“Every Angel is Terrifying”


2017 was a rough year in this country.

Some practices by way of which I have tended (and continue to tend) my own mental health include participation (in both resistance and support in the public sphere), yoga (and regular meditation practice) in the personal sphere, and —again and again— poetry. 

 I have been especially drawn back lately to the poems of Rainer Maria Rilke, especially his  Duino Elegies.  Rilke was born in 1875 in Prague, but after its occupation lived most of his life in France, writing in German.

I’ve also been reading the poems of the more contemporary Eastern European poets whose lives and work were forged in the fires of fascist and totalitarian political regimes. Among many poets from these countries and eras (Adam Zagajewski, Wisława Szymborska, and others), I have been re-reading Czesław Miłosz in particular. Having lived in California for decades after his political exile from Lithuania in 1940, he was eventually able, in his final years, to return there in 1981, after the restoration of Lithuania’s independence.

At a time in which “political catastrophe has defined the nature of our age,”  as Terrence Des Pres has put it, Miłosz’s poems grapple with the central issues of our time, those being (Terrence Des Pres again:) “the impact of history upon moral being [and] the search for ways to survive spiritual ruin in a ruined world.” As does Rilke, in his way, grapple over and over with the mystery of being, and with the potential of sorrow and of longing to deepen and transform our existence, to the degree we participate and surrender to Mystery  as our very mission

Both poets also explore the ways in which there are many voices and forces within each of us, not particularly in harmony, and about the way poetry offer witness and shelter for one and all. When so much of the suffering that we as a species inflict on each other is a direct result of the way we project all our own inner “demons” (all those parts of ourselves with which we are most uncomfortable) onto “the other,” demonizing the other instead (“the wounds by way of which we wound others” as I have heard “sin” defined), the importance of poetry as a home and a mirror for all that we contain cannot be overstated. As Milosz writes in the poem “Ars Poetica,”


“The purpose of poetry is to remind us

how difficult it is to remain just one person

for our house is open, there are no keys in the doors,

and invisible guests will come in and out at will.”


So here are a couple more excerpts from some others of Miłosz’s poems (all of which can be found in his  Selected Poems, 1931-2004.), and two excerpts from Rilke’s  Duino Elegies. And while, for me, the excerpts themselves stand alone powerfully as aphorisms, I hope they will lure you into the deeper dive of the poems from which they come.


“This hasn’t been the age for the righteous and the decent. 

I know what it means to beget monsters

And to recognize them in myself. ”  

                                       (From “Winter,” Miłosz)



“In our lives we should not succumb to despair because of our

errors and our sins, for the past is never closed down, and receives the

meaning we give it by our subsequent acts”

                                   (From “What I Learned from Jeanne Hersch” Miłosz)



How we squander our hours of pain

How we peer past these into the bitter distance

to see if they have an end. Though they are really

our own seasons, our winter evergreen foliage,

ponds, meadows, our interior landscape,

where birds and reed-dwelling creatures are at home.

                                (from Rainer Maria Rilke, “The Tenth Elegy” [translation mine])




Who, if I cried out, would hear me among the angels’ hierarchies?

and even if one of them pressed me suddenly against his heart:
I would be consumed in that overwhelming existence.
For beauty is nothing but the beginning of terror, which we are still just able to endure,
and we are so awed because it serenely disdains to annihilate us.
Every angel is terrifying.
And so I hold myself back and swallow the call-note of my dark sobbing.
Ah, whom can we ever turn to in our need?
Not angels, not humans, and already the knowing animals are aware
that we are not really at home in our interpreted world.


Yes–the springtimes needed you. Often a star was waiting for you to notice it.
A wave rolled toward you out of the distant past, 

or as you walked under an open window, a violin yielded itself to your hearing.
All this was mission. But could you accomplish it?

                                                     (excerpt from Rainer Maria Rilke, “The First Elegy” [trans.                                                           Stephen Mitchell])




“Taking Care,” Part 2

(Note: the following post will mostly be of interest to members of the South Wasco County , Oregon “community of care”:)

In October, a few members of the South Wasco County community who are primary caregivers to older, cognitively-impaired, or otherwise disabled family members, gathered at Canyon Wren Wellness Center for the first of two community wellness classes on the topic of “Taking Care.” It was a rich evening of support, ideas, and information-sharing. As one participant said, leaving, “My shoulders feel much lighter!”

