Resource: Psychiatric Advance Directives (PAD)

Obligatory I am not a lawyer disclaimer here. 

A Psychiatric Advance Directive (PAD) can be one of the most empowering tools you have at your disposal if you have chronic mental illness that needs crisis intervention. Unfortunately, not all states recognize a PAD although you may be able to alter a advance directive ("Living will") to include mental health provisions in other jurisdictions. You can read more about what US states accept here.

What is a Psychiatric Advance Directive?

A Psychiatric Advance Directive is a legal document in which you describe the types of mental health treatments that you would or would not be filing to receive. It also allows you to designate an authorized decisionmaker for mental health decisions on your behalf.

It is essentially a "living will" for mental health.

How does it work?

You fill out a PAD form with your preferences. The forms are fairly self explanatory where it asks a question and you fill in a blank. A witness or notary may be required to be present when you sign the form to make it legally binding. (FYI: Many banks and post offices have a notary on staff in the US)

This form is then copied and put on file with your therapist, psychiatrist, or doctor for use in medical emergencies. It may also be wise to carry a copy on your person or take a copy with you to the hospital if necessary in a crisis.

You can request this form be removed from your file at any time if you need to update it.

Where do I find the form?

Forms for the US can be found here - https://nrc-pad.org/states/

Form provided by the NHS here

"I am going to be honest, this is not going to be an easy form to fill out for most people. You will need to sit and think about where you are at your worst and be realistic about the treatment you will need as well as what you want to happen. The idea is you let your most stable self make decisions for your most unstable self. 

This also means you are designating someone else to be able to make decisions for you and it will require at least one big conversation with that person to ensure they know what you want and agree to act in that capacity. 

Personally, while my husband knows my mental illness the best and I trust him the most, I did know that he will need emotional support if I am in crisis. I made the decision to make additional notes that he should reach out to two friends we refer to as "The Vulcans" if he was ever unsure of what I wanted because one could emotional support him while being rational and the other is someone I know would make the same choice as me in that spot 98% of the time, so if he was unsure she could provide insight. I know this may not be an option for everyone, especially if you don't have a community that talks about mental illness as openly as mine does. " - D.M.

An important part of being an adult is making sure you have a plan in place for when things go wrong. This includes ensuring you have done some estate planning, even if you are younger, because it ensures your wishes are followed when you do not have control. This can include having a Power of Attorney, Advance Directive (Living Will), and Will drawn up. A Psychiatric Advance Directive may be an excellent addition to these documents. 

" I am a firm believer in my mental illness not being my fault but being my responsibility.

Before I had surgery I needed to get my legal documents in order and I wasn't sure where to begin. My grandma gave me a little list of documents people normally put together so I could google forms. I ultimately decided to sign up for the free trial for Law Depot and use their software to create my forms. They do an excellent job of breaking down this process (here) and I was able to get everything notarized at the post office." - D.M.

Control: Maintaining a healthy level of control

    Its not enough to regain control, it has to be maintained to find security and safety. 

 How to regain control as a survivor can be just as varied as the initial source of trauma. There are healthy types of control such as:

• Taking ownership of the narrative, telling your story out loud
• Establishing boundaries in existing relationships
• Creating distance or going no contact with abusers
• Self actualizing and self work
• Starting over fresh
• Therapy (multiple types)
• Exposure Therapy
• EMDR

    Maintaining this level of control will take consistent, imperfect actions until a habit is formed and likely routine maintenance after that. Ultimately self actualization and working on boundaries is necessary.

    Self actualization is the process by which an individual reaches their full potential. There are multiple stages to this process based on Maslow's hierarchy of needs. It starts with physiological needs, moves up to safety needs, then loving and belong, then esteem, and finally self actualization.

    Some of the simple ones such as air, water, food, shelter, sleep, and clothing can present their own challenges depending on the availability of resources or a history of self neglect. Progress is not always linear because you can find love and belonging but struggle with material needs or safety needs. Everyone's journey will vary depending on what resources they have available at the start of the journey.

Ultimately though the journey is about prioritizing your own wellbeing and accepting responsibility for your own needs, accomplishments, and shortcomings.

    Boundaries will also be needed to protect a sense of safety and ensure needs are being met. This can be especially difficult for some and needs practice for most to be effective. It can be hard to speak out and demand the respect your boundary deserves. Additionally boundaries are about what you will tolerate not your control of others.

"I will not allow you to yell at me. I am leaving" versus " You are not allowed to yell at me."

Accepted that other people have free will and will behave badly at times is part of the process. Its not necessarily an enjoyable part of the process but coming to terms with the difference will help build stronger boundaries and a sense of self worth.

Okay, but how do I maintain a healthy level of control?

Start small and work your way up. It will take consistent imperfect practice to make habits and even then you will likely still need to work on some things more than others.

1. Base Needs - Have you gotten enough sleep? Eaten a proper meal? Drank enough water? Took a shower?

  > "At first, you may need to make a checklist to help yourself remember these things or even set timers on your phone. I still use my list when I am having a bad day. Being hungry can really wreck your day." - D.M.

