Does obsessing about pain create more pain? A culture of silence or a culture of telling?

[Donte]

I grew up in a culture of silence. 'Whatever happens in the home stays in the home' was the motto.

When feeling distressing emotions, I was meant to make a conscious effort to let the pain subdue. I was taught that replaying painful memories, talking about my pain with others, or exposing myself to situations that keep the memories active only functions to keep me in distress. At home, at church, at school, in the neighborhood, everyone reinforced this message. My father used to tell me to 'dip my tongue inside my brain before I speak'.

So, does the expression of an emotion act as a reinforcer of the emotion? Does it cause it to be more likely to be felt again in the future?

What's your experience? Is it better to talk about it? Or is it better to distract yourself with something else? Or a bit of both?

For example, if you are feeling depressed, and you talk about your depression with a friend, expressing all of your self-doubts, hopelessness, and sadness, are you more likely to continue to feel depressed? Is it better if your friend stops you from ruminating about your depression and convinces you to go to the movies with him instead? Are you more likely to feel even a little better afterward? Or would it help more if you talk about for a bit but then go to the movies afterwards and distract yourself?

What is the predominant cultural belief around this topic in your community or country of origin?

Does acting on the expressive emotions by talking at length about them strengthen those feelings, or lessens them? Is distracting ourselves preventing us from acting on the depressive emotions? And by doing so, are they more likely to fade away?

Obviously, complicated and enduring mental illnesses like depression or chronic anxiety and panic, are far more difficult to relieve than by just going to a movie. What I'm asking here is: does the more you act on an emotion, the more of that emotion you are likely to feel in the future?

When we feel a strong emotion, we naturally want to express it. But, is the continued expression of an emotion making it stronger? And if that emotion is painful, does the act of sharing it increase the experience of our pain?

How can we help our minds loosen the grip on past distress?

If your cultural or religious upbringing is similar to mine, you may have great difficulties in expressing and sharing your emotions and pain. However, doing it in this forum, anonymously and in the safety of your own home may help you. 🙂

[Donte]

Hi Hayfa,

There is a lot of research done lately in relation to food and mood and in many occasions anxiety and depression can be directly linked to various preservatives in bread and other foods we consume daily. Pesticides and other additives have also being linked to various mental illnesses. When we feel we know something, new knowledge comes and shows us more light into areas we never considered before.

Despite all this, whatever the causes, no matter how much intellectualization of the topic we do, is not going to change the way things are. Sometimes overthinking doesn't help and it's better to accept that we may not know it all or have any answers.

[smallwolf]

I will speak more generally here, ie excluding MI related issues as a result of the wars, natural crises, etc.

The following quote is from an article in the Huffington post on mental health in the Middle East . It reads..."growing problem of not wanting to seek help out of fear of rejection, embarrassment and the stigma attached to labels of mental health". The statement could equally apply to the men in Australia, or so I have been told. But it also makes me wonder what people from these cultures do when they have sort of MI? Or are they/you stuck forever in that downward cycle of despair? Can the family structure assist in supporting some that is heading down a MI path? Or is that individual cast aside? Or is there someone in a family structure you can speak to without fear of repercussions? Is the love between family members sufficient to heal? Taking into account my initial statement, what are the typical triggers?

From my own perspective, for a number of years I was silent. I won't go into the reasons here. But once you don't talk about it, the negative thoughts grow like a cancer (figuratively speaking) inside you. The individual gets to ruminate on the negative thoughts. This might be compounded by our individualistic society, possibly made worse by the fact that families are most likely geographically separated, and we might not know our own neighbors to talk to. Today, the fact that I have coffee with people has created a support network for me. And in that regard, I find it helpful to talk to others for my own journey or healing. The discussions that I have are not with trained professional, just other students or lecturers at the college I attend, and then some. And I can see that I am loved.

My final comment relates to the personalities of the individual concerned. If you are introverted, or depending on which personality test you do, your personality type might be more susceptible to anxiety or depression. Statements made to one person as harmful, could be turned to the strength by another. And in relations to things that happened in the past, it is forgiving and releasing the hurt that allows me to move on. At least that is what I (think I) am working on next with my psychologist.

Tim

[Donte]

Hi Smallwolf,

(wave to Hayfa and everyone reading and posting),

It is very beneficial to pose these important questions each time - because it is very different for each individual case.

Not all culturally and linguistically diverse people have families and not all families are supportive.

In my country of origin, collectively speaking the stigma of mental illness and the impact of labeling it was so huge (at the time of the mass migration), that often families would hide the individual member from the rest of society - sometimes locking them inside and not allowing them to be socially connected or leave the home, out of fear of ridicule and bullying.

Many would treat the whole family as ‘sinners’ who are punished by god for something and deserving the ‘shame’ they get. Often, these individuals would be refused to participate in holy communion or access to religious rituals and ceremonies.

Yet, in every village there used to be a‘madman’ who would go around and against their family’s will (often ostracized being kicked out of the family home), would try to engage with the crowds despite the ridicule and harassment that this brought to the family and relatives.

This is a very complicated situation that goes back a long way - centuries.