A few more people attended the November class, and the response was similar: participants spoke about how helpful it was to receive information about specific medical conditions, community resources, specific strategies for care and self-care, and to share support and hope with others who understand the challenges and satisfactions of family caregiving. And everyone agreed about how good it was to be able to meet in our local community, when the demands of caregiving itself make it difficult to leave home for the time it takes to attend a group, much less the two hour round-trip involved in going to and from a group in, say, The Dalles.

When Steven Woolpert (behavioral health specialist at Deschutes Rim Clinic) and I initially planned the two-session “Taking Care” class, we had intended it to be just the two classes, but with the idea that if the interest was strong in continuing it, we would consider that, too.

Well, the interest was definitely strong! Everyone in the group was eager for it to continue, and several people said they planned to encourage other family caregivers they knew to go, based on their own positive experience. So, Steven and I have agreed to continue “Taking Care” as an ongoing, monthly information and support-sharing group for family caregivers.

Just as with our community wellness classes in the past, the group is open to anyone to join at anytime, and there is no charge to participate: the group will continue to be co-sponsored by Canyon Wren Wellness Center and Deschutes Rim Health Clinic as a community service, with Steven and I co-leading.

The next “Taking Care” group gathering will be on Tuesday, December 19 from 5:00-6:15 pm at Canyon Wren Wellness Center. So if you live in the South Wasco County community, and would like to be on the email list for information and reminders about the class (whether or not you plan to come), please let me know by leaving a message at 503-838-6144, or email  canyonwrenwellness@gmail.com, and I will be glad to add you to the list.

Deschutes River, Maupin. Photo by Kathi Ringo

And speaking of “taking care,” I can’t stop talking about how excited I am about the Deschutes Rim Clinic’s new facility fundraising campaign, and by the ways the community and the state legislature, both, are supporting its success! As you may already know, the fundraising dinner at the Wamic Community Center in November was an overwhelming success, with contributions from the community that evening exceeding even the most optimistic guestimate.

What that tells me in turn is that we as a community know how very, very special and crucial, both, the presence of high-quality, local health care is to the “well-being infrastructure” of our community.

When I was fresh out of training in the early 1980s, my first professional job was as a school social worker in Linn County, providing family and individual counseling and parent support services to kids and families in and beyond Lebanon and Sweet Home. Since there was only me, much of my work involved helping people connect with the community social services they needed. But while the need was huge, at that time local services simply did not exist, and (as in so many rural areas) access to services in the nearest cities was often a deal-breaker: parents, if they worked, could not get or could not afford to take the time necessary to drive the hour or so involved in getting to Albany, where county health and mental health services were located…and those who were unemployed could not afford the gas to get there. 

I did that work for seven years, and my experience resulted in a career-long dedication, in the 25 years since, to locating my own practice in the rural and small towns in which I have lived, instead of in whatever the closest city might be.

A little earlier, I spoke of how lucky we are to have “high quality local care” at Deschutes Rim, and I want to say that again: the primary care available at our local clinic is not only convenient, but it is really, really good. I know that for many of you reading this, I am telling you something you already know, but I am too impressed and too personally grateful not to say so for the sake of anyone who may not yet be aware of it! 

When we first moved to Maupin, my husband and I both established with primary care providers in The Dalles, in part because we didn’t know the community well yet, and because we moved here in the midst of some health issues requiring ongoing specialty care. So it seemed best at the time to just get all our healthcare in The Dalles. But we have both since transferred our primary care to Deschutes Rim, and we couldn’t be happier. Not only because we receive such excellent care nearby, but because it is a way also of “being there” for the services that we depend on, which in turn helps those services to continue to be there for all of us in this community.

In this season of giving, I hope each of us will think about how we might give an extra gift of our resources —money, time, or something else— to the community (the clinic or something else) that supports us each and all.

