David Chapel Missionary Baptist Church�“Mental Health as Part of the Healthy Body: Physical, Spiritual and Mental”�May 29, 2024�

Presented by Nanci Silver Boice, M.Ed., M.A.,

LMFT-S, LPC-S

�Clinical Director at the Austin Center for Grief & Loss

Outline

• The Brain and what it does
• How to help the Brain adjust – think about yourself, evaluate yourself, make a plan, take action, self-care
• Mental health in three groups: Men, Women, and Children
• Loss, Grief and Trauma and self-care
• Ambiguous and disenfranchised Grief

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What the Ancient Greeks said:

• The Ancient Greeks had a saying that went something like this: “what you believe is what you think, and what you think is what you do”.

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• The Church is the “belief” part.
• The Brain is the “think” part.
• The Body is the “do” part.

The Brain

• Through the technology called Functional magnetic resonance imaging (FMRI) that measures the small changes in blood flow that occur with brain activity we can examine which parts of the brain are handling critical functions, evaluate the effects of stroke or other disease, or guide brain treatment. we can see how our brains react to grief, to addictive substances, to depression, to gambling, to the release of hormones when we are scared or angry or sad or threatened and so much more. We can see that a “bad day” is not always about an attitude; it may also be about changes in the Brain.

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Brain Mapping

• Your doctor may order an fMRI to: Determine which part of the brain is handling critical functions such as thought, speech, movement, and sensation, which is called brain mapping. Studying which parts of the brain are involved in certain functions of our body is called functional anatomy.
• The Brain is a learner. It learns through repetition and habit.
• It experiences in time, space, and laying down new pathways.

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Brain learning

• For example, when your partner or spouse or the person for whom you are providing long term care dies, your brain looks different on FMRI films. The Brain learns patterns and predictability and the Brain does not like it when things change, or someone is missing from its Map.
• “Grief Brain” is a very real physical change in the brain. Changing the Brain takes time – we might call that the adjustment period for loss and grief. When someone is trying to stop an addiction, it takes the Brain months to learn new patterns of existing. This is why we say that it takes at least 90 days to break a habit.
• When we suffer from chronic sadness, depression, anxiety, chronic abuse, or trauma, the Brain knows and tries to adjust.

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What can we do to help the Brain adjust, heal, adapt? How do we help ourselves and others?�

1. Take time to think about yourself and what you are feeling or thinking.

• Ask: Are the feelings or thoughts new for you? Has something changed in your life? Have you finally reached a point where the burdens are overwhelming? Are your friends asking you “what’s wrong” or saying, “you are different”?

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What can we do to help the brain, continued:

2. Evaluate yourself:

• Has your sleep changed? Have your eating patterns changed? Are you feeling more “edgy” or are you more easily snapping at other people? Are you feeling tired more often and for longer periods of time? Are you going about your daily routine or has that changed? Have your thoughts about yourself changed? How are you handling the small hurdles and annoyances? Has that changed? Are you more impatient? Are you drinking more alcohol or taking more over the counter medication?

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Helping the brain - continued:

Prepare to Act:

• Ask your friends or an honest family member to help you evaluate yourself. Only ask those people who you know to be honest, wise, and kind. We don’t need judgement when we are working on our mental health or our Brains.
• Make a list of what is going on in your life; include small changes because the small adds up to the big. Do you have new responsibilities such as caring for a child, a spouse or partner, an elderly family member or a chronically ill person. Have you been in an accident or been injured? Are you in physical pain? Has your medication changed?
• Temporary changes can be handled with the help of family and friends. Permanent changes require a plan.

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Helping the brain - continued

Action:

a. Go see your trusted medical health care provider. There are physical issues that can masquerade as a mental health issue. For example, although heart disease is a leading cause of death in women, a number of women never receive proper evaluation or assessment. They are medicated with medication for anxiety or panic attacks when the real issue might be that they are experiencing AFib. Atrial fibrillation is a heart condition that causes an irregular and often abnormally fast heart rate – the same symptoms of anxiety or a panic attack.

