How to Take Care of Yourself When… You Know You Are Going to Die

The experience of a former client: “I was diagnosed with stage IV pancreatic cancer and given a 16% chance for survival in five years’ time.  After all the treatment I’ve been through, we haven’t seen remission.  I don’t have much time left.”

I have heard it said that the point of living is to learn how to die.  In other words, we have succeeded in “living” if we live our lives in a way that- should we die this instant, from any of an infinite number of unforeseeable causes- there is nothing of consequence left incomplete.  Sure, we may never finish writing the book we began nor may we compete in the marathon we planned to run: those things are not the ultimate definition of “success.”  In the case of the former client whose dilemma, above, I am referencing for this article, a young child was left fatherless when the client died.  In his last weeks of life, the thought of not being there to “walk his daughter down the aisle” represented his fathomless grief at dying young.  This was heartbreaking for me, a tragedy that doesn’t make sense.  Most adults have faced senseless tragedy in our own lives or the lives of those around us.  While we can’t control the fact that sometimes, our lives are cut much shorter than the average and with fallout that feels cosmically unjust, we can absolutely control the way we live our lives until that unknowable date comes.  Being given a “deadline” is in one way a kind of gift- it can be a wake-up call out of the torpor in which many of us find ourselves floating.

underwater

Time to Wake Up

So, what do we do with the time we have?  Most of the tasks which we must accomplish to survive in this world are only beneficial because they help us succeed “historically”- in the realm of everyday things like career and finances and preserving material possessions.  These tasks seem to matter much, but they “ultimately”- in the realm of ontology- are of little consequence: paying mortgages, submitting paperwork for professional licenses on time, getting vehicles in for regular tune-ups, etc.  If we don’t tend to these things, our lives will be a bit out of control, things will fall apart… but, ultimately, dying individuals do not look back on their lives and think, “I am most grateful I never overdrew my checking account,” nor “I wish I had maintained my car better.”  In an often-publicized look into end-of-life regrets published by a palliative care nurse after eight years working with the dying, a common thread emerges: openness, authenticity, and strong relationships.  The regrets of the dying circle around the themes of not having been open and authentic in their lives, and not having put enough energy into building strong friendships and family connections.    

The consequences of these regrettable oversights are spending valuable life-energy doing things that are not fulfilling and, as the more than 70-year-long Harvard Grant Study has shown, not cultivating the one thing that leads to a longer, happier life: love.  It’s never too early nor too late to live your life fully.  Here are three suggestions that can guide you towards a regret-free life every day- whether you have 1 day, 100 days, or an unknown number of days left on this planet.

Sometimes, the grief of holding the prognosis that you are probably going to die soon is all you can do.  In those moments, all you can expect of yourself is to receive these three qualities of Amends, Appreciation, and Gratitude from others- and to give them to yourself, when you can.

 

Amends

We’ve all heard the term “to make amends,” but not many of us have an actual practice of regularly making amends.  In short, to “make amends” is to take responsibility for your part of a conflict and to share your regret at having played that part with the other parties involved.  This is a big part of 12-step recovery (step 10, “Continued to take personal inventory and when we were wrong promptly admitted it.”)  

You might be thinking, “But, but, SHE said X and SHE did Y, why should I be the one to apologize?”  You should be the one to take responsibility for your actions- regardless of whether the other person is blameless or is truly the source of most of the conflict- because they are YOUR actions.  You can only control your actions and your words, not those of others.  This is the meaning of another 12-step phrase, “Keeping your side of the street clean.”  Is waiting for the other person to wise up and admit their wrongdoing worth dying with a family conflict over a car that was totaled or a Christmas card that wasn’t sent?  When we remember that death is imminent, it is easier to openly, authentically- courageously- acknowledge our wrongdoing.

