Managing Economic Stress on the Home

Front

Arthur Nielsen, MD

Department of Psychiatry Feinberg School of Medicine;

The Family Institute at Northwestern University; and

The Chicago Institute for Psychoanalysis

Part I:

Stress defined andThe scope of the psychological

damage

Stress Person unable to control an

important aspect of life.

Personal “meanings” important to understand any adverse event.

Social context matters

New York Times Survey

Telephone poll by NY Times/CBS News 708 unemployed US citizens Conducted: 12/15/09 Jobless rate, as now, was about 10%. Sampling error of +/- 4% All answers/situations were worse as

people had been unemployed longer.

NY Times Study Results

Money per se

75% of those with benefits think it “very or somewhat likely” that their unemployment benefits will run out before they find a new job.

83% received no severance package or compensation.

60% have taken funds from savings including retirement accounts to make ends meet.

Money per se, cont.

53% have borrowed money from family or friends

30% of those working [?] had had their pay reduced.

NY Times Study Results

Expenses

26% threatened with eviction or foreclosure or lost their homes.

61% said unemployment benefits not enough to cover costs of basic necessities.

47% are without health insurance or coverage.

54% have cut back on doctor visits or medical treatments.

NY Times Study Results

Emotions 48% have experienced “emotional issues

like anxiety or depression.” 55% have had trouble sleeping. “Has the job loss you experienced

created a major crisis in your life, a minor crisis, or no crisis at all?” 46% Major; 40% Minor; 13% No Crisis.

Shame: 46% have felt embarrassed or ashamed about being out of work.

69% “more stressed than usual.”

NY Times Study Results

Interpersonal impact 48% “had more conflicts or arguments

than usual with family and friends.” 56% of those with children said their

children’s lives had changed some or a lot as a result of their unemployment.

Among those with a working spouse, about half of those had taken on extra hours or another job to make ends meet.

Am. Psychological Association:“Stress in America” Survey

Online within US by Harris Interactive on behalf of the APA

July 21 - August 4, 2009 1,568 adults ages 18+.  1,206 young people ages 8-17 Results weighted for age, sex,

race/ethnicity, education, region, and household income

APA “Stress in America” Study

Some results

75% of adults reported moderate to high levels of stress in the past month (24% extreme, 51% moderate).

42%: stress has increased in the past year.

45% of teens “worried more this year.” 26% of tweens (ages 8-12) “worried

more this year.”

Elaboration of the stats:

Diminished self-esteemLoss of identityLoss of organizing influence of job

Workers still with jobsYoung peopleHealth consequences

Serious health impact:Two disturbing studies

Death rates increased 50-100% among high seniority, male workers in Pennsylvania in the year following job loss, with rates increasing with worker’s age. Columbia University study of recession of the 1980s, published 2008

Layoffs doubled risk of heart attacks and stroke in older workers. Yale University study, 2006

Serious health impact:Two additional disturbing studies

Person who lost job had 83% greater chance of developing “a stress related illness”: diabetes, arthritis, or “psychiatric issues.” SUNY Albany study, 2009

“Persistent perceived job insecurity” was a powerful predictor of poor health possibly “more damaging than actual job loss.” U. Michigan study, 2009

Serious health impact:

Mechanisms

Two-fifths (43%) of adults said they eat too much or eat unhealthy foods as a result of stress. APA “Stress in America” study, 2009

Routine health care reduced since costly. NYTimes study, 2009

APA “Stress in America” study

Depressive symptoms

Feeling depressed or sad: 34% Feeling as though they could cry: 32% Lack of interest, motivation or energy: 40% Fatigue: 43% Insomnia: 47%  Irritability or anger: 45%

Suicide

Rene-Thierry Magon de la Villehuchet

Suicide

Kevin Morrisey

Suicide

Bruce Pardo

Part II

Coping, defenses, and family support

Stress: What makes it worse? Immature psychological

defenses

Hierarchy of defenses (G. Vaillant) Mature: Humor, altruism,

suppression

Neurotic: Repression, undoing, idealization

Immature: Projection, devaluation, denial, splitting

Stress: What makes it worse?

Behavioral defenses Defensive “solutions” or “home

remedies” become problems: Drinking, overeating, porn,

extramarital affairs, gambling. Healthy behaviors overdone

(“personal religions”) of exercise, excessive attention to children or work.

Worst recent film example: Before the Devil Knows You’re Dead

Stress: What makes it worse?

Pathological social defenses

Need to act and find targets for anger

War, genocide, religious intolerance.

Revolutions for good or ill.

Stress: What helps?

Healthy coping vs. pathological defenses

Regaining some control via action Re-evaluating shame, guilt,

identity, and personal meanings Exercise Mindfulness/meditation Music, massage, hot baths, scotch

Stress: What helps? Social/Cultural Activities

Religion

Literature, theatre, movies, television

Sports and other spectating

Hobbies, recreation, travel, volunteer work

Stress: What helps? Support of Marriage and Family

The Case for Marriage

Oregon Trail

Coming home from work

Lending a hand studies

Lending a Hand

Coan, James A.; Schaefer, Hillary S.; Davidson, Richard J.. (2006). Lending a hand: Social regulation of the neural response to threat. Psychological Science, 12, 1032-1039.