2. Safety Needs - Do you feel safe? If not, how can you create a sense of safety in your daily life?

> "There has been points in my life where this was hiding in my closet for ten minutes to reset. Sometimes I cant sleep and I need to plan out our budget for six months to feel secure. Does it feel crazy sometimes... absolutely... but I am the person who has to live in my head and the peace is worth it." - D.M.

3. Love and Belonging- Have you put effort in to foster a healthy, loving relationship? Do you need to reach out to a support group to begin building community? When was the last time you texted or called that friend who cares about you?

 > " This one can be a struggle when all my energy is sapped. I have saved especially sweet texts from people I love on my phone to help me when I really need it. Its so much easier to reach out just to say I love you then." - D.M.

4. Self Esteem - What does your self talk look like? Have you taken time today to note the things you accomplished or are you only looking at the unending to do list?

    > "I keep a gratitude journal for this purpose. I note one of each- something that made me happy today, something that made me feel accomplished, something I did for self care." - D.M.

We will be covering this more in depth in the next section as well.

Safety and Security: Therapy & Self Help

 This section on safety and security is intended to discuss the ways in which survivors can regain a sense of security after losing their sense of safety. It can be useful for survivors and their loved ones. Each person will have a unique experience as they seek to regain a sense of security, simply because the loss of security is incredibly personal.

In the previous posts on safety and security, we have gone over the ways you can feel unsafe and what way security can be regained. This post is about the emotional and mental tools one can gain to move past the fear and build security.

There are many types of therapy available and personal work one can do to help move past trauma. Research is being done on a variety of new therapies that use various substances to aid in therapy such as ketamine and mushrooms. The exact combination of therapy and perhaps medication that works for one person may not work as well for another. It can be a journey. (I talk about my own journey with medication in the Vlog: A Chat About Med Changes” - DM)

The most common therapy that people with severe anxiety or hypervigilance seem to get is called Cognitive Behavioral Therapy which focuses on thought patterns and building in tools to cope with those patterns or problems. This is different from therapy to process trauma which may utilize EMDR. 

“I found a therapist who was an excellent fit for me and my particular constellation of symptoms to work with when I finally gave in to needing therapy. The goal was always to add more tools to my personal toolbox so I could move through my emotions to be functional.

One of the biggest tools was learning to step back from my emotions and work on rationalizing out my anxiety and fears. There are days it works better and days it doesn’t work very well, but keeping perspective that my feelings are valid but not necessarily a true reflection of reality is important. We have a saying in our house - Your mental illness is lying to you. 

It helps to remember this when I am feeling particularly scared, whether its of myself or the world around me. When my brain says “You aren’t safe.” I have to reply “Why not? Explain it to me.” and more often than not we get into clearly irrational levels of unlikely scenarios.

There are risks to leaving home but the odds of those risks are low. I am far more likely to get in a car accident than attacked by a strange man while looking at strawberries in the grocery store. That being said, the realistic risk that each person faces depends on their location and society, but the ability to rationalize what is a realistic risk and what is not helps me decide if my mental illness is lying to me. 

And if I am being lied to it. It makes me want to prove the liar wrong. Spite gets me through what stubbornness has not. Sometimes that means telling my agoraphobia to fuck off because I want to see my friend and sometimes that means just getting out of bed to shower. Because you know what… ptsd likes to tell me I am not worth it and that I'm failing but I am worth it and I am not failing. My level of success is not measured by what others can do but by how far I have grown on my own journey. I am here. I am alive longer than I though I would be. And most days… I am HAPPY with my life. 

My mental illness is a liar but I can use my rationality to help me move past those lies and that is the greatest tool I gained from my self work and therapy. The ability to rationalize the fear and make decisions based outside emotion.

Well that, and working past my fear of medication. ”  - DM

Therapy can be a great way to learn new tools but it is not the only option. Therapy can be difficult for some to access for any number of reasons. There are some excellent self help resources if you want to start on this journey.

Some of the most amazing resources allow you to access workbooks, toolkits, and guides designed for mental health for free online. Mindremakeproject.org and  Mentalhealthathome.org both maintain lists of free therapy workbooks that can be accessed online. It may take a little time to look through their lists to find the resource that is most applicable to you.

“Technology can be an amazing tool for self help as well. I use the Calm Harm app when I am struggling with self harm ideation and an EMDR app when I need help calming down. There are also mood trackers to help you spot patterns and build healthier habits. 

I do still advocate for therapy but the work you do on yourself and by yourself can be just as important to your healing journey. - DM”

Fostering Classes

 Hello Friend,

In case anyone is thinking of taking fostering classes, I wanted to share my experiences and suggestions.

How to Communicate: Asking about Abuse

  The first four posts of the How to Communicate series give the basics on how to have a conversation, when to have a conversation, how to word things, and how to express discomfort. These basics are intended to create a safe, respectful place for conversations to be had. They are the building blocks for successful communication.

  This post is very specifically for loved ones who are asking someone about their past abuse. Those of you who are reading as an authority figure or concerned friend who possibly needs to report abuse you can find more information specific to that issue here. Please use that resources.

