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Wednesday, September 23, 2015

Learning to Practice Safe Stress: Understanding Key Challenges and Stressors for the Disability Community

Here is the link to the abbreviated version of my feature essay that appears in the Sep 2015, ENCV Declaration:  The Whole Health Issue.

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Here is the link to the entire essay:

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Learning to Practice Safe Stress: Understanding Key Challenges and Stressors for the Disability Community

by Mark Gorkin, MSW, LICSW (in consultation with Bob Rudney, author of the disability novel, Lovers Lame, and Director of EXCEL, a Disabilities/Career Support and Networking Group)


Shortly after a recent playful yet poignant "Practice Safe Stress" program for the disability advocacy organizations ENDependence Center of No. VA and EXCEL, I was asked to write a concise piece on "Stress Management," focusing on folks with disabilities. With no time and words to waste...first the “Stressors” (Part I) then the “Stress Resilience Skills and Strategies” (Part II).

Key Stressors

1. Daily Challenges and Obstacles. Having a disability by definition means facing tangible challenges and obstacles to performing daily activities. This not only involves the obvious physical infirmity and added routine/operational time and hassle, for many there's also the challenge of having a mostly "invisible" disability, e.g., depression or other psychological disorders, learning disabilities, internal medical condition, etc. It's often hard for the unaware to empathize when the person seems "healthy" or "normal."

2. Adult Onset vs. Congenital Diversity. Surely, being disabled from birth poses its own unique life challenges and learning curves. Naturally, this individual may have many years to come to terms with his or her medical-psychological condition. (Of course, many folks with invisible disabilities go mis- or undiagnosed well into adulthood.) However, becoming significantly impaired-injured if not immobilized by a stroke or car accident as an adult is an acute and profound life crisis and turning point. First there's extensive rehabilitation, fraught with arduous uncertainty. Then, not only the grief of the immediate trauma and compromised physical aptitudes, but also the pain surrounding loss of identity, self-worth, and sense of competence, or the agonizing comparison between a current and former self. (A novel that perceptively captures the different roads to disability is Bob Rudney's, Lovers Lame.)

3. Normal Stressors. The everyday challenges of work, finances, family and intimate relationships, raising kids, transportation and commuting, etc., are part of the normative experience of the disability community. However, the mundane reality is closer to stress on steroids. One example: the difficulty of both finding a job in a narrow (if not close-minded) job market as well as obstacles to getting to the job, especially when public transportation is scarce or unreliable. (For example, in the Greater DC Metro system, escalators and elevators, not to mention trains, are often out of service, turning a morning or evening commute into an adventure that not even Odysseus would envy.)

4. Social Relations and Isolation. Pursuing relationships may become a “partner accessibility” test, especially if getting out is a physical or psychological challenge. After a while, many forego making the effort. At the same time there's the perception of (if not judgment by) the larger community. Often lacking knowledge about the strengths and vulnerabilities of the disability collective, uneasy with apparent and assumed differences, a subtle or overt pattern of social exclusion, if not outright stigmatization, may become the norm. I recall a woman dependent on a motorized scooter for street motility frustrated by pedestrians who “envied her mode of transportation.” (FYI, Lovers Lame addresses many of these issues.)

5. Navigating Various Bureaucracies. Quick mind game for the non-disabled: How do you typically feel about having to go to the DMV to get a license, to register a new vehicle, or take an inspection test? Am I the only one whose stomach starts churning? Again imagine your stress level if you need to frequently engage with the medical, social service, vocational rehab, or HUD bureaucracies? Not only is the issue of “dependency on others” an ongoing role and relationship challenge, so too receiving conflicting directives from those perched on Mount Olympus.

Closing Summary

Five common stressors for the disability community have been identified: 1) Daily Challenges and Obstacles, 2) Adult Onset vs. Congenital Diversity, 3) Normal Stressors, 4) Social Relations and Isolation, and 5) Navigating Various Bureaucracies. Stay tuned for Part II: Skills and Strategies for Practicing Safe Stress!

