The Lived Experience of Ostracism

h/t whatnot

I first discovered C. Fred Alford’s work about the experiences of whistle blowers. In it, he describes what constitutes “knowledge as disaster”, and my experiences jibes almost perfectly with this list:

“What must the whistle-blower forsake in order to hear his own story?

* That the individual matters.

* That law and justice can be relied upon.

* That the purpose of law is to remove the caprice of powerful individuals.

* That ours is a government of laws, not men.

* That the individual will not be sacrificed for the sake of the group.

* That loyalty is not equivalent to the heard (sic) instinct.

* That one’s friends will remain loyal even if one’s colleagues do not.

* That the organization is not fundamentally immoral.

* That it makes sense to stand up and do the right thing. (Take this literally: that it “makes sense” means that it is a comprehensible activity.)

* That someone, somewhere who is in charge knows, cares, and will do the right thing.

* That the truth matters, and someone will want to know it.

* That if one is right and persistent, things will turn out all right in the end.

* That even if they do not, other people will know and understand.

* That the family is a haven in a heartless world. Spouses and children will not abandon you in your hour of need.

* That the individual can know the truth about all this and not become merely cynical, cynical unto death.

Not only is it hard to come to come to terms with these truths, but when one finally does, it seems one is left with nothing.”

Now plug in this list to Smart’s diagram below.

Multimotive model of reactions to interpersonal rejection experiences.Smart Richman, L., & Leary, M. (2009). Reactions to discrimination, stigmatization, ostracism, and other forms of interpersonal rejection: A multimotive model. Psychological Review, 116 (2), 365-383 DOI: 10.1037/a0015250

That, in a nutshell, is my experience. Ostracism is a cruel death sentence where all of the means to sustain oneself are intentionally withheld. The victim is used as an object of ridicule, contempt and alienation. The dying is slow, and there is full self awareness of what’s happening. Think of open heart surgery being performed without end, night and day without anesthesia, where the surgical team continually ignores the cries for help and instead makes jokes about the patient and his plight.

That is ostracism. Alford describes whistle-blowers who are doomed, but somehow, he never connects their experiences to ostracism. He discusses living as though one is already dead. Yup, that’s ostracism, because in the eyes of those who know and those who commit it, the victim as person has been murdered and only a ghost remains. But because the ghost has a heartbeat and is still enfleshed, it’s an object used for entertainment. In this case it’s used to create a feeling of superiority and legitimacy by degrading the victim as an unworthy, repulsive “other”.

I have been an other for time out of time. There is no re-entering society. I have been a most compliant patient patient and have repeatedly tried and failed to find a job, volunteer, make a friend beyond the most superficial of acquaintance level, and find any meaning or purpose in continuing to exist this way and there is none. In writing about some of my experience, I attracted a cyber stalker nurse and her band of bullying nurses, ambulance drivers and a Texas ER doc who wrote that “if she’s still alive we can make fun of her”. I was diagnosed as having persecutory delusions because my story “reads like a novel.” The outpatient psychiatrist to whom my case was assigned – she sure as hell didn’t volunteer – is married to the CEO of a competing organization in which I had been an inadvertent whistle-blower. In that organization, the mid level manager and director paranoia ran on high octane, and ironically, I wasn’t paranoid enough to save myself.

The paranoid whistle-blower is absolutely fight (sic) that his organization is not just out to fire him, but to obliterate him or her. The whistle-blower’s paranoia is an accurate emotional reading of an emotional reality: the one who has become the scapegoat cannot just be dismissed, but must be destroyed, so that others will know.

It is this aspect of paranoia that is the most difficult of all for an outsider to come to terms with because it represents a truth that is hard to know: that if the organization feels sufficiently threatened by the individual, it will remove him or her. Not just beyond the margins of the organization, but all the way to the margins of society. The average whistle-blower of my experience is a 55-year-old nuclear engineer working behind the counter at Radio Shack.

