are able to see what is real, true, and factual. We are then free to engage in effective behavior to change it. I often hear the question, why do we have to accept reality? Whether or not we accept reality it is happening anyway; if we do not accept what is happening, we become immobile, ineffective, and lose our own sense of agency. And…. in order to change reality we first have to accept reality, right? If we don’t see that things suck, we don’t do anything to change it. If we don’t see the full truth of the situation, we then are impassively living. Moreover, rejecting reality can turn pain into suffering because by losing our sense of agency we feel disempowered and feel we do not have any choices or a way out of the painful present. Rejecting reality causes us worthless, and can create despair; whereas, accepting reality can open our minds up to the possibilities we have, the power we have, the choices we have, and allows us to accurately listen to our emotions which are motivating us to take action with someone we cannot and will not tolerate.

Acceptance is purely the ability to see things as they really are and see reality for what it is. Only after being able to accept something are we able to make effective and meaningful changes because our eyes are finally open. Therefore, acceptance is the most active, difficult, and challenging skill to do in life. The biggest factor getting in the way of acceptance are the beliefs that if we accept something, we are minimizing it. Again, while this is a valid fear, this is not true. We are only minimizing things when we do not accept them because we are not acknowledging the full impact of life and are not allowing our emotions to truly come into fruition.

How do we know we are not accepting something? We feel powerless. We feel stuck. We feel hopeless, and we have no course of action. Acceptance brings us freedom to see things for what they really are and then see how and what we can do. Acceptance can offer us a sense of agency, and the power to truly feel our emotions and allow them to motivate us rather than feeling we “should not” be feeling a certain feeling. For example, anger is consistently rejected from our reality. However, anger can be an incredible catalyst to fight injustice, which we are only able to accurately see with acceptance of reality in the present moment. We can start seeing our own power and what changes we are capable of making. We can start seeing things are not okay and will not be tolerated. For example, the only way to end an unhealthy relationship is to first accept it is in fact, unhealthy. The only way to mobilize a protest is to first accept what is currently happening is unjust.

Acceptance truly opens our eyes to what is, not what we want it to be or are hoping it to be. We can avoid and pretend certain things are not occurring by not accepting them, but when we fight with reality; reality is always going to win. The only way to be an active participant in our own lives, community, and the world is to accept reality.

Acceptance is not the end goal. Acceptance is the first step. We might have to accept something multiple times in even an hour to truly see the reality of the situation. But just because we accept something, does not mean it is okay. It does not mean we approve. It does not mean we give up. It just means we fully see it and acknowledge it as the current reality, which can give us great power to do something about it. When we are not clouded with constantly feeling and thinking in absolutes (have to, must, should, never, always), we gain the freedom to see the possibility of life and truly living. We gain the strength to take control of our lives, make meaningful changes, recognize our power, and mobilize into action.

Exploring Collective Trauma

We are experiencing a collective trauma right now. Collective traumas are a psychological event shared by a group of people and an entire society. The emotions we all are feeling are strong, valid, and evolve into a crisis of meaning. Collective trauma is devastating for individuals and for groups; it constitutes a cataclysmic event that affects not only direct victims, but society as a whole. The emotions we all are feeling elevates into an existential threat which prompts our search for true meaning, and meaningful change. All of the emotions we are experiencing are valid. I have said this twice because it needs to be repeated. We so often dismiss our emotions or suppress them for numerous reasons, which impedes are ability to be authentic and begin healing. Emotions motivate us to action, communicate with ourselves, and communicate with each other. There is no "bad" emotion and every single emotion being felt right now is very real and worthy of honoring and feeling. All emotions have a cause, and while we know the cause; know collective trauma often results in an entire shift in a society or culture. Emotions motivate us to action, and Minnesotans have been motivated to action. I have been brought to tears by seeing and feeling everything Minnesota is going through, but I have been moved to tears by seeing how much we are standing together as a community. Minnesotans have been doing incredible things every single day to care for one another during this crisis and in an attempt to bring forth social justice and change. I have left Minnesota to live in other places many times in my life, but Minnesota has always been my true home because of the people. Minnesotans have gathered together to care for each other and heal, and only action as a community can address systemic racism. Words truly do not matter, only action does, and there have been so many powerful examples of action in order to bring together this community.

The ethical guidelines outlined by the American Psychological Association emphasizes the importance of participating in social justice, but what does that mean? There are so many ways to participate in social justice, but I believe one of the most imperative and essential things to do is education. We need to be uncomfortable. We need humility. We need to be willing to listen and learn, with an open heart and open mind. We need to be humble enough to have difficult conversations and recognize how we can get together to make meaningful changes. Not everyone is build for the frontlines—and this is completely okay! But we can join with action (voting, signing petitions, calling representatives); donating; and staying connected by listening to those in our community. I cannot help but quote Mr. Rogers, because that is what Minnesota is all about.