Mark Gorkin, MSW, LICSW, "The Stress Doc" ™, a Licensed Clinical Social Worker, is a national keynote speaker and "Motivational Humorist" known for interactive, inspiring, and FUN programs for government agencies & major corporations. The Doc is a training and Stress Resilience Consultant for several national consulting firms. He has also led “Resilience, Team Building and Humor” programs for various branches of the Armed Services.  A former Stress and Violence Prevention Consultant for the US Postal Service, Mark is the author of Practice Safe Stress, The Four Faces of Anger, and Resiliency Rap. For more info on the Doc's "Practice Safe Stress" programs or to receive his free e-newsletter, email stressdoc@aol.com or call 301-875-2567.
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Skills and Strategies for Practicing Safe Stress!

by Mark Gorkin, MSW, LICSW (in consultation with Bob Rudney, author of the disability novel, Lovers Lame, and Director of EXCEL, a Disabilities/Career Support and Networking Group)


We have made strides in acknowledging our diversity as a culture and society.  We recently celebrated the 25th anniversary of the Americans with Disabilities Act.  Still, it's also vital to underscore that we are all more human than otherwise.  And this wisdom applies when highlighting Stress Resilience tools and techniques, that is, when extolling the importance of cultivating a mind-body mindset and methodology valuable for the disabled and the non-disabled alike.

However, I will note Two Stress Resilience Resources with which almost all having a disability can relate:

1.  Draw On Your Problem-Solving Skills.  People with disabilities are always figuring out every day “workarounds” – adaptive physical and/or psychological strategies and steps, shortcuts or tricks that challenge personal “limits” or situational “limitations.”  In fact, both anecdotal and research studies suggest that compensatory adaptations help fuel novel if not creative problem-solving.

2.  Grow through Grief.  When we have lost something valuable, something of our essence, there is a natural proclivity, if not mind-body survival instinct, to engage in some form of grief.  For example tears of grief (as opposed to tears induced by a cold, bitter wind) release stress toxins from our body.  I believe we may need to experience a process of feeling stuck, feeling inert, to rant and rage – often a cover for feeling hopeless and helpless – to arouse our most determined if not daring “dark night of the soul to mind-body-spirit rebirth.”  And often a person must hit bottom before he or she reaches out for psychological support and guidance.

Reflect upon my poetic passages.  (And by the way, some form of personal creative expression is a profound way of finding energy and meaning, purpose and passion in mind-body-spirit pain.)

Whether the loss is a key person, a desired position, or a powerful illusion, each deserves the respect of a mourning.  The pit in the stomach, the clenched fists and quivering jaw, the anguished sobs prove catalytic in time.  In mystical fashion, like spring upon winter, the seeds of dissolution bear fruitful renewal.

For the Phoenix to rise from the ashes
One must know the pain
To transform the fire to burning desire!

Now consider the Stress Doc's Natural SPEED Formula for Stress Resiliency and Brain Agility:

S = Sleep.  Don't be cheap with your need for sleep; it's nature's way to ebb and low to help you grow.  Chronic sleep disturbance not only impairs learning, memory, and performance, but research increasingly links it to conditions of obesity and diabetes, perhaps even dementia.  Create a relaxing sleep ritual before bedtime:  bathe or shower, listen to soothing music or sounds of nature, get into bed about the same time each evening, read for pleasure but don't do work in bed, and most important...turn off those darn technology gadgets and games!!!