I was so desperate for help that I eventually sought it from the mental health non-system system, knowing full well that I would be placing myself in the hands of providers who were as likely to treat me with contempt as those who ostracized me did. All of my concerns were validated. For my troubles, I was diagnosed with stigmatizing labels, received treatment which resulted in metabolic, immune and cardiac derangements, was repeatedly deceived, humiliated, degraded and dehumanized, and was coerced and threatened. Physical problems were not diagnosed and treated, but instead were recorded as being somatizations and dismissed, if they were acknowledged at all. I cannot expect to receive competent healthcare from any provider who accesses my medical record because I am permanently and prominently labeled as the “xx year old homeless patient with extensive psych history”. When I pointed out multiple examples in the medical record of that to the outpatient psychiatrist, she sent a note to some of the offenders very politely requesting them not to do that anymore, and she proudly relayed that to me. But still it continued, and having been on the provider side, I know damn well that once patients are labeled, that they are treated with contempt, do not receive even minimally acceptable care, and they suffer for it with higher morbidity and mortality rates.

I took myself off every prescribed medication as none had helped, some were prescribed to mitigate the adverse effects of others, and many had caused direct harm. I read my medical record, identified what lab and diagnostic values were abnormal, and then I did all of the self care activities that I could do with my resources to reverse the damage.

But ostracism can’t be treated with medications and meditation. It requires a real physical friend, a network of professional/work peers, and a place in the social order. None of those are available to me.

Stillman, et al, describe life without meaning and purpose:

Why should social exclusion reduce the sense of life as meaningful? The pervasive reliance on social connection as humankind’s biological strategy entails that people are deeply motivated to connect with other people as a fundamental aspect of nearly all human striving. Meaning itself is acquired socially. Hence to be cut off from others is potentially to raise the threat of losing access to all socially mediated meanings, purposes, and values.

The formation and maintenance of positive close relationships can aptly be characterized as one of the primary motivations for human beings (Buss, 1990; Maslow, 1968). This pervasive drive has been described as the need to belong (Baumeister & Leary, 1995). We define social exclusion as a perceived deficit in belongingness.

Oh, belongingness. Joiner has something to say about that:

The theory posits that serious suicidal behavior will not occur unless an individual has both the desire to commit suicide and the ability to do so. Two factors contribute to an individual’s desire for suicide, a thwarted sense of belongingness and a sense of perceived burdensomeness on others, while the ability to commit suicide can be acquired over time through habituation to the physical and mental pain involved in self-injury.

I have been cut off from a place in society. The mental image I have is the astronaut in 2001 whose oxygen line has been snipped by HAL, the malign robot. At least the astronaut suffocates quickly in the absolute freezing void of space. His awareness of his predicament is full, but brief.

Not so the ostracized, who have to find their way in a hostile wilderness which is incompatible with life. I am out of place everywhere. There is no place to escape to. There is no respite.

In my everyday world, I go places to kill time. To use up the eternal isolation. To go just for the sake of movement. There is no reason for a journey. There is no destination. I try to keep everything out of focus, like looking sideways out a car window, because any conscious realization of my plight is too excruciating to bear, even for a moment. Time has no meaning. There are no holidays, anniversaries, birthdays, wedding, births, deaths, or special events by which to measure life. There is no quality of life. Everything adds up to zero. It is exhausting purposeless, meaningless, hamster wheel work, which is unending.

The psychiatrist conflated psychological assessment with treatment (not just her – I have found this with all mental health providers across disciplines), and I find this in the literature, as well. Assessment of depression, chronic severe insomnia and suicidal ideation is intrusive and painful, and yet, that is the extent of what she did at each visit. I had nothing else to share. My story was invalidated by diagnosing it as delusional. I will not refer to it again. It is not able to be heard by anyone. And I don’t want to cause anyone distress, which this obviously does.

It reminds me of times when people who knew what was happening to me would turn away when they saw me, lest they be seen with me and thus perceived as being at risk for ostracism themselves. There’s nothing like having people literally run from you to bring home how your life is destroyed.

She asked me what I was reading, but I’d reported to her my increasingly and consistently poor ability to comprehend, let alone, remember what I’ve read. I no longer read anything longer than a headline. Culling the literature for this blog post is taking me an extraordinarily long time. It probably reads as disjointed and not terribly well-reasoned. My cognitive ability and memory stink, to use the technical term. Yet, I can’t distinguish whether my nonstop efforts to keep everything out of focus, and so to minimize the consciousness of my predicament is the cause of my ever worsening cognition or just an effect of ongoing isolation.