Stress: What helps? Attachment Behavior

Baby mammals

Harlow’s monkeys

“People need people.”

Happiness correlation

Correlations between a composite measure of happiness and general well-being and

Income: r = .21 Social support: r = .35 Positivity in an intimate relationship: r

= .79

Family on Bike

Part III

A taste of Marriage 101:Managing marital conflict

Conflict in committed relationships: Why a crucial topic?

Conflict is inevitable Conflict is the best predictor of success Conflict mishandled erodes good things Conflict handled well deepens marital

bond Bad news:

Most people not good at handling conflict Good news:

Conflict management skills can be learned and improved.

Applicable in other relationships as well.

The anatomy of destructive fights: What they look & feel like

Distinction between process and content The “music” vs. the “words” Conveyed by body language and tone of

voice

When things go bad, the process is almost always bad.

What to do?#1: A moment of choice!

Remind yourself you have power to make this better or worse.

An “at bat,” a “fork in the road,” a “ball in the rough behind a tree,” namely a “moment of choice.”

Choose to “fight fair” not to “fight dirty” Remind yourself that safety and a healthy

process are as important as the content. Soft start-ups. Sheila as example.

What to do?#2: Meet the emotional challenges of being a good speaker and listener

Pay attention to your which role you are in moment to moment.

Only one pitcher and one batter at a time. Person with the complaint begins as the “speaker”. Be aware that usually both people want to be

“speaker”. Must “take turns” as on playground swings!

Challenges for the “listener”

Emotional challenge for the listener is to maintain an empathic connection with someone who is upset and may be upset with you.

Empathy requires feeling self in other’s shoes without being either overwhelmed or too distant (like ER doctor and accident victim).

Differentiated stance, comfortable with emotions in play.

Challenges for the “listener”Listening to criticism

Legitimate criticism: ideal listener can accept personal responsibility without needing to defend against undue guilt or shame.

Unfair criticism: ideal listener can manage the feeling of being unfairly blamed—by seeing it as defensive—and focus instead on what is really upsetting the speaker.

Most common case: Both!

Challenges for the speaker

To communicate clearly a need, complaint, or hurt without concealing it behind self-righteous blame, guilt-tripping, or simplistic one-sided accounts of things.

To stand up for yourself without putting the other down; at best, to make them your ally.

Must be comfortable asking for things. Must resist urge to hurt or seek revenge.

Formidable challenges:

Most important reason why marital harmony and conflict resolution is so difficult to sustain.

What to do?#3: Avoid certain language choices

Don’t use hyperbole:“You always…” or “You never..” even if it feels this way. “You often [or frequently]…” is less inflammatory.

Don’t use one-sided arguments, ones that leave out obvious truths.

Don’t swear or attack the other person’s character. Don’t argue that others agree with you. Don’t argue that others do it your way.

What to do?#3: Avoid certain language choices, cont. Don’t argue that you should be forgiven or topic

dropped because the other is also guilty of something similar or equally bad.

Don’t argue from, “Look what else I’ve done for you, you should do this for me!”

Don’t argue from, “I do it for you.” Don’t argue from, “If you really loved me, you would…” Don’t argue from absolutes or “shoulds.”

What to do?#3: Avoid certain language choices, summarizedMost appeals to ethics, rules, authorities,

friends and relations function to conceal the act of asking, the relativism of the request, and the danger of refusal. "You should be ashamed that you didn't..." "Everyone knows that you should..." "Dr. Expert says that husbands (wives) ought to..." are ways to avoid, “Honey, I would really like it if you would…”

What to do?#4: Make certain language choices

Personalize your requests, rather than cloaking them in appeals to virtue or logic.

Convey respect; sometimes explicitly. Criticize actions, not the other person’s character. When requesting change, be clear about what you

want the other to do. Stay on topic. Don’t “kitchen-sink”. Be concise.

What to do?#5: Work on self-awareness

Ask which of your hot buttons have been activated or whether your Core Negative Image (CNI) is in the room.

Do the same for your partner’s CNI.

What to do?#6: Take steps to remain calm

Don’t just press on. Take steps to “self soothe.”

Deep breaths Whatever self-talk calms you

If you are reaching your limit, let your partner know.

Consider calling a time out.

What to do?#7: Work harder at empathy

Unilaterally take the role of empathic listener. Cease attempting to problem-solve. Take up role of news reporter. Works for me!

Try to recall situations you’ve experienced that are similar to those your partner is describing.

Remind yourself that in any heated argument there is always truth on both sides.

Van Gogh Couple

References

1. Christensen, A. & Jacobson, N. (2000). Reconcilable differences. New York: Guilford.

2. Goldbart, S. & Wallin, D. (1994). Mapping the terrain of the heart: Passion, tenderness and the capacity to love. New Jersey: Jason Aronson.

3. Markman, H., Stanley, S., Blumberg, S. (2001). Fighting for your marriage, 2nd ed. San Francisco: Jossey-Bass.

4. Nielsen, A.C., Pinsof, W.,et al.: “Marriage 101: An Integrated Academic and Experiential Undergraduate Marriage Education Course.” Family Relations, 53: 485-494, 2004.

5. Real, T. (2007). The New Rules of Marriage. New York: Ballantine Books.

QUESTIONS/COMMENTS