If this concept is entirely new to you, this article breaks it down pretty well.  I especially like the article’s focus on not just identifying the action for which you are apologizing, but the character defect of yours that allowed it to happen.  It’s also always powerful to identify the negative impact you believe this had on the other party, and your plan for fixing any damage caused and for preventing future lapses on your part.  For example, “Joe, I’m sorry that I cut you off in the staff meeting yesterday- you were making a point, and I was acting out of impatience and self-centeredness.  It must have felt insulting when I did that.  If it’s okay with you, I’d like to apologize for it at the beginning of next week’s meeting, to clear the air among all the staff so they know that what I did wasn’t right and that I am working on being more patient and kind.”

It’s important for us to always remember- whether veteran amend-makers or those new to making amends- that, similar to forgiveness, we are doing this work not only to be kind to others, but to free ourselves of the psychic, spiritual, and emotional binds of conflict and resentment.  We can only have deep and loving relationships if we are committed to this kind of open and communicative integrity.  What sounds most fulfilling: hiding behind self-righteousness and having shallow relationships, or vulnerably admitting when wrong and having deep relationships built on trust?

While it takes time to build trust between people, it is never too late to make amends.  The other party in the conflict may have written you off and may refuse to respond to what you have to say- but knowing that you faced your shortcomings and courageously sought reconciliation will free you from the burden of that guilt and shame.  When making amends, we make them with zero expectation from the recipient.  We are taking responsibility for our own actions, not taking inventory of others’ actions.  In fact, it is critical to only address our actions and not the actions of the other person during the course of our amends.  This is why it is important to have a script, so that we don’t regress mid-conversation to defensively trying to explain our actions based on the others’ actions.

If there is nothing else you have time to do before dying, it is worthwhile to identify all the outstanding conflicts in your life and investigating your part in them, writing a succinct but full script hitting all the key points (your role, your character defect, your regret at causing the other person pain, your plan for rectifying the problem) and delivering that script- whether in person, on the telephone, or in a written letter.  Do it promptly.

If you are unsure, find a friend or spiritual teacher who is willing to look at your amends with you and see if they seem right.  Always consider the recipient when making amends.  Does the other person fear you / your history of violence?  In that case, stick to a phone call or letter and clearly state that you only have one thing to say, that you do not intend to write or call again, and that you expect nothing in return from him or her.  Do you have reason to fear the potential violence of the other person?  Write your script in your own journal and do not deliver it.  Just.  Get.  Clear.  And then move on.  

Beyond people, there are other instances that call for making amends.  If you have a “Creator” concept in your spiritual views- particularly the Christian belief that you will go to hell unless you have humbled yourself before God and asked for salvation- this would be an important time to make sure you do that.

Moving forward, make daily amends- every night, look at your day and determine if you have anyone to whom you need to make an amend, and then do it promptly.  

         

Appreciate

In tandem with making amends, appreciating is the best way to strengthen relationships.  It also happens that spending time thinking about what we appreciate lifts our mood.  Every day, dozens of people we can name and thousands of unknown people contribute to our lives.  While it is beneficial just to think of and silently appreciate all this support coming our way, outwardly expressing this appreciation is the more “open, authentic” avenue.  The more you are able to express your appreciation to the people around you, the happier everyone will be.  Would you rather leave a neutral / critical legacy, or a grateful legacy?

If you are generally thoughtful, you probably already thank the people in service positions that you come across- checkout clerks, waiters, receptionists.  It’s always nice to say “thank you” when someone helps you.  It’s a delight to be able to share even more appreciation, with a specific gratitude.  For example, “Thank you for your patience as I unloaded my cart,” or “I appreciated the reminder call yesterday, I had actually forgotten to put the appointment on my calendar.”  Something sweet to do if you have several errands is to buy / snip a bouquet of fragrant, seasonal flowers and give one or two stems to the people in service positions that day that you come across, along with a verbal “thank you!”

As for people who occupy more time in your life, like colleagues or family members, making a point to catch them doing something you appreciate or admire and telling them is a joyful practice.  Small and beautiful / practical gifts, like flowers, coffee, or lunch, are easy and yet impactful.  If you have little time left on this planet (read: any of us,) spread appreciation in all directions.  Make it a goal to tell 1, 2, or 5 people each day what you appreciate about them.   