Except for the visits to the psychiatrist, I have not had a single substantive conversation with another person for many years. And I wouldn’t really call the content of the visits conversation. In reality, I was always on tenterhooks trying to not evince distress, lest she decide to forcibly treat me.

I’ve lost the ability to have a social conversation. I can’t relate to others because I have no social commonalities – no family experiences, no contacts with people considered friends, no work role, no social role – nothing on which to any longer identify with others. When I was still trying to regain involvement via volunteering, as soon as someone got a whiff of my isolation via lack of those connections, they would abruptly cut off the conversation. I never heard from any of them again. The psychiatrist had been told this repeatedly when she poked and prodded into why I no longer sought outside activities. That amounted to self punishment. It’s painful to be rebuffed and excluded over and over and over. I am a slow learner, but I finally got the lesson: in order to avoid inflicting pain on myself, do not try to go where you are not welcome. That would be everywhere.

But she did it herself. She’s in a position in which, if she were to go out of role, granted, she could have provided me networking referrals to jobs.

But of course, she didn’t. Boundaries, you know. I was an assigned case, a cluster of pathological symptoms. Not a person, not someone with advanced education and related professional experience, not even a plain old person. She made two specific suggestions about how she saw me being able to contribute: to serve as a personal care attendant (adult baby sitter and butt wiper) or as a pet sitter. As if that wasn’t confirmation of my deemed worthlessness. Early on I had given her a copy of my vitae, and to her credit, she read what I had offered to her via a sample of my writing and the Alford article referenced here. And I don’t believe that she conducted therapy as a rule. I’m pretty sure I was an exception and guess that she primarily practiced psychopharmacology along with her administrative duties.

In my medical record, it turns out that her sole treatment goal for me was to keep me “in the realm of suicidal ideation. Dx: existential despair, but no worse than usual.” And that was the most positive thing written in my entire medical record. How is that compatible with life?

Stupid me. If I had gotten my records earlier, I could have saved myself the repeated distress of being “clinically assessed” (read psychologically debrided without anesthesia with wounds left gaping) and left to try to forget until the next session of torture and tell.

In my world, no one returns phone calls and emails. I received a total of 6 pieces of US mail last year (not addressed to “or resident”) – all from organizations requiring paperwork and none from individuals or anyone who knows me personally. I used to keep NPR on to hear reasonable, non-violent human voices. But I finally stopped because I often couldn’t follow the patter and it became just more intrusive and irritating noise. Now I just keep a fan running to drown out gunshot season – any loud abrupt noise especially during open window weather. I exist in a noisy world but with more silence than a monastery.

I can’t get any enjoyment out of any experience. Food tastes like nothing. Everything is a tone of grey and shadow. Aromas that in the past evoked pleasant memories are undetectable, and most aromas smell foul. Music is just notes, too loud and evoking nothing. People are nothing but harbingers of pain and dread. No one has voluntarily touched me except to perform medical procedures using my body as just an object, such as blood drawing and injecting a joint, in many years. I know better than to reach out a hand or to offer a pat on the shoulder. It would most decidedly not be welcomed.

There is no reason to prolong this, but my attempts at providing my own euthanasia failed. The LD50’s weren’t enough, and I don’t have the means to provide myself with a peaceful and painless death. I’ve come to realize that a painful death is preferable to this unending dying.

Ostracism means that there is no burden to anyone. Society has already unburdened itself of me.

Ostracism is a death sentence, and every person who knows that it’s been imposed on someone and yet who does not intervene, is a member of that judge and jury.

I can’t stand the notion that the rest of my natural lifespan is going to be spent in this wholly silent, totally isolated and destitute way of existing. It’s enforced insanity. The conditions explain why most whistle blowers get sick and die early.