Many of these generational and cultural attitudes have been carried to a degree to today’s communities abroad and in Australia.

When the individual is also not English literate, their options and access to information that can lead to supports and assistance can be minimal to non-existent.

If the family is meant to be your only support, but instead, the family views this individual as a problem; an issue, causing ridicule and affecting you in negative ways then that person can be deeply disadvantaged.

(Many families with daughters would hide the fact that someone among them has a mental disability as this would influence the chances of their daughters finding a fitting groom and their prospects of marriage would be affected).

The same applies to finding work, accommodation, getting a loan etc.

Shame and stigma are deeply ingrained into the collective soul of various groups that makes it very difficult for the individual (and the carers) to access supports and seek external help.

So what can we do? We can start the conversation - one person at a time, one carer at a time, one family at a time with bilingual/bicultural workers who understand the impact of stigma and approach each case according to the needs.

[Hayfa]

Hi smallwolf

Your post reinforces what I was saying, yes...at the end of the day it is the pain from fear and doubt that are the underlying causes of the situational life of the individual.
First comes the event that brings with it all that fear and doubt, it may then be followed by the opportunity to move through it with the necessary support, or no support depending on the individual decision, or in this case as you smallwolf have said and further elaborated by Donte, the family decision.
It is sad these situations of socially isolating someone who is suffering can happen but you are right smallwolf, some situations can be turned around by the sufferer whereby he or she is strengthened because they have decided not to suffer any more.

It is worthy of a conversation among communities and we have to understand that there are many factors that affect whether the messages will be received or not. Some culturally diverse communities need more time to get to a point of understanding what MI really is and what is needed to get support, again here; a collective culture of fear and doubt about seeking help and how admitting MI and other disabilities may be viewed within their cultures.

Hayfa

[Donte]

Hi Hayfa,

Your post has made me think a lot and in depth and reflect on this lately. Thank you for expanding my thinking in this area.

Wondering how the physiological aspects of an illness such as depression or anxiety come to the picture/play a part.

I understand that often depression or anxiety could be caused by situational factors such as traumatic events, terminal illness, loss and grief, violence etc. but there is also a clinical, physiological side to consider, like in every other illness. Mental illness affects the brain which is of course part of our physical body. So there are physical symptoms and impact.

There are numerous cases where absolutely no trauma has taken place and yet the individual develops a mental illness. Sometimes babies are born with one or develop one early on in life.

It could be a case of neurotransmitters in the brain not functioning properly due to poor diet, hormones, imbalance of certain proteins and amino acids in the brain, hereditary causes, preservatives and additives in foods, pollution, toxicity, pesticides, or even as a side effect from other medications that the person is taking. For example, people on antiretroviral medications can develop depression as a side-effect of these meds.

Surely, we cannot completely rule out any physiological anomalies or impact of other illnesses, co-morbidities and medications or alcohol and other drug abuse etc as a cause of depression or anxiety (even though mental illness is much more than just depression and anxiety).

The idea that mental illness is always just a result of pain caused by fear and doubt doesn’t sit well with me. It is definitely not applicable in every case.

I’m not dismissing that these can be triggers but one size doesn’t fit all and mental illness is much more complex.

If it is just fear and doubt that causes mental anguish and pain, then removing these should remove the illness.

Yet, one may remove fear and doubt (or any other external situation that may cause problematic reactions) and still not restore mental health - similarly to let’s say, removing sugar from the diet of a diabetic and still the person has diabetes.

I am not an expert on this topic but as someone who lives with depression and anxiety for most of my life I cannot dismiss the idea that these could very well be physiological diseases with physiological causes, even though external situations and traumatic experiences can have an impact on them.

[Doolhof]

Hi Donte and All,

Mental health issues run in my family, some of us suffer quite disastrously at times. Even though the illness and symptoms are the same or very similar, there is little collective family assistance or understanding of mental health issues as I feel some of the family think of it as being a weakness.

In our family we have not tended to actually lock family members away, but they have been shunned, misunderstood and isolated in many ways. Maybe even controlled in some instances so their illness does not embarrass others.

My Mum was openly ridiculed, bullied and isolated in our community, this flowed down to us children. She did not have extended family to help her. As her children,we were tarred with the same brush. It can happen anywhere.

Finding adequate mental health care for myself has been a huge struggle, I have no idea how people who do not speak the English language manage to find assistance!

I have even presented myself to facilities that I had hoped would be able to help only to be told that without an appointment they can do nothing. I need to call for an appointment: I call, am transferred to 4 different people, then returned to the first person I connected with to be told again they can't help me.

What has to happen in order for all people to be able to receive the help and care they need and deserve? How many people give up as it is all too difficult to cope with?

Cheers from Dools

[smallwolf]

Donte,

While I am not an expert in this field, I can only comment on my own experience. I just want to take up on a comment you made regarding "be physiological diseases with physiological causes" as related to me (?). This last bit is still ongoing...

Over the last while I have had a number of blood tests for different things. On seeing my psychiatrist the first time, organised a blood test to identify what could (outside of my mind) contribute to my depression. While my iron levels were not high per se, my ferritin levels were. Two blood test with high ferritin levels, and the GP can refer you to a specialist. I also had an ultrasound on my abdomen.