 

Generosity    

Yet another pro-social action that has strong positive impacts on the doer is generosity.  Whether gifts to people you see often or donations of time or resources to causes you appreciate, practicing generosity not only leaves a positive impact in your physical absence, but also helps you thrive while you are here, with feelings of purpose and connection.  I am most fond of acts of generosity that are experiential- where I can directly interact with those receiving my offering.  For example, if you donate money to a homeless shelter, can you also sign up to serve a meal there?  If you donate supplies to a youth program, can you also attend their open-house event and meet some of the families that benefit from the program?  How about making 15 sack lunches and taking a bike ride to pass them out at a homeless encampment?  Offering to carry bags when you see someone struggling?  Spending your Saturday helping at a public tree-planting event or an athletic event?  Doing a chore around the house that someone else normally does?  The possibilities are infinite.

It’s easy to be blind to the ways we can be generous, but if you commit to finding one way each day to practice generosity, the small but important actions will be easier to identify and do.  The more you can work generosity into your daily experience, the more beautiful your life and your legacy.   

 

            

     Important skills you are strengthening:

Amends

Communication

Personal Responsibility

Gratitude

Appreciating

Generosity

 

Share Your Experience

How do you live your life fully, every day?  Please share about it in the “comments” section.  The internet is a powerful resource for learning from others- make your experience count!  

How to Take Care of Yourself When… Your Own Mind is Your Worst Enemy, Part II

In the words of one of my clients: If anyone else said to me the things I say to myself, I would call it verbal abuse.”

Part I of this article addressed ways to take care of the anxious, negative, and critical mind when it targets people and incidents outside of oneself.  What happens when the same quality of mind takes the form of self-critical internal commentary and self-limiting automatic thoughts?  I hear from many people- particularly from those who are newly self-aware- that their thoughts towards / about themselves are abusive.  They have an oppressive inner voice that comes down harshly upon them- with name-calling and cursing included- for relatively minor mistakes.  They catch themselves staring in the mirror and mercilessly picking apart their own appearance, inwardly criticizing every bulge and sag.  The thoughts are automatic, and have been around for a long time.  Once they begin “hearing” this voice so clearly, they are disturbed that it has been going on so long.  It is as if they are waking up from a trance and discovering they have been in a toxic relationship… for decades… with themselves!

How did we get this way?  Why on Earth would so many people be so unkind to themselves?  It could be an internalized oppressor- the voice of someone abusive from the past, whose rude names and general disrespect for you has become the playlist for your own inner voice, always ready to tear you down at any sign of weakness.  It could be the influence of our wider culture, with its youth-and-beauty-worshipping messages creating an impossible physical ideal you have become programmed to expect of yourself.  It could be the same culture leaching its sexism, homophobia, racism, classism, and any-other-ism into your psyche, giving fodder for an unsettled mind to use against its closest, easiest target: you.

I like to hold out the possibility that the self-abuse isn’t meant to be personal: rather, it is a product of our evolution- as I mentioned in Part I- where our minds have developed to take special note of negatives, in order to avoid failure or harm that could be lethal.  In the case of viewing oneself, the mind goes overboard in criticizing and wanting to push away today’s “problems” that are not life-threatening, such as the social, financial, physical and other “shortcomings” we recognize in ourselves.  Maybe the mind believes that the harder it comes down on the “shortcomings,” the more likely they are to retreat- like fighting off an attacking tiger, tooth and nail.  Anyone with any kind of experience working with people knows that abusive language and actions do not fix “shortcomings-” rather, they increase shame and self-hatred, leading to either magnified “shortcomings,” or the eruption of a whole new problem.

If any of this sounds familiar to you, it’s time for an internal intervention.  Here are five ways to respond to the inner bully.  Are you ready?