ResearchBlogging.org

Alford, C. Fred (2007). Whistle-blower narratives: the experience of choiceless choice Social Science, Volume 74 (1), 223-248

Smart Richman, L., & Leary, M. (2009). Reactions to discrimination, stigmatization, ostracism, and other forms of interpersonal rejection: A multimotive model. Psychological Review, 116 (2), 365-383 DOI: 10.1037/a0015250

Stillman, T., Baumeister, R., Lambert, N., Crescioni, A., DeWall, C., & Fincham, F. (2009). Alone and without purpose: Life loses meaning following social exclusion Journal of Experimental Social Psychology, 45 (4), 686-694 DOI: 10.1016/j.jesp.2009.03.007

Van Orden, K., Merrill, K., & Joiner Jr., T. (2005). Interpersonal-Psychological Precursors to Suicidal Behavior: A Theory of Attempted and Completed Suicide Current Psychiatry Reviews, 1 (2), 187-196 DOI: 10.2174/1573400054065541

Williams, Kipling D (2001). Ostracism: The Power of Silence 2001 Other: 1572306890

Chasing Tails

Thomas Joiner’s interpersonal theory of suicide is one I refer to often here.  However, even he doesn’t move upstream to look at distress causality.  Exhibit the last:

J Psychiatr Res. 2012 Apr 2. [Epub ahead of print]

Behaviorally-indexed distress tolerance and suicidality.

Source

Military Suicide Research Consortium, United States.

Abstract

Research indicates that distress tolerance exhibits a complicated relationship with risk factors for suicidal behavior. Specifically, low self-reported distress tolerance has been linked to perceived burdensomeness and thwarted belongingness. Contrastingly, high self-reported distress tolerance has been linked to the acquired capability for suicide. Given the frequently discrepant findings between self-report and behavioral indices of distress tolerance, we sought to expand upon prior findings by testing these relationships utilizing a behavioral measure of distress tolerance. Additionally, in an effort to further clarify the role of distress tolerance relative to painful and/or provocative experiences in the acquired capability, we examined whether distress tolerance serves as a moderator. Results revealed no significant associations between distress tolerance and burdensomeness or belongingness; however, distress tolerance was positively associated with the acquired capability. Furthermore, the interaction of distress tolerance and painful and/or provocative experiences significantly predicted the acquired capability, with the strength of the association increasing at higher levels of distress tolerance. Results highlight the potential importance of perceived versus actual ability to tolerate distress with respect to suicidal desire. In contrast, the results reflect the importance of actual persistence in the acquired capability.

Hurts So Bad

Illustration of the pain pathway in René Desca...

Image via Wikipedia

Social rejection, that is.

Current theorizing suggests that the brain systems that underlie social rejection developed by coopting brain circuits that support the affective component of physical pain (1, 2, 9). The current findings substantively extend these views by demonstrating that social rejection and physical pain are similar not only in that they are both distressing, they share a common representation in somatosensory brain systems as well.

-snip-

Although the experience of social rejection is commonly accompanied by reports of various emotions (e.g., fear, sadness, anger, anxiety, and shame), it is generally assumed that these feelings cumulatively give rise to a unique experience of “social pain” (3537). The results of the meta-analyses we performed in this study, which indicated that fMRI studies of specific emotions rarely activate OP1 and dpINS, are consistent with this view.

Decision making ability goes down the tubes:

Researchers have known for a long time that there is a link between social exclusion and the failure of self-control. For instance, people who are rejected in social situations often respond by abusing alcohol, expressing aggression or performing poorly at school or work.

-snip-

The new study, however, is the first to use MEG to show that there are actual changes inside the brain when test subjects are manipulated to feel socially excluded. MEG is an imaging technique that measures the magnetic fields produced by electrical activity in the brain.

Analogous to a trapped, wounded animal, no?  Except in this case, being trapped means being trapped in ongoing living with intentionally inflicted and unrelieved distress.

Here’s the linkage:

“Although it has long been suggested that mu-opioids play a role in social pain — and there are convincing animal models that show this — this is the first human study to link this mu-opioid receptor gene with social sensitivity in response to rejection,” Eisenberger said.

“These findings suggest that the feeling of being given the cold shoulder by a romantic interest or not being picked for a schoolyard game of basketball may arise from the same circuits that are quieted by morphine,” said Baldwin Way, a UCLA postdoctoral scholar and the lead author on the paper.

Eisenberger argues that this overlap in the neurobiology of physical and social pain makes good sense.

“Because social connection is so important, feeling literally hurt by not having social connections may be an adaptive way to make sure we keep them,” she said. “Over the course of evolution, the social attachment system, which ensures social connection, may have actually borrowed some of the mechanisms of the pain system to maintain social connections.”