It’s all about taking care.

A Good Night’s Sleep

If that headline caught your attention, you may be one of the 70% (by one estimate) of Americans who have trouble falling asleep, staying asleep, or waking up feeling rested from sleep. If you don’t sleep well, you are probably quite aware already of the ways sleep deprivation lowers energy and impairs judgment, mood, concentration, coordination, comprehension and memory.

These days, medical science is even more concerned with the growing evidence that insomnia is one of the most powerful contributors to such major health problems as obesity, diabetes, heart disease, hypertension, immune system disorders, severe mental illnesses, general disease risk and overall life expectancy.

While the specific science of this is beyond the scope of this column (though it’s pretty interesting stuff!), it comes down to the fact that chronic sleep deprivation increases inflammation levels in the body…and inflammation is now known to play a key role in the development and maintenance of many chronic diseases.

So if you or yours have persistent difficulty with getting a good night’s restful sleep, it is something to take seriously, and to take steps to address: your overall health depends on it!

In planning my topic for this month’s column, I had intended to write about a topic associated with military veterans in some way (since it’s Veterans’ Day Month),unnamed which was exactly what got me to the topic of sleep, since sleep is one of the most prominent and frequent symptoms of Post Traumatic Stress among veterans of deployments, and one that makes other symptoms worse.

According to the Dept of Veterans’ Affairs, insomnia has been found to occur in 90-100% of Vietnam-era Veterans diagnosed with Post-Traumatic Stress. It was also the most commonly reported symptom in a survey of Veterans from Afghanistan and Iraq.

Given the demands of the job for active duty servicemen and women, problems with sleep are hardly surprising: soldiers are trained to be highly and persistently vigilant, able to instantly react in case of need. And once the most reactive part of our nervous system (that fast-acting part of our brains connected with our fight-or-flight response) has been trained to remain always activated or ready to activate, re-training to relax is…well, complicated.

Which is why, in their trainings for behavioral health therapists on a range of conditions (but especially for trauma-related conditions), the U.S. Center for Deployment Psychology (CDP) places tremendous emphasis on accurately and thoroughly evaluating and treating problems with sleep. And because the factors that may be contributing to insomnia for one veteran  (or civilian, for that matter) may be very different from that of another, (even if both have experienced acute or prolonged trauma), The CDP advises that behavioral health therapists begin with a detailed, exhaustive (these take a couple of sessions just to complete) structured interview in order to comprehensively review and  identify potential contributing factors. Clients are asked, meanwhile, to complete a detailed sleep diary for a couple of weeks. Click here for these resources)

What I have learned from using both these tools with people in my practice is how very individual and complex a given person’s sleep problems can be –civilian or military– and how very important it is, therefore, to take whatever time it takes to gather all the data that might even possibly be related to a given person’s sleep issues. Often, in the process of doing so, surprising discoveries are made that can naturally suggest a remedy.

All that said, everyone with sleep difficulties would do well to start with the basics of what is antiseptically referred to as good “sleep hygiene,” since the strategies involved can go a long ways toward ensuring a good night’s sleep. But don’t take my word for it— give them a try!

1) Avoid caffeine, alcohol, nicotine, and other substances that interfere with sleep


News flash: caffeine and nicotine interfere with restful sleep, and are generally best avoided for four to six hours before bedtime. And while alcohol may help you fall sleep, it also causes wakefulness, “rebound anxiety,”  and generally poorer quality of sleep later in the night. So if you do drink, experts advise (for this and general health reasons) no more than one to two drinks, and none within three hours of bedtime

2) Turn your bedroom into a “sleep room.”

A quiet, dark, comfortable and cool environment can do a lot to support sleep. Turn down the heat, turn off all artificial light, and use earplugs or white noise machines to mask sound. Make sure your mattress and pillows are right for you. And if a pet regularly wakes you during the night, you may want to consider keeping it out of your bedroom (I know, I know: I don’t want to do that either!). And keeping electronic devices out of the room will help to strengthen the mental association between your bedroom and relaxation, while also reducing your exposure to the electromagnetic fields (EMFs) they emit, which are thought to interfere with normal sleep. Better yet, unplug your WiFi system at night altogether: the EMFs they emit have been implicated in melatonin suppression in humans, and there is evidence that their higher rate of oscillation (vibration cycles) affect the natural electromagnetic field of your body at rest…and not in a rest-supporting way! In short: make your bedroom a place that becomes associated with sleep and sex and rest only, by furnishing and using it for only those activities.