From my last vist to my GP, found out I have 2 abnormal genes, one from either side of family. Additionally from the blood test, everything came back OK except for that, and the high ferritin levels. Why am I telling you this? Because high iron levels can lead to haemochromatosis. Putting aside cancers and cirrhosis of the liver problems, but one of the sypmtoms is "Neurological/psychiatric disorders; impaired memory, mood swings, severe irritability, depression". (source: https://haemochromatosis.org.au/symptoms/) Caught early enough, the treatment is rather simple (?) by removal of blood by venesection which can possibly be done done through the Australian Red Cross Blood Service.

There are many factors that can lead to the depression; a bit like a jigsaw. One part of that jigsaw is what I have described above. Rather than just saying it is all in the mind, other factors should (?) be considered as well. Getting the iron levels down may not "remove" depression, but would/should be one less contributing factor.

Maybe a bit off-topic about silence vs telling, but hope you get something out of it.

Tim

[Donte]

Hello Doolhof,

Thank you for sharing your experience in this forum.

The Australian Institute of Health and Welfare states that organizations experience unprecedented levels of demand for culturally appropriate services because of the increasing number of older culturally and linguistically diverse people. The Institute also suggests many Australian health professionals have identified cultural diversity as a CHALLENGE.

People from culturally and linguistically diverse (CALD) backgrounds are considered a ‘special needs group’ under government priorities. Research highlights that many have higher levels of disadvantage and other risk factors than Anglo-Australians, and that these factors may affect their life experience and mental well being.

The ‘Review of Australian Research on Older People from Culturally and Linguistically Diverse Backgrounds’ identified a number of factors which contribute to older people from culturally and linguistically diverse backgrounds experiencing special needs. These are determined by individual experiences and circumstances and include:

Socioeconomic disadvantage:
In general older people from CALD backgrounds have poorer socioeconomic status compared to the older Anglo-Australian population.

Language:
Higher levels of English language ability have been found to be associated with better health, well being and better social inclusion outcomes.

Cultural interpretations (translations):
In addition to language barriers, differing cultural practices and norms can lead to misdiagnoses, lack of understanding and barriers to service use.

Length of time in Australia:
This has been shown to have an influence on health and well being outcomes, as well as help-seeking behaviors. Also, age at migration contributes to an individual’s life course and different experiences of ageing.

Lack of exposure to Australian services and systems:
There is a lack of knowledge in navigating Australian systems and services, particularly for migrants who arrive in Australia at an older age. Consequently, older CALD Australians have been found to present later with conditions such as dementia and cancer.

A preference for family members to provide care:
This propensity exists among older people from CALD backgrounds from some cultures. However the literature also highlights the need for caution in making the assumption that all migrant families ‘look after their own’ as this is not a homogeneous group.

(FECCA Report 2015 / page 10)

[Donte]

Thank you smallwolf for your valuable input into this conversation.

Your story validates the experiences of many.

This is indeed a complex issue and there are numerous factors contributing to one's mental illness. Sometimes talking about it or thinking positively and taking deep breaths, exercising, eating well etc may not 'solve/cure' the issue/illness. Hopefully, it may contribute positively though towards the reduction of the severity of symptoms.

I'm glad you are in good hands and undergoing all the relevant tests needed to establish your prognosis. X

[Hayfa]

Hello Donte'

Thank you for your further thoughts on this thread, it is becoming very interesting and important to discuss more.
Firstly, I need to say that my original post made no reference to depression and anxiety, I was responding to your very first post that asked 'does the expression of an emotion act as a reinforcer of that emotion? Does it cause it to be more likely to be felt again in the future?'

Emotions are strong feelings derived from one's circumstances, mood or relationships with others or, the philosophical definition, instinctive or intuitive feeling as distinguished from reasoning or knowledge.
Now thinking about this for a minute, depression and anxiety are a mental and physical experience of anguish (this incorporates fear, doubt and all the negative emotions that cause this feeling of pain).
The more complex mental health illnesses that you describe may be borne out of anxiety and depression that was left unaddressed.

I especially want to draw your attention to Sir Michael Marmot who is world renowned for his work on addressing the health inequities for the past 30 years. His definition and work about the social determinants of health have been recognised and adopted by the World Health Organisation. The social determinants of health are the key drivers of the conditions of people from their birth, where they grow, live, work and age. The social determinants of health come from circumstances shaped by the distribution of money, power and resources at a global and national level.
This means that a person's physical and mental health will be impacted over the course of their life through many hundreds of combinations of things.
To understand what an individual is experiencing let's imagine it like an iceberg on top of the water, this iceberg clearly shows the physical and mental symptoms and pain being suffered...if we dive under to take a better look at the hidden part of the iceberg we will see what is giving rise to the stuff happening on top. We have many interrelated environmental, individual and genetic factors that overlap and relate to cause what is going on in someone's situational life, there is a multitude of factors that will cause the individual physical and mental health conditions. So as you can see all these problems are interrelated and compound causing physiological factors in the individual.
Everything is very related, there is not one sole cause from the impacts of physical and mental health.

Hayfa