 

Compassion

It’s tempting to respond to a negative inner voice with forceful rejection.  However… this is more of the same pushing-away energy that is hurting you.  Hatred cannot heal hatred.  Only love can heal.  When you discover that you are breeding hateful thoughts about yourself, the medicine you need is compassion.  The simplest way to do that is to pause and softly embrace the pain when you see hurting.  Whether you are having a bad day and need to cry or you catch that negative inner dialogue, you can apply compassion:  “It’s okay to cry, I am here for myself, holding my heart with tenderness and reverence,” or  “I hear you, negative inner voice, and I know you are coming from fear and insecurity.  I can assure you that I am safe and you don’t have to be afraid.”

Do you have a spiritual practice that addresses compassion?  All the spiritual traditions I have studied hold compassion in high regard.  Prayer, reading, and imagery on the topic of compassion can help make this virtue so present in your mind and heart that it becomes your natural language, replacing the critical or abusive.  Muslim, Christian, and Jewish theologians have written much about compassion.  Compassion is a central tenet of Buddhism, embodied by the bodhisattva Guan Yin.  If it suits you, pray to be filled with compassion.

desertfeathers

Call in the Medicine that will heal your heart

 

Dwell in the Light

I find that it is easiest to procure positive thoughts and feelings when I immerse myself in positivity… and steer clear of negativity.  Positive conversations, articles, films, and music all shape my mental state to one that is pretty much full-time positive.  This is not rocket science.  I have an appreciation for the macabre, the underworld, my own shadow self… but I don’t live there full-time.  You can be a complex and mysterious person with dark and light facets who chooses to dwell in the light.  If you are one of the many people drawn to dark and violent media and conversations and you struggle with dark and negative thoughts… well, you may want to reconsider your choices!  What we put into our consciousness is what comes out of it.  Would you prefer to feel light and positive?  Feed yourself full-time on the light and positive, and see what happens.  

 

Forgiveness

When you begin to see that you have been hurting yourself from the inside (and probably with the choices you make on the outside, too,) it can be frustrating and bring up anger, more self-hatred.  This, of course, will be a self-reinforcing cycle.  So, like compassion, forgiveness is the medicine needed here- not resentment.  I have mentioned forgiveness practice here before, in the last paragraph of this article.  Forgiveness practice goes through a cycle of multiple objects- first yourself, then someone you have hurt, then someone who has hurt you.  The entire practice is so fruitful, but you can meditate on self-forgiveness, alone, if that is what you need today.  

The words you can use are something like this: “I see that I have hurt myself deeply, and I am so sorry.  I have been confused and in pain, and I have made choices that led to my own and others’ suffering.  I allowed my pain and confusion to spill over and multiply, creating more of my own pain.  I forgive myself for making this very human mistake.  I am committed to protecting myself from further self-abuse, to taking care of my suffering so that I do not cause myself or anyone else to suffer needlessly.  From the bottom of my heart, I bring forth forgiveness and compassion for all those places in me that hurt and don’t yet know how to heal.  I am here and I will take care of myself.”

 

Higher Power

Do you have a Higher Power concept in your spiritual life?  Whether God, the Divine, Great Spirit, Holy Spirit, Suchness, any among the myriad world pantheons of Gods and Goddesses or Bodhisattvas, Mother Earth, your Guru or mentors, or that part of yourself that is most wise, this is a time to call upon your Higher Power for help.  Light up some incense and place your pain at the feet of your Higher Power.  Summon the support of your Higher Power in transforming your internal dialogue.  

The action of humbling oneself and acknowledging the need for support is a key to transformative healing.  This is part of the magic of 12-step programs.  Steps 1-3 say: “We admitted we were powerless over our addiction – that our lives had become unmanageable.  We came to believe that a Power greater than ourselves could restore us to sanity.  We made a decision to turn our will and our lives over to the care of God as we understood God.”  You could view your hurtful relationship with yourself as a kind of addiction to self-hate, just as substance and behavioral addictions could also be described.  Whether it’s poisoning ourselves with toxic thoughts or toxic substances, sometimes we need help from a Power greater than ourselves to break free.