3) Establish a sleep-supportive pre-sleep routine

Train your subconscious to prepare for sleep by developing a pre-sleep “transition” routine. This might include taking a bath or shower, putting on night clothes, reading a book, meditation, or relaxation exercises. Avoid stressful, stimulating activities (like doing work or discussing emotional issues). And if you tend to take your worries to bed, create a ritual to deliberately set them aside for the night: write them down, for instance, and then put them in a box or jar until morning…and close the lid.

4) Go to bed when you are tired

Struggling to fall sleep just leads to more tension…which makes sleep even less likely! So go to bed at the hour that is right for you, even if this means going to bed earlier or later than your partner. Then, if you’re not asleep after 20 minutes, get up and go do something relaxing (preferably not involving electronics) until you feel tired enough to sleep. But keep the light dim; bright light stimulates the brain.

5) Don’t watch the clock!

images-1Checking the clock when you are trying to fall asleep (or after waking at night) increases stress, making it harder to fall asleep. In addition, a digital clock emits a steady stream of artificial light that stimulates the brain even when your eyes are closed. Turn your clock’s face away from you.

6) Expose yourself to natural light

Exposure to natural light in the morning and regularly during the day is essential to keeping our internal clocks on a healthy sleep-wake cycle. So let in the light first thing in the morning and take sun breaks during the day if you work indoors.

7) Keep your internal clock set with a regular sleep schedule

Going to bed and waking up at the same time each day programs the body’s “internal clock” to expect sleep at a certain time each night. Some sleep experts say that waking up at the same time each day no matter when you went to sleep the night before is the most important of the two in setting and maintaining your body’s clock.

8) Experiment with napping

For some, afternoon napping may make sleep more difficult at night. For others, it may help nighttime sleep by easing the “fight to stay awake” exhaustion that can actually make falling asleep more difficult later. So experiment! If you do nap, it’s better to keep it short (45 minutes or less) and before 5 p.m.

9) Make your evening meal early, and light.


Finish dinner at least two hours before bedtime and avoid foods that cause indigestion and reflux.  Eating early and lightly in the evening also allows the body to “cool down” (from the metabolic heat of the digestion process) by bedtime…and cooler body temperatures “cue” the body for sleep.

10) Ditto with your evening fluids!

Drink water throughout the day, then not close to bedtime. This will help you stay hydrated enough not to wake thirsty, while also avoiding the need for nighttime trips to the bathroom.

11) Exercise wisely

Exercise in general can help you fall asleep faster and sleep more soundly. But vigorous exercise late in the day can be more stimulating than relaxing, so save that long run or Zumba class for the morning (or at least several hours before bedtime) and relax with a “restorative yoga” DVD instead.

12)  Follow through!

Some of these behaviors will be easier to include in your daily and nightly routine than others, and none of them may have immediate results. But if you persist with them, your chances of achieving restful sleep will definitely improve.

If sleep problems persist even so, try keeping a sleep diary on your own, and/or use a structured interview questionnaire to ask yourself the relevant questions, and see what they point to– you may be surprised at the associations you are able to make on your own. In addition, consulting with your primary care and/or a behavioral health provider (counselor) trained in sleep problems is always a good idea (clinical hypnosis, for instance, can be very effective). Your PCP can take steps to diagnose and treat what may an underlying medical issue contributing to sleeplessness (there are many that do). And a behavioral health care provider can help you to further identify mental, emotional or behavioral factors, and to plan behavioral strategies that can lead to better sleep.

Sweet dreams…


I have been thinking a lot lately about breathing.

I think about it a lot anyway, since “mindful breathing” is so much at the center of both yoga practice and emotional stress relief techniques, and my work involves one or both of these every day.