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Previous diagnoses and caring for the brain

If you have been diagnosed with mental health condition, and you are under the care of a medical care provider, check in with your pharmacist. Pharmacists are trained professionals who can tell you if what you may be experiencing is a side effect of a drug. Continue to ask until you are respected and understood.

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Self Care = Mental Health Care

Taking care of your mental health also means taking care of your physical health.

• - go outside for at least 10 minutes each day
• -ask someone else to sit with the person for whom you care
• -participate in a hobby such as gardening, singing, or doing a craft. These activities stimulate both sides of the brain and lay down new neuro pathways.

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Laughter!!

“Laughter is the best medicine” This old axiom is supported by current mental health research. Laughter changes body chemistry and brain function. It increases heart and respiratory rates and oxygen intake. Laughter lowers the levels of the stress hormone, cortisol. After these initial changes, a person moves into a state of relaxation. While these effects may not be equivalent to aerobic exercise, they are beneficial: 10-15 minutes of laughter per day may burn 10-40 extra calories Watch a funny movie, tell jokes, watch cartoons, laugh at your own mistakes, laugh with friends!

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Favorite Joke

• Where do you put a noisy dog? In a barking lot”

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Self care - continued

• use services such as AGE of Central Texas adult daycare for the elderly
• -breath deeply, move your arms up and down and around, lift each leg and twirl your ankles
• -change one thing about your eating or consumption of alcohol
• -ash for help and be specific about what you want and need.
• -learn to say, “no” Saying “no” is mental health care!

Men and Mental Health and Self Care

• Much of the old stigma around seeking a mental health care professional has dissipated. However, in some communities and cultures, men are still resistant to asking for assistance. At the same time, we put a lot of pressure on men to reach a certain standard in their lives. If you identify as male, or if you have a male friend, or someone you love, I would coach you to encourage them when they are feeling angry, overwhelmed, undervalued, depressed, unfulfilled, lonely, …. Talk with them and seek solid guidance. The YWCA and the YMCA have programs for men. We offer a men’s loss support group. AGE of Central Texas offers information, referrals, and programs for older men.

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Men and Mental Health and Self Care

• , “I’m Fine: How to talk to the men in your life about their mental health.” When talking to men about their mental health, try the following ways to get a man to talk:
• -directly acknowledge a difficult situation When we are worried about our own or someone else’s mental health, it is not the time to beat around the bush. When the person says, “I’m fine”, ask again.
• “No, really, how are you? I care about you.”
• “Research has found that when asked, 78% of people say that they’re fine even if they’re struggling with a mental health problem. Concerns like doubting whether people really want to hear the honest answer and not wanting to burden others were cited as the main reasons people avoided these conversations. However, that second ask might be the opening someone has been waiting for to finally talk about it.”

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Men and Mental Health and Self Care

• “If you begin to notice warning signs in yourself or others such as substance abuse or addiction, increased risk-taking behavior, a loss of interest in passions or hobbies, and changes in diet or routine, it might be time to get professional help. Organizations like Heads Up Guys offer free online depression self-check tools to help you identify warning signs.

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Women and Mental Health and Self Care

1. How do we grow and discover with how grace and resilience,

2. The importance of social connections: These relationships can provide emotional sustenance, practical assistance, and a sense of purpose and belonging.

3. Embracing change and adapting to new realities: Embrace changes with an open mind and cultivate flexibility and resilience in responding to new realities.

4. Self-care and prioritizing personal well-being: Self-care and prioritizing one's own well-being is very important for all of us and especially for those who care for someone else. This includes maintaining healthy habits, seeking out fulfilling activities, and setting boundaries to protect our physical and emotional health.

5. Cultivating a positive mindset and attitude: Adopt a positive mindset and attitude, emphasize the power of optimism, gratitude, and resilience in facing life's challenges. Approach aging with a sense of purpose and positivity.

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Loss, Grief, and Trauma

Loss and Grief are Normal and Universal. We are all in this together.

Ambiguous / Disenfranchized Loss and Grief

?Ambiguous loss is a person's profound sense of loss and sadness that is not associated with a death of a loved one. It can be a loss of emotional connection when a person's physical presence remains, or when that emotional connection remains but a physical connection is lost. Often, there isn't a sense of closure.”