    Asking about abuse is a very delicate process. Ideally, the person you are talking to has already shared a little bit about their past and have shown an openness to sharing. The most important part of asking is compassion. Take some time to consider how scared, upset, angry, frustrated, or hurting your loved on might be feeling. It is unlikely that you completely understand the depth of that feeling without your own experience. You are about to ask them to relive some very painful moments and going into that you need to consider how you would like to be treated if roles were reversed. They may choose not to respond at all or shut down.

   When will you ask if the second consideration. Aim for a time that your loved one is relaxed, fairly calm, and in a decent mood. Pick a time where they have alone time, will have alone time later, and will not be completely without support. Try for a time where they have minimal responsibilities to attend to but not so much free time that you will be leaving them in a dark place for days.If they are nightmare prone, morning is better than evening.

   You have sorted out the proper when and now you need to decide on where. We discuss finding that 'right' place in the How to Communicate: Social Situations blog. This is the same process. Pick somewhere neutral but safe feeling. Home is not the best choice because it can feel too confining and might 'taint' the safe feeling later. I recommend a local park, nearby cafe, or diner personally. These places provided limited distraction, but have a clear escape. Some people like to fiddle with things when they are uncomfortable and these places have such outlets. Be sure the location you have chosen is free of interruptions and will allow you plenty of time for the ensuing conversation.

  How do you ask once you are where you need to be at the right time? You begin with your nonverbal cues. Uncross your arms, look at your loved one, consider holding their hand. Begin by making them feel loved and that this is an open sharing space.

  What do you say though? It depends largely on what you already know and what you plan on doing with that information. Information needed for legal reasons or to report a suspicion will need to be collected in a very specific way. Please use the link here to find out more about that process and what to do.

  Asking out of concern or to reach out is a different more organic process. Supposing you just have suspicions of abuse you might say something like, " I have been noticing that you seem [ sad/angry/down/etc] lately and was wondering why. I hate seeing you like this and want to help." The answer might not be what you expected, particularly if the person is not yet ready to share.

  Supposing you are aware that 'something' bad happened with someone but the details are vague and you are confused. Your dialog might begin with, " You have mentioned that ____ happened with/by ____. I am a little confused about what happened but I really want to help you move past it. Would you mind explaining more or telling me how I can help?" The answer here could be more vague than you want or just a list of things like hugs and friends that they need to feel close to. They may choose not to talk about things now but will mention it again later.

   Now, suppose you know that your loved one was abused. It was in the news or they said as much. You are curious what happened, you want to help, or you think they can help someone else. There is a good chance that this survivor already has a set response to questions. They may be very quiet about it or very open. A good line is, "I heard about _____. I want you to know that I am here for you if you want me to be." Or " I know that you do/dont like to talk about ____. I understand that. I know ____ went through something similar and could use a friend like you sometime." Responses to these lines will vary by how open the person is about their past. They may share and offer to answer any question you have or ask you to mind your own business. Graciously accept whatever response you get.

 Our collaborator T. would like to add that in all of these scenarios it is entirely possible to get a very negative reaction to your questions. His advice is as follows.

  My thought here is that while a negative reaction may not be something you can control, you can communicate about it in a positive way - and that's what this is really about: positive communication.  -T.

   You managed to work out when, where and how to ask. You worked up the nerve to just spit it out and now you are waiting for a response. They could do any number of things or say anything.  Be ready for anger, fear, guilt, relief, or tears. They might joke about their past even. Now, your job is to practice the listening we mentioned in the basics blog. You want to give them all your attention, respond promptly, and do not react emotionally. Do not defend or blame anyone, allow them to simply speak their piece on the matter. You may ask questions when prompted but try to avoid asking for graphic details. Be prepared to ask them to stop if it gets to be too much for you.

   Think about how you'd like someone to communicate with you if the situations were reversed, and try to model your communication after that. Not being accusatory, belittling, and so forth. -T.


   Once you have heard their story, take time to absorb it. Do not treat it as gossip, or use it to start drama. This person has trusted you with something very personal. You may find that the new information you have needs to be told to an adult or authority figure. Keep in mind that the survivor you talked to might truly feel their life is in danger so be sensitive when alerting authorities. They may choose not to be your friend after that.
 
  Asking about abuse is a very delicate process that can go in many directions. It inspires a lot of emotions and thoughts in the survivor. Ultimately, your job as the person asking is to remain emotionally even, be compassionate, and provide a safe place to share. These things help a victim turn into a survivor, by encouraging them to share again in the feature. It gives them another safe place to turn to.

How To Communicate: Expressing Discomfort

    There are a number of social skills we are taught as we grow up and receive our formal education. We largely live in a society that promotes positive reactions and emotions while ignoring a need to express negative ones. Negative reactions do not have to be harsh, mean, or exceedingly blunt. They encompass more than merely expressing anger or fear, but also learning how to say no, how to express alternate interest, and how to express discomfort. Many people use the concept of a "white" lie in place of learning these skills.