Back to the usual: the interpersonal theory of suicidality.  The two conditions of thwarted belongingness and perceived burdensomness are met with social rejection that isn’t fully remediated. Baumeister explains that human attachment is a fundamental – essential for survival – need:

A hypothesized need to form and maintain strong, stable interpersonal relationships is evaluated in light of the empirical literature.  The need is for frequent, nonaversive interactions within an ongoing relational bond.  Consistent with the belongingness hypothesis, people form social attachments readily under most conditions and resist the dissolution of existing bonds.  Belongingness appears to have multiple and strong effects on emotional patterns and on cognitive processes.  Lack of attachments is linked to a variety of ill effects on health, adjustment, and well-being.  Other evidence, such as that concerning satiation, substitution, and behavioral consequences, is likewise consistent with the hypothesized motivation.  Several seeming counterexamples turned out not to disconfirm the hypothesis.  Existing evidence supports the hypothesis that the need to belong is a powerful, fundamental, and extremely pervasive motivation.

 

Suicide becomes the means to put a permanent end on an inflicted permanent unbearable degree of suffering – real physiologic and psychologic suffering.

One thing leads to another

A cartoonist gets thwarted belongingness but not the myth of attention seeking motivation.

Which leads to the inevitable discovery that there are also mental health professionals writing inane things on the web about suicide.

Which leads to the perceived importance of the components required for social acceptance – eg, belongingness.

For , honesty and kindness—which researchers describe as communion traits—are more important for relationships than intelligence and ambition, both considered agency traits, says Oscar Ybarra, professor of psychology. Agency traits help people attain skills, talent and status.

“Social life pressures people to view themselves as possessing high levels of communion traits and to ensure that others have this perception as well,” he said.

Which, in turn, leads to the other main factor in suicide – perceived burdensomeness: in this case, the perception of ill health:

Our findings provide initial evidence that perception of poor health is associated with a significantly increased likelihood of suicidal ideation and suicide attempt among adults in the community.

Which leads to the hypothesis that suicidality is minimized in societies which don’t use ostracism, have mechanisms for supporting and comforting those in ill health and who use kindness, honesty and inclusive humor in abundance.

Won’t You Come In and Set A Spell?

I’d like to invite one and all who think about dying, wanting to die, plan your own death, attempt(ed) to die, study these thoughts, beliefs and behaviors or care for or about those who do, to help me in my exploration of alleviating distressors “upstream” from suicidality.

It occurred to me that survivors of suicide are usually described as family and friends of those who died by self inflicted death.  But what about those of us who remained alive after our attempts?  I haven’t found a term for that. Isn’t that interesting?

And what about those of us who find no relief in having remained alive after suicidality?  Or who don’t find relief from suicidality?

Perhaps there is belongingness and worthiness to be found in helping those who are navigating – mostly alone – these very rocky shoals.  Maybe bringing your wisdom, experience and perceptions in how to regain thwarted belongingness and regaining a real and abiding sense of purpose and meaning to someone who is suffering will help you to acquire the same attributes.

I was thinking about the study out today that demonstrates a deep and broad lack of trust by people with depression of their physicians. Then I thought about the known problem of medical students’ reluctance to seek help for mental illness.  I think there may be a lot of overlap in these two studies in the following areas:

There is fear of the negative consequences of reporting symptoms of mental illness – stigma, loss of career, loss of income, loss of health insurance, loss of healthcare (after a psych diagnosis, the quality of healthcare goes down significantly and dramatically as symptoms are chalked up to psychosomaticism and preventive healthcare doesn’t include aggressive care for psychotropic medication adverse effects),loss of personal relationships, loss of home, loss of social standing, loss of social roles, loss of self worth.  There is also the fear of coercion in accepting treatment.  And there is fear of undesirable effects of treatment.

But in admitting suicidality, there is a real danger of losing one’s civil rights, of being detained, incarcerated and treated against one’s will, of being publicly humiliated and shamed, and worst, of being intrusively assessed and evaluated with no care which alleviates intolerable distress.  Every single time I tried to bring up suicidality and how to deal with it, the treater instantly launched into the “dangerousness” assessment.  I eventually learned to clam up immediately and not to bring up suicidality again.

Is it any wonder that we scratch our heads and can’t figure out why people attempt suicide then?  It’s really because no one wants to know the lived experience – the phenomena – of suicidality.