But between the many days of smoky air this summer, and a cold I am still fighting as I write, I have been especially aware of how much I, at least, can take breathing itself for granted, not to mention the fresh, clean air that Oregonians enjoy more of than many people do, and which is so important to health.

I’ve also been interested in the growing number of personal accounts from people in our community about the benefits —some gradual, some rapid— experienced as a result of actually using the breathing skills learned in yoga, say, or in a community “Feeling Good” class. One person tells of the profound effects she has noticed on her long-time depression, not eliminating it completely, but very noticeably lightening her “baseline” mood level on a daily basis. Another tells of being able to literally breathe a severe headache away, by using one of the specific techniques she had learned.

And while there are plenty of tools and activities that relieve stress, isn’t it good to know and to (even more important:) remember that perhaps the most powerful of these (and the one that makes the others work anyway) is not something “out there” somewhere to buy or to do; it is literally as close as our own breath.

In addition to its benefits to mood and emotional stress, it turns out that deep, directed breathing has direct and powerful effects on cardiac function, brain function, digestion, and immune system  health— and maybe even the expression of genes (that last one I won’t go into here, but it’s pretty interesting stuff!).

According to a physician in the Cleveland Clinic’s Center for Integrative Medicine, numerous scientific studies have shown that people experiencing even such chronic and severe conditions as asthma, heart disease, and chronic obstructive pulmonary disease benefit from breathing practices, often to a profound degree.

But what western science and medicine are just now coming to understand and appreciate about the importance of breath work, eastern medicine systems (Chinese medicine and Indian Ayurveda, among others) have known for centuries. In yoga, practitioners regularly use “pranayama” (which literally means “control of the life force”) breathing as a tool for affecting both the mind and body. Certain breath techniques are energizing, others are relaxing, others affect our experience of pain; others support the harmonious operation of the various bodily systems keep us feeling “in balance.” There are literally scores of specific breathing practices which can be used for these or other specific purposes. Some of these can be learned on one’s own (with a book or cd, for instance); some are so powerful that it is best to work with a teacher or other experienced practitioner, to learn the right technique.

But more importantly, intentional breathing techniques can be used as a method to train the body’s reaction to stressful situations and dampen the production of harmful stress hormones. As described in an earlier column, this is because the way we breathe either stimulates and maintains the activation of our sympathetic nervous system (the “fight or flight” response which is activated by stress) or our . parasympathetic nervous system, which is the one that calms us down.

If you are over 60 or so, you may remember the book “The Relaxation Response”, which Harvard researcher Herbert Benson published in 1975. In the book Benson describes and demonstrates how short periods of meditation which focus on the breath can profoundly alter the body’s stress responses. While there has been a lot more research and many more books published on the topic since, Benson’s is probably still as good as any: easy to find, easy to read, and only more, not less, relevant in 2017!

Needless to say, breathing is not a cure-all to every medical and behavioral problem. But I would also argue that it is and excellent place to start with addressing any and all of them, given how powerful it is in influencing our immediate reactions and long-term well-being. And best of all, it’s free, and literally right there under your nose!



Caring for Someone With a Serious Mental Illness

While a lot of joking goes on in our community (and our society in general) about mental illness, actually having a serious mental illness is no laughing matter. On the contrary, it is a form of suffering that those of us lucky enough never to experience it cannot begin to imagine…and I’ll bet we would not make scornful jokes about it if we did.

If you are someone who looks after an adult family member with a serious mental illness (SMI), or are close to someone who does, you know how complicated and stressful that, too, can be. It can also feel incredibly lonely, in part because the demands of caregiving can be so consuming. And since an individual with SMI may not able to participate successfully in social situations, family members and other caregivers can find themselves socially isolated by —and with—the limitations created by the illness. Parents may irrationally blame themselves for the illness itself, and/or fear both the judgement and well-meaning advice of others—judgement and advice which unfortunately may be exactly what they receive, and which may just add pressure (“however much you are doing, you should do something more”) and/or shame to the game. As a result, many people are reluctant to talk openly about their situation.635983291937039786-276024670_Mental-Illness

The fact is, family members and others who are responsible for adults with a serious mental illness face intense, persistent, and often insoluble challenges in providing appropriate support for the person with the disorder, and the wear and tear over a lifetime can be substantial.