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Ambiguous Loss or Disenfranchized Grief

• 1. a move due to company job transfer
• 2. a move necessitated by military service
• 3. estrangement from a parent or from a person to whom the grieving person was previously close
• 4. the transition of a child from living in the home to living at college or getting married or finding a life partner
• 5. transitioning from one school to another
• 6. family estrangement
• 7. job transitions or changes in your place of employment; perhaps new leadership

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Ambiguous Loss and Disenfranchized Grief

8. incarceration of a loved one or friend?

9. migrant families who move, experience isolation, fear, and the children must reestablish connections in schools

10. a sense of loss due to prejudice, bigotry, or discrimination?

11. retirement

12. taking on the care of another adult

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What does ambiguous loss feel like?

• Ambiguous loss can feel lonely, stressful, and confusing. Feelings need to be validated and the significance of the experience recognized. However, there is often no formal recognition from others that a loss has occurred — or if others do acknowledge it, they show no recognition that it is of any major significance. You or your family may have intense sorrow, numbness, bitterness, persistent longing, pain, rumination, guilt.
• Notice the same symptoms as death grief.

Scenarios of Ambiguous Loss and Grief

1. Goodbye without physically leaving – physically alive not emotionally or relationally part of your life.

This happens when the person you are grieving is physically alive but not emotionally or relationally part of your life. Examples include divorce, estrangement, incarceration, relocating to a new country or a chronic illness like dementia. The relationship you had with the person is over or substantially changed. This can result from your decisions or be a situation entirely outside of your control.

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Scenarios of Ambiguous Loss and Grief

2. Leaving without a goodbye

• You may mourn a person who is physically gone under circumstances where you are unsure if they are dead or alive.
• Example, the person may have an addiction that leads to abandonment or a missing person scenario. These situations are difficult because you can’t say your farewells. There may not be a traditional funeral or another mourning period, which can lead to a lack of closure. This sense of loss is also experienced by children when a parent leaves the family due to a divorce.

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Scenarios of Loss and Grief

3. Situational goodbye

Sometimes, feelings of ambiguous loss aren't due to a relationship change but occur because of other situations. They could affect you personally or occur elsewhere in your community or in the country or world but cause significant feelings of loss in your life. This could include the COVID-19 pandemic, a change in future plans, natural disasters, political unrest or a loss of financial or personal security.

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What to do with Ambiguous Loss and Grief

• Don’t try to solve it or make it “go away”. Your body and brain need to sit with your grief. You need space and time.
• Take time to ask, to Listen, to identify, to Affirm, to Encourage
• Ask: “Is there something that you need me to listen to today? I can sit and listen.”
• Remember, ask a second time, and a third time.

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Ambiguous Loss and Grief in Children

• Sometimes children and teenagers will exhibit behaviors and attitudes that do not appear to be signs of grief.
• By broadening our thoughts about what ambiguous loss might be for a child, we might be able to help the child process the loss and handle the grief.
• Examples of situations that might cause ambiguous loss and unidentified grief in a child or teenager:
• 1. bullying
• 2. a best friend moves away or joins a different friend group
• 3. the child does not “make the team” or get a role in a school play

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Ambiguous Loss and Grief in Children

• 4. the child’s adult confidant or friend is ill or has developed dementia
• 5. the child’s sibling leaves for college
• 6. a parent begins to travel more than usual for a job or a parent is deployed
• A child has little control over his/ her life and will often not be able to pinpoint their feelings unless an adult is willing to ask and to listen. Additionally, children don’t understand that they might feel lonely, lost, isolated, or sad through no fault of their own.

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Grief Tools for all types of Loss and Grief

• Forget the old “stages of grief” model. Dr. Kubler-Ross never addressed the grief after death. Her research was with people who were in the process of dying.

Tools: The Grief Wheel

Loss and reorientation theory – Dual Process Model�

Narrative theory of grief

We grieve differently based on our personal traits, our experience, our perceptions, the event, our culture, our history, our families, our own stories of life.

Narrative theory allows us to tell our story and our experience with death, loss, grief and trauma. It allows each of us to find power in our story and to identify the things that allow us to move through loss and grief; to hold close those things that we choose to hold close and to cast off the things we choose to cast off.