 

Affirmations

People who have worked all or most of the 12 steps are also familiar with the concept of affirmations.  Affirmations are short, powerful, positive phrases that counter negative self-views you have been carrying.  While identifying affirmations as you work the steps is an in-depth exploration of negative self-beliefs via the process of making a “searching and fearless moral inventory” (step 4,) you can do a smaller version of this right now.

Let’s start with one negative belief you have about yourself.  Let’s say you find yourself criticizing your appearance.  You get deeper, and you see your negative self-belief is “I am ugly.”  Can you dig deeper?  Maybe you find another layer, “I am unloveable,” or “I am worthless.”  Once you think you’ve found the belief that is ailing you, play around with crafting positive affirmations that oppose that negative statement.  They will begin with “I am…”  Various options here could be “I am Beauty,” or “I am loveable,” “I am Love,” “I am worthy.”  These are not statements that you will believe- at least, not fully and deeply.  That is why they are important!  If you do this for several beliefs, you may come up with a list of 10 or more affirmations.  Put them on small note cards, put them on your bedstand or in your bag, and shuffle through them once or more every day.  Say the affirmation out loud as you look at each card.  Say them to yourself in the bathroom mirror.  Say them under your breath if you can’t get privacy.  You are studying for a self-love test called “Life,” and the sooner you get this part down, the further you can go!

            

Important skills you are strengthening:

Loving-kindness

Compassion

Forgiveness

Affirmations

Share Your Experience
How have you healed from self-hating and self-defeating beliefs and internal dialogue?  Please share about it in the “comments” section.  The internet is a powerful resource for learning from others- make your experience count!  

How to Take Care of Yourself When… You Have Illegal Compulsions

“I’ve been arrested for exposing myself in public… more than once… and I struggle regularly with my compulsion to do it again.”

 

Humans have compulsions to engage in all kinds of behavior.  Some people compulsively eat snacks when watching TV, other people have compulsions to smoke a cigarette every hour, and some others have compulsions to expose themselves to non-consenting strangers.  There is a wide range of social, cultural, ethical, and legal acceptability among human compulsions.  Addictions are a type of compulsion.  I would argue that every one of us has one or more addictions and / or compulsions.  Even people who are substance-free and live lives above-board legally may need to decompress in front of the computer or television as a matter of habit… and compulsion.  It’s just what they feel they need to do, and they do it without really thinking about it.  

If you look deeply, you might realize you have a compulsion to overeat, to surf the internet, to spend money, or to gamble.  Maybe you have been aware of your own compulsion for some time, because you try to keep it a secret or risk potential ridicule or judgment from your romantic partner or family.  Cross-dressing, hoarding, self-injury, and consuming pornography can be such compulsions.  Some compulsions are shared by much of the US population, some are shared by few… some can cause you to lose romantic partners, others can cause you to lose your last penny- and still others can cause you to seriously harm others, become imprisoned, and prevent you from ever finding secure employment. 

Peeking Out

There is healing on the other side

Some compulsions are not especially distressing to the person who has them.  Others cause the person distress, as they do not fit into the person’s view of his or her ideal self.  These compulsions are called ego dystonic.  It’s a matter of perspective: one person’s “distressing compulsion” could be another’s “harmless habit.”  You already know you have a compulsion if it’s an illegal one, because you’ve had to make the choice of whether to pursue it and face serious consequences… or not.  Most people with illegal compulsions also find them ego dystonic.  The illegal compulsions I’m aware of include paraphilias– abnormal sexual desires- that involve partners unwilling or unable to give consent, such as strangers rubbed up against in frotteurism, or minors exploited in pedophilia.  Other illegal compulsions would be to murder people (as in: serial murderers,) addiction to scheduled substances (such as heroin or prescription medications for which you do not have a prescription,) and kleptomania (in which items are taken from non-consenting individuals or stores.)