P = Priorities.  In a world that bombards us with messages and constantly demands our attention and time, two skills are critical:
a) distinguishing urgent vs. important – remember, urgent is a life or death emergency; everything else can be prioritized; just because another feels “the sky is falling down,” doesn't make this person an objective or accurate forecaster.  Don't let another's false sense of urgency become your anxiety!  Especially when dealing with a head honcho, consider reframing his or her words:  “I know this is a very important problem or issue.  [You've more accurately described the situation, nor succumbed to emotional exaggeration.  Having a verbal counter is itself stress reducing.]  Because it is important, let's take five minutes to help me re-prioritize, so I will have the time and energy to devote to this project.”  Don't just continue to load more and more stuff on your plate.  Definitely a formula for stress indigestion!

b) importance of saying “No” – how comfortable are you saying “No” to friends, colleagues, and family?; a sign of adult maturity is knowing that there are circumstances when you may need to disappoint others...and it's okay.  It doesn't make you a bad or selfish person!  Remember, burnout is less a sign of failure and more that you likely gave yourself away!  My “Vital Lesson of the Four 'R's”:  If no matter what you do or how hard you try, Results, Rewards, Recognition, and Relief are not forthcoming and you can't say “No” or won't “let go”...(because you've invested so much time, identity, money, energy, and/or ego in one right person, position, or possible outcome) trouble awaits.  The groundwork is being laid for apathy, callousness, and despair!

Tips for saying “No”:  1) acknowledge the importance of the other's request, 2) quickly explain why your schedule, workload, energy level, etc. dictate you saying “No,” then either, say 3) while I can't help you with ABC, I might be able to help you DEF, that is, you are not slamming the door; you still want to be a team player, or 4) invite the person to call you back in a day or two to see if your availability has changed, 5) anticipate the other will not be happy with your new, boundary setting behavior; they may well attempt to shake your resolve, 6) concisely repeat your position; don't over-talk out of a sense of guilt (over-talking undermines your conviction; as if you still must explain or justify yourself).

N & N – “No & Negotiate” – ranks with “R & R” as a Stress Management tool!

Remember these two Stress Doc maxims:  A firm “No” a day keeps the ulcers away; and the hostilities, too!  and
Do know your limits and don't limit your “No's!”

P = Passion.  I'd like to reprise a word that for many is disappearing – “hobby.”  Do you engage in an activity that nurtures and stimulates your mind, body, and/or soul?...One that may or may not involve another individual.  And a hobby may have an even deeper resonance.  I recall my dad's journey.  He finally had enough of the doctor-recommended shock therapy treatment (that lasted for fifteen or so years) for a depressive breakdown and acute hospitalization.  (I was about two.)  He was able to work, had his struggles with family relations...and he finally had enough.  He broke from the family shroud of silence, got into psychotherapy, and never again needed shock treatment.  Fortunately, he reunited with the family and, in many ways, became a role model!

But his most daring mid-life exploration:  taking up tennis.  His older brother was a great athlete, and my father shied away from this competition.  Not necessarily a good strategy for an angry Type A New Yorka, juggling a father with alcohol issues and a mother suffering from chronic depression.  During this period of renewal, he dedicated himself to this avocation, always on the court, paying for lessons, even started coaching my mom; this was his new mid-life passion!  (He even quit smoking cold turkey when he realized that it contradicted his new lifestyle.)  Then one day he challenged his brother to a tennis match...And mid-life moment on the mountaintop – He WON!

But I don't share this story to parade the conquering hero.  Actually, IMHO, what was most heroic was his willingness to dig deep into his Pandora's Box and take on a hobby, a new learning curve, one that was historically fraught with memories and feelings of failure and shame.  He was able to “Confront the Intimate FOE:  Fear of Exposure!”  Perhaps the biggest take home:  through a new TnT energy source – Therapy and Tennis – my father was developing a new self-image and identity; he was turning long-standing pain into purpose and passion.  All I can say is, Amen and women to that!

E = Empathic Engagement.  As I once penned:

E is for the “empathy”
Found in a caring shoulder
But all give without take is a big mistake
For now you shoulder a boulder.

It's vital to have a “stress buddy,” someone in your corner, but one also mature enough to give you candid and constructive feedback; a person who can engage in real head and heart TLC, the Stress Doc variety:  Tender Loving Criticism and Tough loving Care!