  Expressing discomfort and saying no to answering questions can be very hard for survivors. We live in a society where positive emotion is very wanted while anything sad or hurting is perceived as weak. It can be infinitely easier to say "I am fine" rather than " Please stop, this is bothering me." The second statement can feel like you are asking for mercy or giving another person power to hurt you. It is true that someone can continue to say or do things that bother you, but you have now given yourself a socially acceptable out. You can walk away, terminate contact, or report this behavior to higher ups when in a professional setting. In many ways you are giving yourself the power to act rather than allow yourself to be hurt in this way.

 I personally do not care for the white lie reaction. I spent a long time pretending bad things didn't happen and sometimes those white lies make me feel like I am back in that places. I am pretending for other people again, which is unfair to me. I do not deserve to hurt, be made uncomfortable, or be deprived of human understanding for actions that I did not ask for or want. -D.M.

   The next question is what is discomfort?

      It is to make someone uncomfortable or uneasy. This can be done in a variety of ways such as insulting language choices, graphic descriptions of violence or sex, persistent conversation of strong views, menacing behavior, invasion of personal space, or use of personal information in a nefarious way. The continued asking of personal questions, slander of a person, or threats can also be discomforting. Essentially, it is anything that makes the recipient feel uneasy, unsafe, or generally bad.

   Survivors of abuse will find themselves in situations where they are uncomfortable. Many of these can be resolved by stating the discomfort as the other person may not even realize that are doing anything. Each person has pet peeves and many survivors have personal triggers that are social acceptable behaviors, and many times the other person is not trying to be invasive. Simply saying " Excuse me, but it makes me uncomfortable when people ___________, could you please stop?" will solve many problems. This sentence makes it clear that your issue isn't personal to the offender. This line is really good for people who have new triggers or unusual ones. " May we please leave? I find _____ unsettling." is also an acceptable out in certain social situations. No one needs the full story why this bothers you, but a simple explanation that something is bothering you is helpful.

  A personal example is that I am very particular about who I allow in my personal space. I am nervous when men I do not know well are too close to me. Personal space is a cultural concept and varies from one and a half feet to four feet around a person. I generally want to have enough space that I can literally run around or away if I need to. This can be difficult in business and academic settings. I found the best way to express my discomfort here is with a joke. "I don't have a bubble, I have a trapezoid. You are standing in my trapezoid." is often a catchy enough phrase that it is remembered and different enough that people step away while laughing. -D.M.

   A survivor might find themselves dealing with a very nosy person. Someone who has a general idea of what happened but wants details. They may not realize that details are painful blow by blow recaps or they may not care. The best response here is something like, " Please stop asking questions. I do not wish to recount those details, they make me sad and are not anyone else's concern." or "Why do you ask?" Sometimes the best defense is a good offense. You might find that they are trying to understand, or need help themselves. Other times it catches them off guard.

  Another situation that survivors might find themselves in is defense of an abuser or a blame situation. The purpose of expressing discomfort here is for the social out. Its the nice way of saying "I'm done bitch." This is someone who is not interested in hearing your side of things or who is in denial. The best response is something like " I understand what you are saying but I disagree. Clearly we will not be agreeing and I think its best if I go now." The other person may be calling you names, blaming you, making you feel guilty but using this line or one like it puts you on the high road. Ultimately, if guilt is to be legally established, it will be in a courtroom where such behavior is not allowed. Do not try to fight over this, its not worth it to you and it wont change their mind. Trying to do so might be incredibly damaging to a survivor however.

  The key with expression here is to remain polite, state your issue and then either move on or move away. There is nothing wrong with disagreeing or asking someone to stop,  you just have to do it in a positive way.

 The opposite side of the discomfort circle is what to do if you are a loved one listening to a survivor. You are probably aware that this person is sharing a very personal and intimate part of themselves. You may be trying very hard to be supportive but feel that the conversation is detrimental to yourself. It is okay to express discomfort here as well and doing so in a compassionate way will prevent this from being a painful experience for both of you. Wait a moment until a natural pause in the conversation and say something along the lines of...

  " I am sorry to interrupt. I know this is hard to share and I appreciate that you trust me enough to do so. I do not feel that I am the right person or capable of being here as much as you need me to be. May we stop here for now? I want to help you find someone who can be there in the way you need. ( or I want to hear the rest but need some time to absorb this.) "

  This statement conveys that you still want to help. That you are not abandoning the speaker. You simply can not handle this situation or you need time. It may seem harsh but I assure you it is infinitely better than when I was told "please, please stop. Its killing me to hear your story." My friend couldn't hear it but I was living it. It broke my heart because it felt like he didn't care at all. -D.M.

  The level of information at which a person feels they need to stop a conversation will be different for everyone. It is important that the survivor respect that, even if it is very hard to hear. First conversations should not contain graphic descriptions unless asked by an officer of the law or a judge. Allow your loved one time to absorb the simple fact that it happened. They will have questions,  but wait for them to ask those. It will help them come to terms with this truth a bit easier. Ultimately you want the whole of your past to be told but you don't want it to be a slasher film type shock. You want a long book series that allows the reader to accept this reality.