The most negative consequences of any compulsion only comes to those who act on their compulsions- and not all people do.  In researching for this article, I read a piece written by a celibate pedophile called, “I’m a Pedophile But Not a Monster.”  The author bravely and vulnerably shares what it is like to have a compulsion that goes against his own wishes for himself, and causes him to be reviled by complete strangers… even though he has chosen to never act on his pedophilic compulsion.  Those of us who are not afflicted with illegal or self-harming compulsions often don’t and choose not to understand them nor to have compassion for those who suffer with them.  The important thing to realize is that most people who have such compulsions would rather not have them.  As a society, we push away the things we don’t want to understand… which only makes those situations worse.  The societal and individual habit-energy is the same: push away what makes us uncomfortable.  Push it into the recesses of consciousness and pretend it doesn’t exist.  Every time, those dark places decay into a major problem.  We need to shine a light on all sides of ourselves as individuals and as a society in order to understand and heal.  

If you have illegal compulsions, you can take care of yourself.  As of now, the wider culture will not support you in this and seems almost complicit in your committing a crime by ignoring you until you have committed that crime.  This is not an excuse to not care for yourself.  Some of us have a harder road than most to realizing self-care, and those of us who are likely to have experienced trauma as a child (as have most people in the “illegal compulsion” category) and who are criminalized by the wider society (all people with illegal compulsions) and who are misunderstood and villainized by most people (again: most people with illegal compulsions) have the hardest time of all.  Here are some concrete steps any of us can take- and those of us with illegal compulsions most need to take- towards self-care:

 

Take a Look

Very few of us turn our awareness onto our behaviors to look deeply and understand what compels us to do what we do, and to take responsibility for our choices.  And fewer, beyond that, make the choice to not escape uncomfortable feelings through compulsive behavior- to instead sit with discomfort and befriend our challenging thoughts and feelings and transform them into insight and compassion.  I refer to these types of skills as those of the psychological superstar.  The opposite of a psychological superstar is moving through life as if asleep, not really aware of what motivates you or even what you are actually doing.  Most of us, of course, are in the middle somewhere.  When you have illegal compulsions and are blind to your motivations and actions, you find yourself, at best, at risk of legal repercussions.  At worst, you hurt yourself, hurt others, and can lose everything dear to you.   

The first step to becoming a psychological superstar is to realize where you aren’t expressing the superstar-potential that lies inside you.  This is where recognizing your own addictions and compulsions comes in.  Recognizing is the first step to healing.  All of the illegal compulsions involve the violation of others’ rights or the consumption of substances that are known to cause physical damage to the user- barring a few substances that are scheduled due to political reasons rather than science.  If you look closely and see that you are compelled to hurt yourself or others, chances are that this is an ego-dsytonic fact- and yet, your baseline feelings are worse, because this compulsion is a kind of self-soothing action you have learned to turn towards when you are suffering.  The truth is that every compulsion- illegal or not- causes temporary relief, but does nothing to address the underlying pain that brought the behavior about in the first place.  Add the potential shame for having engaged in the compulsion, and you have a greater mass of pain in your consciousness to compel you into the behavior again.  

If you have identified your own illegally compulsive cycle, it’s time to take action to free yourself.  You are the best person to do this job; as I mentioned before, our wider culture has not prioritized helping you to get free; our wider culture only acts as a judge and executioner.  You need to be your own friend, your own counselor, so that you never see that real-life judge nor executioner.  You can identify places where you can make new choices and you can get yourself to the resources that will preserve your health, integrity, and future.  Reading this article is just the first step.