As with other chronic illnesses, SMI which begins in childhood affects the course of a child’s development in other areas (physical, social, and emotional), resulting in limitations and/or eccentricities in the way they function as adults. The illness can also put severe strain on the family system, since families often become organized around the needs and behaviors of the mentally ill child. These needs and demands may persistently require more of the family’s resources (of time, attention, money and energy), which can leave other children feeling neglected, with effects on the family system that persist over time. In addition, outside childcare can be hard to find, since coping with the behaviors and needs of a mentally-ill child takes more skill, wisdom and patience than the average neighborhood babysitter is likely to have! As a result parents may find themselves with no time away from caregiving to replenish their personal energy and refresh their own relationship. Adult siblings may feel torn between the needs of their own partners and children, and the needs of the sibling that requires ongoing care.

Single parents coping with adult children with SMI have their own unique challenges, especially as they themselves age, since they are often facing both a present with no-one to share the load, and an uncertain future with respect to their own potential care needs.

When it is the parent himself or herself who is the one with SMI, that person’s child may become (by necessity) exceptionally resourceful and “tuned in” to the needs of others, but at the cost of being able to feel safe and at ease in the world, since she may have needed, from early on, to not only make sure her own needs for safety and security were met, but also those of the adults in her family. As an adult, this child may find herself continuing to be responsible for the welfare of a parent who becomes increasingly less able to cope.

For some adults with SMI, the combination of medication and other treatments with family and community supports are stabilizing enough that the person with the illness is able to function independently and well. For others, SMI (which includes, by the way, such conditions as schizophrenia and other psychotic disorders, some more severe forms of bipolar disorder, traumatic brain injury, and dementia disorders) simply does not respond to medication or other kinds of available treatment. And for some, medication calms symptoms but comes with side effects that the person is unwilling to accept.

For these reasons, the circumstance of a severe mental illness in a family member is something that can most often only be managed, not “fixed”. And the list of associated strains is long: one website devoted to the topic listed 28 individual “major stressors” that family caregivers may experience…for a start.

Fortunately, there is help available for family members and other caregivers of adults with SMI. While behavioral counseling can be of use for individuals with severe forms of mental illness, counseling can often be most helpful in assisting family members in meeting their own caregiving and coping challenges, and in understanding that SMI is not their fault!

As with everything, there is a lots of good information available online. The American Psychological Association website (www.apa.org) includes a “Caregiver Briefcase Homepage,” along with other educational information and links to many other support resources.

One of the most important resources to be found there is The National Alliance on Mental Illness (NAMI) which has a chapter in Oregon. By its own description, NAMI is the largest education, support and advocacy organization on mental  health in the nation, its mission being “to improve the quality of life of persons with mental illness and their families through support, education and advocacy.” There are currently two NAMI “friends and family” groups active in the Columbia Gorge: one which meets the 1st Thursday of every month  from 6-7:30 pm at One Community Health Center (1040 Weber St.) in The Dalles, and one which meets in Hood River on the 4th Saturday of every month from 10-11:30 a.m. at the Hood River Public Library (502 State St). For more information about NAMI Oregon, call the NAMI Oregon support line at 800-343-6264.

And if you are someone you know is interested in starting a “friends and family”  NAMI group in South Wasco County (I’ve been thinking about this), email me at canyonwrenwellness@gmail.com.

Do you have a topic you’d like to see addressed in this column, or other comments? I’d be glad to hear from you! email me at the address above, or you can leave a voice message at 503-838-6144. For more information about my therapy practice, visit therapist directory webpage or www.donnahendersonlcsw.com

And if you are interested in my new creative arts website, you can find that at www.donnacatehenderson.com

“An American Sickness:” News We Can Use

I don’t know anyone who isn’t distressed these days about the state of our American healthcare system, and the uncertainties about its future. We may hold differing opinions about what needs to be done to solve skyrocketing healthcare costs and unequal access to services, but what we all share is the worry: worry that we or our loved ones might, at any moment, be faced with an urgent health care need we won’t have the resources to meet, or insurance that we will no longer be able to afford, or that proposed new legislation (this seems to change daily) will allow insurers to once again refuse to cover the conditions for which we most need coverage in the first place.