   One thing to bear in mind, though, is that if someone decides they want to cut off communication, you have no right to press them to do otherwise.  If that happens, send an apology by the lowest-pressure means you can (email usually works well), and let them know that if and when they want to reopen communication, you will be there. -T.

   Many of these lines can be used for a lot of other social situations but the majority here are intended for survivors and their loved ones when trying to have difficult conversations. Ultimately, you want everyone going into this with a sense of respect and compassion.

  Our collaborator T. would like to add that sometimes an apology is necessary if you find yourself discomforting another. The following is his explanation of how best to apologize.

   How to apologize:  

   The media is unfortunately full of non-apology apologies, but gives very few examples of how to apologize well.  There are three things you need to do in a sincere apology:  
1. Take responsibility for your actions and the harm they caused. [ In this case, causing discomfort.]
2.  Let the person know you regret harming them.  
And last, but not least: 
3.  Tell them what you intend to do differently in the future to prevent harming them again in that way.
[ This could be choosing a better place or time, being more sensitive to their emotional needs, or respecting someone's desire not to be told excessive details. Both the survivor and loved one have these rights.]

   An apology like that will show real thought, and good intentions.  It may be satisfying in the short term to cast yourself as the wounded party, but in the long run, it's not going to help you keep that relationship going.

  Apologies can be key in repairing any damage done by causing discomfort. They allow both people to reset the relationship with new boundaries that may not have existed previously. Either party can suffer discomfort or need to apologize for causing discomfort. There is no shame in apologizing for a mistake and doing so can be essential in  maintaining open lines of communication about such personal topics.

How To Communicate: Social Situations

    Communication is about connecting to other people and sometimes its easier to do that in the 'right' setting. This post is about figuring out what the right setting is for certain conversations, particularly those about abuse or trauma.

    The 'right' setting is a physical, mental, and emotional place. Obviously, you want to have physical conversations in a place where you can hear, see, and properly interact with the other person. A mosh pit is probably not the best choice. You want a place that you will not be interrupted in, and where a private conversation will remain private. In addition, long conversations are better suited to places where comfortable temperatures and seating are available. Note that the above are just physical qualifiers for the 'right' setting.

  Being in a good mental place when communicating is also important. I am sure most of us have had a conversation with someone who is incredibly tired, and they tend to get easily confused or speak in repetitive loops. When trying to talk to someone who was doing paperwork, often they forget what you said right after you said it. Here are some mental factors to consider. Is your 'audience' coherent and focused enough to have the conversation you need to have? Can they give you their full attention for the amount of time you need it? A long conversation might be best had during some free time after someone has had time to 'unwind' from their day but not so close to bed time that they fall asleep. Those are some of the mental factors you need to consider before deciding to have a conversation, particularly a sensitive one. Also remember that these factor in regards to yourself, people don't tend to listen to those who make incoherent or rambling conversations.

  The last part of picking the 'right' place is emotional. This applies to a number of situations, such as dealing with an angry customer or having upset a coworker, but its essential for having conversations about personal experiences with abuse.

  A person's emotional place can be harder to gauge than their physical or mental. Hard conversations are best had in a neutral space, away from what is considered "safe" (at home for many people), but also in a non-threatening place. This allows the speaker to feel safe enough without "tainting" their safe place. I strongly suggest going on a walk to a park. This helps one feel that they can physically walk away from the conversation (opposed to being in a car) if it becomes too much. It also decreases a feeling of crowding or suffocation. Some people need to have an exit strategy ready at all times, and an open space will help them. There are people who find open space to be scary. Those sorts of people may do better in a cafe or diner. It is still a neutral place that has many exits.

  Emotional also includes their emotional state. You want your conversation to be open with interaction from both parties. This is best done with everyone is 'even'. It is best not to try to have an emotionally charged conversation with someone who is sad, crying, enraged, or frustrated. It is also unwise to time your conversation in such a way that it overshadows moments of intense joy, affection, or pride. It is possible that someone who is sad may open a dialog about their experiences, at which point the listener should be aware that this is a form of venting. They need comfort and understanding more than questions.

  These three parts come together to form a 'right' place for a conversation. That might be sitting on a bench under a tree while on lunch break from a very calm work day. It could be sitting in the car killing time before a movie on a day off. It could be hanging out with friend after school in the local park. The key here is that it is a physically comfortable, quiet place with little distraction and that the parties are relaxed and calm.

  This 'right' place is needed for both parties. If you are a victim or survivor who wants to share your story, it is important that you pick someone receptive to hearing your story who is emotionally even at that time. You want a space that provides privacy and yet allows the other person space, there is a good chance you are asking that person to move outside their comfort zone. Be considerate of these things and it will lead to a better and more welcoming place to share your story. Accept that your listener might express discomfort and wish to end the conversation, or they may have questions. Decide how you will handle these reactions beforehand.[The next post will cover how to handle discomfort and another will talk about how to share your story. Please read those for a better handle on these sorts of situations.]