Narrative work is respectful because it allows each person to tell his/her/their story in the space and time that fits that person.

Narrative theory example

• “My father died when I was five. He died in an airplane accident. He died doing what he loved and how he wanted to be remembered. Even today, I really miss him and his laughter and kindness. He never met a stranger. When I go to the airport, I look at people and send best wishes to them that they might also die doing what they love to do.”

This person is telling their story. They control the narrative, and they control what emotions they want to attach to their story and what character traits they want to attach to their father. It is based in absolute reality; there is no wishy-washy thought process or “feel good”, “be happy” language. The person has taken back their power to tell their own story.

Happiness Psychology & Positive Psychology�

• Martin Seligman, PhD states that he feels the main problem with psychology is the focus on pathology and the neglect of focus on ways to improve the lives of everyday people . The focus in Positive Psychology is not on one’s mood but is on “well being”. PERMAH
• Positive Emptions
• Engagement
• Relationships
• Meaning and Purpose
• Accomplishment
• Health ( added by Rhonda O’Cana)

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Positive psychology theory

• This is a mind, body, soul, emotion theory. It uses all of the attributes of being human to look at death – a normal and universal experience.
• It encourages the living to use all of their qualities as they walk through life without the physical presence of the deceased.
• Positive Emptions - when you feel positive, use those emotions
• Engagement – social engagement with others and with self
• Relationships – family, friends
• Meaning and Purpose – discover yourself at this new phase of life
• Accomplishment – what are your strengths and how can you use them
• Health – take care of the body

How do we move experience loss & grief?

• People follow different paths through the grieving experience. There is no right or wrong way to grieve. There are no specific phases. The so called “stages are not linear; they occur in waves or in cycles like a slinky.

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Identify your loss

• This is step one. Identify your loss.
• It's important to validate your ambiguous loss. One way to do this is to write down everything in your life that has changed or will change due to your loss. Nothing is too small to include. Don't minimize your list, as that can short-circuit your journey. A list for a parental estrangement may include wedding dress shopping together, sending Mother's Day cards or holiday gifts, having inside jokes and more. The list for an incarcerated loved one may include lost holidays and milestones, vacations, daily conversations, and physical intimacy. The list for a loved one suffering from dementia may include planned trips, sharing holidays, living in the same place and shared memories. When you are done with your list, share it with a trusted friend, family member or mental health counselor.

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Recognize multiple emotions

During the grieving process, many people experience multiple emotions simultaneously. You can feel relieved to have your divorce finalized but saddened over the loss of the future you envisioned. A loved one's dementia diagnosis can make you distressed, even as you welcome the opportunity to spend more quality time together and continue to visit often.

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Don’t compare; don’t judge yourself

It's impossible to compare emotions because people aren't simple or the same. There are many variables or contributing factors that are more or less important to each person. It's not helpful to minimize your grief because your situation doesn't include death.

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Grieving can be compounded

• . For example, a person could be moving a child to college, caring for an ill family member, and coming to terms with an estranged loved one. Separately, these situations may be manageable, but when they happen simultaneously, the person could struggle with deep feelings of ambiguous loss.

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Consider ceremonies

When there is a physical death, it's common for the community to gather to pay tribute to the lost person and lend support to those grieving. Traditions vary, but there is usually a memorial service, sharing of meals and retelling of happy memories. While full closure may not be possible with ambiguous loss, ceremonial activities can provide therapeutic benefits. You could write a letter to the person, plant a tree, donate money or time, host a remembrance ceremony or do other meaningful activities. A mental health counselor can help you find a creative way to process your loss through such ceremonies.

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Seek support

People aren't meant to carry their emotions alone. Most need others to help them work through their feelings and move forward. Family members, friends, social support groups and your faith community are good resources to help you work through your feelings. You may be able to find a support group focused on a particular type of ambiguous loss, such as divorce, estrangement, addiction, or missing persons. Professional counseling can help you explore your emotions and develop healthy coping skills.