In fact, many if not most of us have some kind of horror story already: maybe about being surprised by a six-figure bill for an emergency surgery procedure for which our insurance denied coverage (or for which we were uninsured); maybe we have our own equivalent of the “$2000 Bandaid” story in which a patient’s insurer was charged $2000 for an emergency room application of a Bandaid to a cut finger (the patient’s portion for the Bandaid was $200).

And when I say “I don’t know anyone who isn’t distressed,” I include myself. Maybe, like me, a large part of your distress has been a result of the belief (for me until recently) that it is all too enormous and complicated a problem to understand. Which belief has left many of us feeling helpless, bewildered and frustrated, with no clear sense of how to take effective action. Leaving us, in short, both stressed and distressed.

As you may remember from my previous columns, “stress” itself is actually a normal part of living, and not actually a problem. In fact, we need stress to motivate us to solve problems (“stress” is the feeling that lets us know that there even is “a problem”!), and it is stress that triggers the body’s immune system to attack viruses and bacteria. But stress becomes distress in the absence of the information, means, or motivation to take the kind of action that allows us to respond effectively to the “signal” of stress…and it is persistent distress that hurts our health.

So recently, when some friends gave me a copy of An American Sickness (subtitle: “How Healthcare Became Big Business and How You Can Take it Back”),  I was initially hesitant to even open the book, afraid (I admit) of simply feeling even more overwhelmed by the scale and scope of the healthcare mess than I already felt.

410kNvpsHYL._SX327_BO1,204,203,200_But since the book had been a gift, I thought I owed our friends the courtesy of at least starting it, so that I could say I’d tried to read it…

So I did start reading… and soon found myself reading…and reading…and reading. I am so glad I did.

Written by Dr. Elizabeth Rosenthal, who is both an MD and a long-time New York Times journalist, An American Sickness is a fascinating explanation (which reads like an exceptionally detailed “whodunit” ) of how the American health care system –which is made up of hospitals, insurance companies, physicians and drug companies– has gone from where it started (as a caring, not-for-profit industry with patients’ best interests at heart) to where it is today (a highly profitable, basically unregulated industry pursuing maximum profits at patients’ expense). 

While the details contained in the book are not likely to put any reader at greater ease, still, knowledge is power. For me, just having so much clearer an understanding of where we are and how we got here has been an antidote to my distress, by providing the information necessary to take action (instead of just feeling “reaction”), as a patient and as a citizen.HCCH_HDR

The thing is, the American healthcare system is one big machine, with many interlocking and interdependent parts. And as any mechanic knows, understanding how the machine works is the first step in figuring out how to work on it. Happily, this book includes sections at the end with concrete tools for ways that we as individuals can do just that, whether that be at the level of political lobbying, or when signing agreements or questioning charges regarding personal health care…since (as Rosenthal points out), a lot of the overcharging that goes on, goes on because it remains unquestioned and undisputed, including by consumers.  


As described in the book jacket,

This is about what we can do, as individual patients,

both to navigate the maze that is American healthcare

and also to demand far-reaching reform.

But don’t take my word for it— give it a read! Widely available through library systems, your local, independent bookstore, and (if you must:) online.

“Getting to Know You…” (…the veterans among us, that is)

In my May, 2015 blog post I wrote specifically about the topic of post-traumatic stress and military veterans.

But PTS and other service-related injuries are not the only challenges that returning veterans face. For all service members, returning to American civilian life means reentering a society in which the norms, values and training of military culture itself (loyalty, respect, duty, “service before self,” honor, integrity, tradition, and personal courage) are at odds with the values of the society that our military exists to protect: a society which values individual (above group) goals and interests, competition over cooperation, relief from pain over endurance of pain, and personal expression over personal restraint.