The Truth Is Blind and Brash yet also Discriminates

Last year I spoke to the Texas Govt. Division of Blind Services.  About one-third of the 120 participants were blind or seriously vision-impaired.  This was a very new experience for me.  And in an informal social setting, a blind woman picked up on my discomfort.  She quickly said:  “Just be yourself.  Don't be afraid to say words or phrases like, 'I see.'  And if feeling unsure, ask questions.”  She definitely became a stress buddy.

The other social engagement quality observed was how these blind individuals employed a feisty humor both with their sighted partners and with blind colleagues, e.g., warning one another to “watch where you poke that walking/sensing pole.”  I believe this banter reflected a sense of owning one's disability and was a vital way of affirming a sense of self-efficacy and common humanity.

Of course, poking fun of one's flaws and foibles may be social context-dependent.  In a job interview, for example, Bob Rudney, suggests consciously and selectively using a playful touch.  While you are not obligated to disclose or talk about a disability, depending on your physical condition, you might lightly suggest that you may unintentionally do something awkward.  Most folks will be impressed by your candor and self-assurance, despite feeling anxious.  Also, be prepared to field questions; provide examples of successful problem-solving rather than disability diagnostics.  And engage the interviewer in joint problem-solving ideas when unsure, for example, of the strategic “accommodations” response.

E = Exercise. The benefit of regular exercise is both physical and psychological.  Of course, for the disability community there's a wide range of freedom of movement or lack thereof.  Even when significantly restricted there is a variety of yoga movements and precise or fine muscle exercises that have neurochemical effect.  You may not need to do thirty minutes of vigorous, non-stop, large muscle movement activity – brisk walking, swimming, dancing, etc. – to release brain chemicals like endorphin and dopamine, the mind-body's natural mood enhancers and pain relievers.  Research suggests adept practitioners of meditation induce this brain boost.  And remember, it's less a runner's or meditator's high and more that we can step back and see things with a calmer disposition and fresher perspective.

When stressed, everything feels up in the air.  The answer: to feel grounded.  There is nothing like a an exercise routine for creating a beginning and end point for a tangible sense of accomplishment and control.  Actually, you’re developing a “success ritual.”  And while I don’t always love to exercise, after my thirty-minute routine…well, I do like feeling virtuous.  ;-)

D = Diet. A diet high in saturated fats (red meat, whole milk products, fried oyster po-boys; having lived in New Orleans, I’m convinced the restaurants are owned by the cardiologists) and simple sugars (sodas, cookies and excess salt; sorry folks) induces drowsiness and mental torpor, not to mention clogged arteries.  And too much alcohol and caffeine is a roller coaster headache – moodiness or depression often follows aggression and agitation.  Balancing protein, fruits and vegetables, complex carbs, grains, nuts and sufficient water is vital for optimal energy and alertness along with cardiovascular health.  Remember, a mind is a terrible thing to waist! 

Closing Summary

Two general stress resilience steps and skills were introduced, ones especially familiar to the disability community:
1. Draw on Your Problem-Solving Skills
2. Grow through Grief

And then we outlined the Stress Doc's Formula for Natural SPEED:  Sleep-Priorities-Passion-Empathic Engagement-Exercise-Diet.  Are you prepared to take the plunge?  Are you ready to...Practice Safe Stress?

Mark Gorkin, MSW, LICSW, "The Stress Doc" ™, a Licensed Clinical Social Worker, is a national keynote speaker and "Motivational Humorist" known for interactive, inspiring, and FUN programs for government agencies & major corporations. The Doc is a training and Stress Resilience Consultant for several national consulting firms. He has also led “Resilience, Team Building and Humor” programs for various branches of the Armed Services.  A former Stress and Violence Prevention Consultant for the US Postal Service, Mark is the author of Practice Safe Stress, The Four Faces of Anger, and Resiliency Rap. For more info on the Doc's "Practice Safe Stress" programs or to receive his free e-newsletter, email stressdoc@aol.com or call 301-875-2567.