   If you are a loved one who is asking about experiences, it is important to remember that these conversations are very personal and very difficult for the victim or survivor. It might get easier with time but its never as simple as talking about the latest book you have read. There is a good chance that the person you are talking to was threatened with violence if they ever said anything, and for someone currently being abused, it is possible that this disclosure will result in physical harm. (If that is the case, please report to authorities if doing so is safe in your area. You might lose the friendship but you could save their life.) Try to listen without interrupting, as it is easy for someone to lose steam and stop sharing a bad memory. Realize that no matter how much you love someone, this conversation might be more than you can bear. Consider in advance what your tolerance point might be and how you will politely and kindly express your discomfort. [The next post will cover how to express discomfort.]

  Ultimately, you want to consider asking yourself the following questions when thinking about starting a conversation about personal experiences with abuse.

• Will we be interrupted?
• Would I feel safe here?
• Am I the best person to ask these questions? Can I handle the answers?
• Will they be okay after we have this conversation?
• If not, will they have time and a safe place to compose themselves?
• Will I need a similar place?
• What is the purpose of this conversation?
• When and how do we end this conversation?

  These basic questions will give you an idea about how appropriate this place and time are for the sort of conversation you are wanting to have. These conversations are rarely easy to have and consideration as the to the 'right' place helps makes it an easier process. It will also help the survivor be more receptive to future conversations.

  Ultimately, picking the 'right' place may be the prime factor in whether or not a conversation is had at all. Emotionally sensitive topics often are pushed aside in favor of 'safer' ones. Hopefully, these steps will allow you to create a proper space for intimate conversations and be more aware of social situations.

How to Communicate: The Basics

     May The Stars Shine Upon You  is a blog about surviving abuse, you are probably wondering why we have a communication section. The reason why is because communication is a huge part of getting past abuse. It is needed to reach out for help, assist in legal action, connect with others, and share person experiences. Loved ones will need it when they try to understand and help those who have suffered. Its a huge part of the healing process and often we forget that hard conversations don't have to be a production or huge confession. They can be normal conversations, even if they deal with difficult subjects.

  Communication is a very important tool for almost every person alive. It is a means of connecting to other people. The technical definition is "the act or process of using words, sounds, signs, or behaviors to express or exchange information or to express your ideas, thoughts, feelings, etc., to someone else," according to the Merriam-Webster dictionary. Communication is more than just words. Its our body language, facial expressions, words, tone, inflection. All of these and more can be used to connect and share with others.

  This post is to cover some of the basics of communication. Ideally, the whole communication series will cover a variety of topics and situations in relation to abuse but also in general. These basics can be used in most any social interaction, as will a number of the other topics in this series.

   So, what are the basics?

• Actively Engage
• Active engagement is simply setting the stage. It's creating a mental space where you can give the other person your full attention and can convey that attention to them. Make eye contact, put away electronics, step into a quieter place, etc. Make your communication a priority. Pay attention to your body language.
• Listen
• Good communication requires that you are participating fully, that means listening as well as expressing yourself. A good listener will quietly give their full attention to the other(s) present. They will take notes mentally or on paper, not interrupt, and allow themselves a moment to fully appreciate and consider what has been said to them. They do not allow their emotions or opinions to overshadow the person who is speaking.
• Be concise
• A true exchange allows for the listener to respond. Ideally, this is done using simple and concise statements. Give yourself a moment to think about what was said and what you want to say. You don't need the shortest response, just one that makes sense to the other person in the exchange. This step is very hard in emotional circumstances. Try not to send mixed messages.
• Ex:   A significant other might say, "This isn't working, I need space." In response, you might be thinking, "Who are you sleeping with?" or "What did I do?" or just "Why?" Try not to blurt all those things out, even though you want to know what's going on. You both need time to think about things, so the best response in that instant will probably be something like, "Aright. Please let me know when we can talk about it, so that I can better understand what is going on."
• Be courteous or civil
• Understandably, various relationships will not allow for this or might change the context of what civil is. It is human nature to be defensive sometimes but do try to remain civil. Avoid name calling, blaming, or offensive language. Try to maintain basic manners. This will help the person you are talking to remain open to communication with you, and possibly others down the line.
• Do not try to force strong opinions or beliefs on another
• Simply put this is best expressed by Linus of the Peanuts' gang; "There are three things I have learned never to discuss with people: religion, politics, and the Great Pumpkin."
• The above silly line from a comic best captures the concept that some topics are emotionally charged and will derail a conversation. This is because some people try to strong arm others into their beliefs. Its the golden rule, do unto others as you'd have done to you. Respect their opinions, and hopefully, they will respect yours.

 These basics provide a good starting point for any communication. Wiki How has a more in depth version that can be read here. Communication, like many other skills, requires a bit of practice for one to excel at. It is perfectly normal to be nervous, excited, or shy when attempting to speak with another, particularly about sensitive topics.

   Sensitive topics often require a few extra basics.