As a result, service members returning to civilian life can feel a profound sense of alienation from the very culture they have dedicated their lives to defending and protecting.

060522-F-3109T-1258 U.S. Air Force Lt. Col. Robert Ammon’s children run to him as he arrives in South Burlington, Vt., on May 22, 2006. Ammon is returning after deploying to Iraq. DoD photo by Master Sgt. Rob Trubia, U.S. Air Force. (Released)

For many veterans, the resulting “culture shock” of coming home brings with feelings of disorientation, loneliness and anger, for reasons that civilians may have no way to understand. Add post-traumatic stress to the picture and you’re looking at a world of lonely pain. As one veteran described it to me, “So when some guy cuts me off in traffic, and it sets off HUGE road rage, part if it might be my PTS that’s getting triggered, sure, but part of what gets triggered is moral rage! It’s like, ‘That guy just made his personal desire to get ahead more important than me and everyone else on the road…and that is just so wrong!’”

So what can we civilians do to more genuinely welcome, honor and better understand the veterans among us? Thanking them for their service is an important gesture, to be sure. But we owe them much more: we owe them our active engagement in the ongoing challenges of “coming home.” That might mean learning about and connecting vets and active service members with the kinds of resources available to help them retrain for civilian life, to connect with other vets, and to heal the wounds of war. But it also means actively educating ourselves on military culture and experience.

How? Like with everything these days, there’s lots of information available online at the click of a cursor. But the best way to make that education personal and meaningful is to ask a veteran or service member you know to teach you something about the military experience, from the point of view of their own. While many veterans are reluctant to respond to idle curiosity (and sometimes tactless questions) about their experiences, the same ones may be glad to talk about it with a truly interested, open civilian listener.Co-Counselling_(CCI)_counsellor_on_the_left_SS

And by letting the veteran or service member take and keep control of the conversation, we are likely to receive answers to much better questions than we could ever think of to ask anyway. (For some great examples of how not to start that conversation, check out the YouTube video  “Shit Civilians Say to Veterans” (https://www.youtube.com/watch?v=T4Esni1RbwU).

As for resources available for vets with transition challenges and service-related injuries: an increasing number of governmental and private, non-profit organizations offer a range of healing and support services for combat veterans and their families, many of them at low or no cost. In each Oregon county, the Veteran’s Support Office (V.S.O.) for that county (V.S.O.s are county government services independent of the V.A.) helps veterans with everything from navigating the VA to connecting with the growing number of education, health, recreation, counseling, financial and other support services available in our local area. For post 9/11-deployed war zone veterans in Oregon and Southwest Washington, the “Returning Veterans Project” (“RVP”) based in Portland provides free (yes, FREE!) counseling and other health services. Similarly, “Give An Hour,” a national non-profit organization, offers free, confidential mental health services to any veteran, active-duty service member, and/or family member who requests services through their organization. In the case of both Give an Hour and RVP, services are donated by licensed professionals with practices in the community (I volunteer with both organizations). For more information and to request services through either organization, visit http://www.returningveterans.org/ or www.giveanhour.org.

There is also a growing number of “veterans-helping-veterans” organizations, both national and local. In Wasco County, the just-established “Outside the Wire” project (which has its own space now in The Dalles Civic Center) is creating opportunities for veterans to come together for creative activity and fun. The project’s band, Got Your Six,  plays at the Oregon Veterans’ Home in The Dalles each 2nd and 4th Thursday of the IMG_0625month at 6:00, and the public is welcome. And in Maupin, the annual Poker Run benefit for veterans (June 10 this year; see the notice in the Chamber of Commerce column) is a great way for veterans to enjoy some food and fun together, while raising money for programs which directly support their health and well-being.

If you are a civilian friend or family member of a veteran reading this, consider making a deliberate effort to invite a conversation— not just to satisfy your curiosity, but with the intent of being educated beyond the comfort zone of your preconceptions.

If you are a veteran, I ask for your patience: we civilians may need you to help us to even identify what we need to know, beyond the maybe-thoughtless questions we ask. Thank you for that patience…and truly, for your service.