 

Own Your Isolation

All people with illegal compulsions feel isolated.  Social isolation and the anxiety it feeds worsens the compulsion, and having the socially-unacceptable compulsion pushes you further into isolation.  This cycle can be broken.  Underlying thoughts that fuel the cycle are along the lines of, “Why would the healthy/normal/beautiful people want anything to do with sick/weird/disgusting me?”  Anger at being isolated can fuel the acting-out of the compulsion… but we’ve already determined that acting out the compulsion is only going to get you into trouble and increase your self-hatred, feeding a self-destructive cycle.  You don’t need to self-destruct.  Just because you had a disturbed childhood or otherwise inexplicably violent / intrusive thoughts and feel worthless, which has led to behavior that puts you in an isolated place- which would make anyone resentful and angry- leading to further isolation… does not mean all hope is lost!  Isolation, like any emotion or experience, is impermanent.  

You need to see, name, and own your isolation.  See how it comes from the outside, but also from the inside?  Do you see how your choices reinforce it?  The choice to not make eye contact when walking down the street?  The choice to over-share inappropriate information with strangers?  The choice to not make friends, but instead go straight home after work and not reach out to anyone?  These are examples of ways that people who feel shame and isolation push others away with small but significant actions.  Your life happens to you, to a degree.  Beyond that degree- the cards you have been dealt- you have the freedom to make a choice in every moment about how to live your life.  

Every.  Single.  Moment. Is a chance to think and act in ways that are likely to bring greater health, happiness, and freedom into your life.  It is courageous to own your isolation and decide to make different choices moving forward.  The next two sections, Seek Care and Seek Community, describe ways to change your relationship to the world around you.        

 

Seek Care

Much compulsive behavior is cyclical.  There are uncomfortable feelings, followed by a ritualistic planning and then engaging in the compulsive behavior.  The compulsive activity leads to temporary numbing or mild relief, yet the relief is never as good as had been hoped when fantasizing about engaging in the compulsion.  Then, there are negative consequences in both the external world and the mind and heart of the person with the compulsion.  The frustration, shame, and overwhelm from these consequences feed into a repetition of the cycle.  Breaking this cycle is not easy, and having help from a mental-health professional who understands this process is a good idea.    

Addictive Cycle

While all licensed therapists have studied this cycle to some degree, there are many clinicians who specialize in addiction or even specific addictions, such as gambling or sex addiction.  Sex addiction- specialists are likely to be most prepared to treat people experiencing paraphilic compulsions.  Very few therapists would consider themselves prepared to work with a free (not in prison) murderer… and very few (if any?) serial murderers seek treatment.  The limits of confidentiality, at least in California, state that a therapist must protect his or her client’s confidentiality.  Even client reports of past murders are not reportable by the therapist.  However, a client’s statement of developing plans to harm someone in the future must be reported, to protect the potential victim and also the client.  A client who has homicidal urges- regardless of an acting-out past- who wants to heal and does not want to harm others may have to take the risk of seeing a therapist and honestly reporting homicidal urges, understanding that the clinician will use her or his best judgement to keep the client and a potential victim out of harm by involving law enforcement or a psychiatric hospital.  In the end, is it better to have legal attention or psychiatric hospitalization before a crime is committed, or after?  Most of us would agree that legal and medical intervention without having committed a crime is best. 

Whether your own compulsion is legal or not, there is help.  I am aware of resources in public mental health systems (meaning: for those with the lowest income) for substance-abuse recovery and basic group therapy, but there is not always the option for individual therapy.  This means that, if you have a paraphilia that is illegal or if you have homicidal urges, you may have a difficult time finding treatment.  If entering a public health system is your only option for treatment due to low income, a good way to frame your needs during the intake process would be, “I believe my particular symptoms would not be well received in group treatment.”  At the same time, you need to have symptoms of a specific mental illness in order to receive any treatment at all.  Chances are, you probably do have symptoms of at least depression or anxiety- so you need to express those symptoms in order to be approved for treatment, while not disclosing your specific unwanted thoughts if you do not feel comfortable disclosing them.  If you feel pushed by the intake clinician to specify the content of your thoughts, you always have the right to decline.  Speaking from experience, knowing that a client has “unwanted / intrusive thoughts” is just as good as knowing that a client “has thoughts about exposing herself in public” when it comes to the data needed for diagnosis.  Only share what you feel comfortable sharing.  Once you are working with a therapist whom you trust, you can dig deeper into your story.         