• Be aware of your verb tense
• This is very important when convey a sense of responsibility. "You make me mad." says something completely different than " You made me mad." One suggests that you are ready for a confrontation and the other suggests you are ready for resolution.
• Be aware of the connotations of words.
• The connotation of a word is its extra meaning. Often a word might have a good or bad connotations associated with it that has little to do with its literal meaning, or the meaning could even vary between different groups of people. While this adds richness to our language and the human experience as a whole, it can be detrimental to a sensitive conversation. One should also be mindful that some words will be negative to others, regardless of context, so it's best to avoid them all together.
• Ex.: Cheap and Inexpensive both have a literal meaning of an item being low in cost or reasonably priced. However, something that is called cheap has the added implication of being of lesser quality. The words mean the same thing but are taken in different ways.
• This one ties back to the victim or survivor concept mentioned in the last post. Consider carefully what you wish to convey, how your audience will take your word choice, and if another word might be a better fit.
• "I" statements
• "I" statements are frequently mentioned in pop culture. The basic concept is that you focus your statements on yourself rather than the person you are speaking with. This shifts the conversation in such a way as to decrease the level of defensiveness. 
• Ex.: " I am very frustrated that we aren't getting along." Opposed to, " You make me so angry, why do you always fight with me?" Focus on resolution.
• These types of statements also help to prevent generalizations when speaking about a variety of topics, including emotions and experiences. 
• Ex.: Don't say, "I understand what all who've been abused are going through. They're just like me." Instead, say, "I have survived abuse, but I do not speak for all those who have been abused. My experience is unique to me in many ways, although it shares similarities to what many others have experienced."

   These communication basics can be used in almost any situation. This skill is important in academic and professional settings, but also in personal ones. These basics will help anyone reading this when they find themselves needing to have delicate interpersonal relationships.

   

Blog: How "The Lists" Helped Me

   The last two posts were about recognizing child abuse and abusive relationships. I discovered both of these lists after removing myself from abusive situations. I wish I had read them sooner.

  Even without these lists, I have noticed that survivors seem to sense one another. We each have some tell, some defense, that is so ingrained into our lives that it is impossible to ignore in another. As a result, this sense has allowed me to reach out on more than one occasion and support someone else in their recovery. It has also allowed me to vent to others who understood and in a way build a support group (minus the stale donuts and sub-par coffee).

  The first time, it was a girl sitting in front of me in one of my Home Eco classes. She was a grade beneath me. I remember thinking she was very pretty, incredibly smart and had this fabulous taste in books. She was also in agony behind her brilliant smile. It was the way her smile never reached her eyes, and how she moved when she thought no one was watching. One day, I worked up the courage and leaned forward to say "Hey, I know what you have been through. If you need a friend, come find me." She did. We spent all of lunch sitting in the plaza talking. Her story was more brutal than mine, but she suffered in much the same way. Today, I am lucky to still count this beautiful woman as a friend. She might even be my hero, as she has borne upon her shoulders more weight than any mortal should. It was not just the abuse, it was the many losses she has suffered since then. She is amazing, and I will never forget that moment I leaned forward.

  I often wish that I had some better resources to share at that time - some way I could explain how "normal" all our pain was; uniquely our own but not such that we were alone.

  The lists about abuse and abusers helped me see how dangerous and dysfunctional some of my relationships had been. It helped me see that I deserved better. I could almost imagine my best friend telling me my own story, and what I would say to her. I would never have suggested she stay. I would have done anything to save her, but for some reason I could not convince myself that I deserved saving. Its one of the battles I still fight on some level to this day. Some part of me that is convinced the abuse was somehow my fault. It has also made it very clear to me that I have had some toxic relationships to end with some people who were giving off these glaringly huge red flags, people who failed me in a very extreme way. I then had to decide if I would forgive them and continue a relationship or end that relationship. It gave me the ability to address not only my role, but those of my caretakers when I was a child. Those of my friends and family when I was a teenager. It has helped me make better choices about who should be part of my support group today.

    It also made me much more aware of behavior in others. I read the lists, and I posted it on my social media sites but I KNOW that if someone reads it and doesn't want to acknowledge their own truth, then I can do nothing. I have learned to be a more compassionate friend and a better listener. I have become more willing to share my own story. It's easy to say "Don't tolerate his controlling behavior." or "He shouldn't ever hit you." but I remember my own excuses. I'd tell people that my ex and I, well "we fought as passionately as we did anything else". This was a lie that I did not believe, but one that others would not argue with. Now I know to ask, " But how passionately do you cook together? Debate books? Go running?" Not sex, sex and passion are much the same to most people. How passionately do you do the little things? That's where the lie is revealed. I know the list, but I know the lies that one can hide behind too. You really do need both. You need the authority of a professional telling someone what should not be acceptable, but also a relateable friend.

  Today, I use the lists as a resource. I can give them to someone in trouble. I can use it to help a child. I can share them with younger people to help them prevent those situations. And I sometimes read them to remind myself that I am getting better. I can cross off some of those behaviors. I have made progress.

  My apologies if this blog rambles a bit. I just wanted to give those reading this a little perspective on those lists. Those words mean little really and yet describe some pretty horrid things. Despite that, they are part of my recovery.

- D. M.

Signs A Child is Being Abused

   If you are a care giver for a child and are concerned for their well being. Please review the longer, more comprehensive pdf supplied by Child Help ( http://www.childhelp.org/page/-/pdfs/Child-Abuse-Definitions.pdf ). The following list is compiled mainly from this source, and contains only the more common symptoms.