The psychological autopsies are largely stupid, in my view.  There are living, breathing, distressed people who are more than willing to explain if only someone was there to be open enough (and not terrified) to listen and to help work through the distress.

I think that “someone” is those of us who experience suicidality. We may be our own best resource.

So if this speaks to you, consider yourself welcome.  Bring your best – critical thought, analysis, resources, references, support – and help to build ways to lower distress, prevent it in the first place, and find some relief for yourself.

 

Emotions and Social Behavior

Well, so much for keeping up with blogging.  An unexpected health insult, weeks of bedrest and sequelae of fatigue and brain fog haven’t done me any favors. But whatever, here’s a bit of catch up, even if presented through a dense fog….

Kipling Williams is one of the few researchers who is investigating ostracism.  I want to read his major opus, Ostracism: The Power of Silence, but will have to wait until I can do so in library residence, as it doesn’t circulate. (If you have a copy to lend or re-sell at a bargain, I’d be thrilled.)  The library has it catalogued under social isolation, and in a collection titled emotions and social behavior.

The latter label struck a chord, for what is suicidality but distress signaling (the emotion) which if unaddressed, leads to suicidal attempts (the social behavior)?

So when I start thinking more clearly again, I’ll try to put together some sort of framework for addressing the distress signaling:

  • alienation
  • burdensomeness (perceived)
  • demoralization
  • despair
  • grief (situational)
  • guilt
  • helplessness
  • hopelessness
  • ostracism (externally applied isolation)
  • pessimism
  • powerlessness
  • realism
  • self identity loss – externally removed (loss/denial of social roles)
  • self loathing
  • shame
  • social isolation (as opposed to voluntary avoidance and isolating behavior)
  • thwarted belongingness
  • worthlessness (perceived and externally applied)

To date, no one has studied people who have made suicide attempts or completed suicides to evaluate what behaviors they used to try to adapt to the distressors, what train of events (thoughts, feelings and behaviors) they experienced when the distress wasn’t adequately relieved, and what directly led to the suicidal ideation, the suicidal attempt, and the completed suicides. But at certainly needs must be done in order to treat suicidality upstream – preferably before the suicidality is entertained and certainly before it is acted upon.

Understanding Aspects of Thwarted Belongingness – Humiliation

I think I’m going to use Thomas Joiner‘s work as a frame of reference for a while.  So back to the notion of thwarted belongingness.  What groups of people might that have applicability?

I think any stigmatized group might be affected.  In the US, that might be LGBT self identified people, whistleblowers, people who have visible disabilities, people who are bullied, and people who do not act in the proscribed ways of their communities. For example, religious denominations which practice shunning or repudiation.  Moreover, in the US immigrants are often targeted for humiliation and ill treatment.  Blacks and Latinos in the US, and people of minority races within their local communities are often segregated and excluded in significant ways.  Families can scapegoat vulnerable members and deny them belongingness.

There is an essay in Psychiatric Times by Jane B. Sofair about humiliation being a factor in suicidality.  That would be another example of intended exclusion with a result of thwarted belongingness. She lists signs of risk around humiliation, and they struck home:

TABLE: Near suicidal signs7,8

• Inability to form a working alliance
• Unwillingness to be known
• Intolerance of being understood
• Agitation
• Cogitation
• Detachment and despair
Social isolation
• Change in treatment compliance patterns
Suicidal ideation, plan, and intent with preparations
• Discrepancy between verbal self-report and actions
• Perceived environmental humiliation

Note that isolation is once again mentioned. It’s a recurrent theme, and it can be addressed in psychological treatment, but more important, as a public health issue and societal value, it can be addressed at all levels – individual resources, local, state and national policy and culture.

Thwarted belongingness can often not be self-managed. It requires external resources: people who voluntarily include and support the victim – mentors, coaches, champions and trustworthy, reliable and consistent people. Work regulations which do not allow for capricious harassment and at whim terminations, punishments and retaliation are key. Schools which assure that all students, teachers and staff are treated with respect, dignity and inclusion are vital. Communities which value all of their members with these same values are fundamental.

Does psychiatry have a role to play? I’m not sure. Certainly this is not a distressor which should result in medication, seizure induction or deep brain stimulation. And what else does psychiatry in its extant iteration offer?