 

Seek Community, While Also Protecting Your Privacy

There is nothing quite as healing as communicating with people who share your experience.  An otherwise isolating experience can turn into a community-building experience when you look for others who know your struggle.  The more rare or socially unacceptable your situation, the harder it will be to find community.  It’s still worth trying.  The author of the previously-mentioned article writes about finding a community of pedophiles online, and finding some who shared his perspective that it is best to not act on the pedophilic compulsion.  He also made the choice to be open about his real identity, which led to him being harassed and now publicly known as a pedophile.  For the purposes of self-care, I would suggest cautiously seeking community, while being smart about what information you share online.  

For less complicated compulsions, such as substance or behavioral addiction, there are 12-step programs available- in-person in larger cities, and also by telephone and internet.  A lot of people have hang-ups about 12-step programs on account of the spiritual component.  All I can really say to that is that recovery requires humility, and letting go of what you think is the answer.  If you attend a meeting and see people who have recovery that you want to have, why not look a little deeper?  If you attend a meeting and don’t see people with the recovery you want, I suggest attending more meetings.  It’s true that 12-step meetings are not for everyone- but then, recovery is also not for everyone.  Many people are on a path to die because of their addictive and compulsive behaviors.  If you find humility and surrender to guidance from outside of your own head impossible… the prognosis is not good.  Are you more afraid of accepting that you don’t have the answers, or of living another day doggedly pursuing relief from a substance or action that will never deliver the relief you seek?

Finding others who know your struggle and sharing resources and mutual support on the path of recovery has saved many a life.  

 

Develop a New Ritual

Between the stages of emotional pain and acting out in the compulsive / addictive cycle is the preoccupation with the substance or behavior, which can be described as a kind of ritual.  The heroin addict thinks about how great it will be to get high, locates the heroin and the implements needed to use it.  This could be a 10-minute or multi-hour ritual.  The exhibitionist fantasizes about the reaction of the victims to his self-exposure, about how great the orgasm will be when he sees their expressions.  He then finds the right place to do the exposing and masturbating, and waits to find the right victim.  This could be a 1-hour or a multi-day ritual before acting out.

As mentioned earlier, every moment offers us the chance to make positive choices- and there are many moments in these sequences at which a different choice can be made.  The earlier a different choice is made, the better.  If fantasies are entertained for any significant time, the enchantment of the substance or behavior will win.  Therefore, it is important to create a new, soothing ritual to begin at the first sign of heading down the old ritual’s road.  The support of a recovery community and / or therapist is very helpful in this.  The first thought of, “I just want to get high” is the red flag waving, saying, “it’s time to pay attention to what’s happening here” and initiate, instead, a crime- and self-harm-free ritual.  Best of all would be a self-care ritual!  

Maybe you don’t have a self-care regimen at all.  This is the time to identify 2 or 3 actions you can take for yourself that you find soothing.  They can be anything from getting outside for a walk, to listening to spiritual music, to meditation, to speaking with your therapist or 12-step sponsor.  All you need is something you can do in response to the earliest signs of fantasy, in order to short-circuit the pattern you have had over the years or months, and create a new pattern.  Instead of the first moments of fantasy leading to preparation and acting out, now the first moments of fantasy can lead to making positive choices for your own physical, mental, emotional, and spiritual health.  

Self-care is within reach for anyone- every moment is an opportunity for the situation to make a turn for the better.  What are you going to do to help it along?  

 

Important skills you are strengthening:

Creating Community

Looking Deeply

Personal Responsibility

Seeking Care

Recovery

Share Your Experience

If you have experienced healing around compulsive behavior, please share about it in the “comments” section.  The internet is a powerful resource for learning from others- make your experience count!