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Your toolbox for ambiguous loss & grief

• Go outside! More and more research supports the positive effects of fresh air and sunshine on the brain. As care givers, our brains need a reset, a restart, a refreshing moment.
• Reward your brain with nutritional foods.
• Use Positive Psychology - every time you think of a thorn, think of a rose in the situation; tell a friend about a positive in the day and overshare it to allow the experience to be fixed in your brain; smile at another person three times each day.
• Disenfranchised grief – monitor yourself. You are entitled to grieve.
• Create practices that encourage happiness: write a gratitude letter, develop a forgiving attitude towards yourself and others, perform a random act of kindness, buy a friend a cup of coffee, walk outside, think of three good things that happened that week.

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Thank you

Thank you for caring for others and for caring for yourself. You are valued, respected, and acknowledged.

How to contact me:

Nanci Silver-Boice, M.Ed., M.A., LMFT-S, LPC-S

(she/ her)

Clinical Director

The Austin Center for Grief & Loss

nboice@austingrief.org

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References

• Rich Oswald is a psychotherapist in Psychiatry & Psychology in Eau Claire and Menomonie, Wisconsin.
• https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/coping-with-ambiguous-grief
• https://www.healthline.com/health/mental-health/disenfranchised-grief#examples
• The Montana Happiness Project – John Sommers-Flanagan, Risa Sommers- Flanagan, Salois, and Wright
• Work of Venna Prasad, PhD, LPC at The University of Texas Health Sciences Center at San Antonio
• Martin Seligman’s work “Flourish” and his 2004 TED Talk. Director of Penn Positive Psychology Center at the Univ. of Pennsylvania.
• Rhonda O’Cana, LPC-S, Palo Alto College in San Antonio.

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References

• Substance Abuse and Mental Health Services Administration’s Wellness initiative
• Counseling Today Magazine, “Happy Days” by Lisa R. Rhodes, Jan. 18, 2024.
• Dr. Patrick O’Malley, “Getting Grief Right” book and article in New York Times, “Getting Grief Right”
• Sonja Lyubomirsky , PhD, her presentation on Happiness at the Happiness@Work conference in 2018
• Understanding Your Grief, Alan D. Wolfelt In this book, first published in 1992, Dr. Wolfelt offers concrete steps toward healing.

References

• It’s OK That You’re Not OK, by Megan Devine
• Man’s Search for Meaning, by Viktor E. Frankl
• A Heart That Works, by Rob Delaney Rob Delaney’s son was diagnosed with a brain tumor as a 1-year-old and died two and a half years later.
• Notes on Grief, by Chimamanda Ngozi Adichie
• The Year of Magical Thinking, by Joan Didion
• Sad Book, by Michael Rosen, illustrated by Quentin Blake
• Books for children: Not the End by Mari Dombkwski, Illustrated by Nazzar Horokhivskyi
• Attic Day by Jean Havina-Madsen, Blue Balloon Books
• The Invisible String by Patrice Karst, illustrated by Joanne Lew-Vriethoff

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Resources

• AGE of Central Texas – services for the Elderly https://ageofcentraltx.org/  
• AGE does not do therapy but they have tons of help for elderly and caregivers, including adult day care centers 
•  
•  Please call 911 or go to your nearest emergency room. 
•  �If you live in Travis County, please contact: 
• � HELP line Integral Care: 512-472-4357 – 24/7 walk in crisis care 
• �Travis County Crisis Intervention Team: 512-854-3430 
• �APD Austin Crisis Intervention Team: 512-854-3450 
• �Crisis Text Line: Text TX to 512- 472-4357. 
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• Veterans Crisis Line at 800-273-8255, press 1. I 

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Resources

•  LGBTQIA+ call the Trevor Project Lifeline at 1-866-488-7386 or text START to 678-678.  

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• In the Austin, TX area, contact Austin-Travis County Psychiatric Emergency Services at (512) 472-HELP (512-472-4357). 

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• If you suspect human trafficking, call 911 and. call the Office of the Attorney General, Human Trafficking and Transnational/Organized Crime Section at 512-463-1646 or email at humantrafficking@oag.texas.gov. � National Human Trafficking hotline 888-373-7888 or text 233723 
• National Suicide Hotline – keep calling back! They will get to you, but they are handling many calls. Do not give up! 988

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