• Physical Abuse
• Recurrent injuries with inconsistent or implausible excuses
• Unusually shaped bruises or injuries ( as if from an object)
• Injuries in uncommon locations, such as neck, back, underarms, etc.
• Burns, lacerations, welts ( especially in young children)
• Broken bones
• Wearing long sleeves or pants in warm weather
• Hair Loss
• Nightmares, Insomnia
• Regression
• Artwork or expression of violence
• Fear, withdrawal, depression

• Sexual Abuse
• Compulsive masturbation and/or the desire to teach others to masturbate
• Sexually acting out
• Unusual curiosity about sex and sexual topics
• Bleeding or injury to genitals ( complaints of pain or itching in these areas)
• Torn, bloody, or stained undergarments
• Frequent sore throats, yeast or urinary infections without explanation
• Bed wetting, soiling oneself, and playing with excrement 
• Difficulty sitting or walking
• STD / Pregnancy, particularly in early adolescences
• Expression of unusual sexual themes in school work or artwork
• Substance Abuse, running away, fire starting
• OCD or Depression
• Sleeping problems
• Fears or phobias
• Somatic symptoms

• Emotional Abuse
• Hiding or averting eyes
• Lowering gaze
• Forcing a smile
• Poor Self-esteem
• Depression
• Defensiveness, confusion, or denial
• Eating disorders, sleeping disorders, nightmares, speech disorders
• Suicide or suicide attempts
• Regression
• Difficulty in relationships
• Delayed development
• Nervous disorders

  It goes without saying that many of these symptoms on their own can exist without abuse being present. However, a number of them existing together should provide reasonably suspicious of abuse. Care takers who notice these symptoms should read the PDF file from which this list was compiled and follow the guidelines at the end for reporting.

Am I Being Abused? / The Signs of an Abuser

 
   It can be difficult to know what constitutes abuse. The abuser may not use their fists or leave bruises; it may not seem intuitive. Below, is the list published by the Dear Abby advice columnist on the signs of domestic abuse, it can also be found here. It is very clear cut and, unfortunately, a little more difficult to find on more official sites. The National Domestic Violence Hotline site has a list that can be found here. Abuse comes in many forms, some of which have their own hallmark signs to look for. Stars suggests LoveIsRespect.org as a comprehensive resource for those questioning what consitutes abuse.

The Signs of An Abuser, as published by Dear Abby

  The signs of an abuser are:

(1) PUSHES FOR QUICK INVOLVEMENT: Comes on strong, claiming, "I've never felt loved like this by anyone." An abuser pressures the new partner for an exclusive commitment almost immediately.

(2) JEALOUSY: Excessively possessive; calls constantly or visits unexpectedly; prevents you from going to work because "you might meet someone"; checks the mileage on your car.

(3) CONTROLLING: Interrogates you intensely (especially if you're late) about whom you talked to and where you were; keeps all the money; insists you ask permission to go anywhere or do anything.

(4) UNREALISTIC EXPECTATIONS: Expects you to be the perfect woman and meet his every need.

(5) ISOLATION: Tries to cut you off from family and friends; accuses people who are your supporters of "causing trouble"; the abuser may deprive you of a phone or car or try to prevent you from holding a job.

(6) BLAMES OTHERS FOR PROBLEMS AND MISTAKES: It's always someone else's fault if anything goes wrong.

(7) MAKES EVERYONE ELSE RESPONSIBLE FOR HIS OR HER FEELINGS: The abuser says, "You make me angry" instead of, "I am angry" or says, "You're hurting me by not doing what I tell you."

(8) HYPERSENSITIVITY: Is easily insulted, claiming hurt feelings when he or she is really mad. Rants about the injustice of things that are just part of life.

(9) CRUELTY TO ANIMALS AND TO CHILDREN: Kills or punishes animals brutally. Also, may expect children to do things that are far beyond their ability (whips a 3-year-old for wetting a diaper) or may tease them until they cry. Sixty-five percent of abusers who beat their partner will also abuse children.

(10) "PLAYFUL" USE OF FORCE DURING SEX: Enjoys throwing you down or holding you down against your will during sex; finds the idea of rape exciting.

(11) VERBAL ABUSE: Constantly criticizes you, or says blatantly cruel things; degrades, curses, calls you ugly names. This may also involve sleep deprivation, waking you up with relentless verbal abuse.

(12) RIGID GENDER ROLES: Expects a woman to serve, obey and remain at home.

(13) SUDDEN MOOD SWINGS: Switches from sweet to violent in a matter of minutes.

(14) PAST BATTERING: Admits to hitting a mate in the past, but says they made him (or her) do it.

(15) THREATS OF VIOLENCE: Says things like, "I'll break your neck" or "I'll kill you," and then dismisses them with, "Everybody talks that way" or "I didn't really mean it."

* An abuser can be any gender, as can a victim. Age, social status, gender, race, etc are irrelevant when deciding if someone is an abuser or if someone is a victim.