PSYCH 406 (Psychopathology) - Suicide as Related to Major Depressive Disorder

Abstract

This essay describes the symptoms and diagnostic criteria for major depressive disorder, with an emphasis on the symptoms of thoughts of death and suicidal ideation. It further reviews methods of treatment, and then finishes with a review of ways therapists can forge and strengthen therapeutic relationships with suicidal patients.

 

Introduction

To exist or not, as a human being, is up to us. Albert Camus (1979) contends suicide is the only genuinely profound philosophical question to answer. True, every individual has the choice to exit life, however the cost of that exit can be significant for those left behind. Not even counting the invaluable cost of loss of life, suicide attempts alone accounted for nearly $27B in health care costs in 2019 in the United States (Hughes, et al., 2023). Even despite the massive expense from the fallout of suicide attempts, the emotional toll and impacts heaped on loved ones and friends who remain behind in the wake of a successful or unsuccessful suicide will take countless hours of therapy and grieving and perhaps even significant pharmacological expense to remediate. From a psychological, to an emotional, to an economic perspective, any way to advance the understanding of the patient’s motivation for suicide and greater insight into how to prevent suicides would be a worthy endeavor not only for the individual, but also for the common good. To that end, this essay will explain the most common disorder which leads to suicide.

This essay will describe major depressive disorder, including all the criteria that must be met in order to diagnose an individual with major depressive disorder (Maddux & Winstead, 2016 and American Psychiatric Association, 2022). Along with those criteria, it will also outline the symptoms and warning signs of those seeking to end their life (National Institute of Mental Health, 2022). It will then review three major avenues of treatment for major depressive disorder, which include electroconvulsive, psychopharmacological and psychotherapeutic forms (Maddux & Winstead, 2016). Lastly, the essay will delve into the topic of clinicians establishing the clinician-patient therapeutic alliance to assist patients in opening up about the challenges they face with suicidal ideation (Foster, et al., 2021).

Description, Symptoms, Diagnostic Criteria

While the impacts of major depressive disorder (MDD) can be persistent and influence human productivity, symptoms can worsen and lead to the untimely death of the sufferer. Maddux and Winstead (2016) note that MDD will perhaps be the number one cause of premature death and human disability globally in the next one hundred years. In the United States alone, the suicide rate has increased over a third between 1999 and 2018 and with the recent COVID-19 pandemic, that trend has continued to rise (Moutier, 2021). Therefore, spotting MDD symptoms effectively and early is key to suicide prevention.

The symptoms of MDD described in the DSM-5-TR (American Psychiatric Association, 2022) begin with understanding what a major depressive episode is. Symptoms include nine key markers: 1) a depressed mood, which may include feelings of helplessness and hopelessness, 2) the loss of interests or pleasure in activities the person normally enjoys, 3) losing 5% or more of their weight in 30 days while not intending to diet, 4) poor sleeping habits stemming from insomnia or perhaps sleeping all day, 5) constant agitation in movement or a significant lack of movement, 6) general lack of energy, 7) self-loathing, exceptional feelings of guilt or worthlessness, 8) significant challenges in concentration, deliberation, thinking or even decision-making, and most importantly, 9) repetitive thoughts of dying, death or suicide. As for this ninth symptom, the patient does not need to demonstrate it every day for a two-week period; once is sufficient to qualify. The patient must exhibit five or more of the nine listed symptoms (two of which must be a depressed mood and loss of interests) for a period of at least 14 days, and these must cause a substantial impact on their social life, job or other important aspects of their life, and the attribution of these symptoms must not stem from some other condition such as drug use, or another disorder such as schizophrenia (American Psychiatric Association, 2022, p. 183, 185). Lastly, in order for MDD to qualify as the diagnosis, the patient must demonstrate having one or more major depressive episodes, without any type of mania or hypomania.

One other important aspect of the diagnosis is related to whether there is an identifiable cause of the patient experiencing the symptoms. Some people may have recently dealt with an impactful and emotional event in their life such as the loss of a baby, a bankruptcy or loss of job, living through an act of God such as having a home and all possessions burned down in a wildfire or even having contracted a serious medical illness such as terminal cancer (American Psychiatric Association, 2022, p. 183). While many people may exhibit major depressive episode symptoms stemming from one of these drastic life events, it does not mean the person qualifies for the diagnosis of MDD.

As noted in the ninth symptom of MDD, if a patient has repetitive thoughts of death or suicide just once in a two-week period, along with the other symptoms, then they may have MDD. It is also important to note external markers which may predict if a patient is suicidal. Maddux and Winstead (2016, p. 193) observe that a majority of suicidal people convey their intent to kill themselves. More specifically, the National Institute of Mental Health (2022) provides a list of warning signs which loved ones and other people around the patient can spot. The patient may verbally express ideas of suicide, feelings of guilt or sense of being a burden on other people. They may express feelings such as helplessness, hopelessness, being trapped, having no purpose, or being sad, anxious, angry or expressing unendurable pain be it physical or emotional. Lastly, the patient may communicate in non-verbal ways such as searching online for ways to die, pushing close ones away or retreating from normal social interactions, acting with recklessness (e.g. risky skiing, driving, cliff jumping), consuming more drugs or alcohol, and sleeping and eating less. Related to the warning sign of recklessness, Maddux and Winstead (2016) note that suicides may be underreported because the act of suicide may appear to be accidental. For example, 15% of automobile accidents with a fatality may actually have been suicide related.

Treatment Options

There are three major avenues of treatment for MDD: electroconvulsive, psychopharmacological and psychotherapeutic therapy. The essay will briefly describe mechanisms which address the first two methods and then more deeply address the third method through a discussion on cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT).

Electroconvulsive therapy (ECT) was discovered as a form of therapy in the 1930s (Maddux & Winstead, 2016, p. 205). The method for application is to deliver between 70 and 130 volts of electrical shock to the patient’s brain. The patient may endure nine or ten rounds of ECT over the course of several weeks. While ECT has proven to be somewhat effective, experts still do not know exactly why it works in some cases. One theory is that electrical shocks downregulate 5-HT (serotonin) receptors. Despite proving somewhat effective, patients’ memory functions degrade, and they have a more difficult time learning and recalling knowledge. Related to ECT is transcranial magnetic stimulation (TMS). TMS does not produce memory dysfunction and can be more precisely tuned. The only side effects reported are benign headaches and minor discomfort.

Pharmacological forms of therapy for major depressive disorder address dysfunction in serotonin regulation (Maddux & Winstead, 2016). Studies have shown that when individuals’ serotonin levels are depleted or if reuptake has been altered, then it begins to have a negative impact on mood, which may act as a catalyst for a depressive episode. Three medications have been used for quite some time to treat depression: monoamine oxidase inhibitors, tricyclic and tetracyclic antidepressants. More recent developments in antidepressant medications include selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). All five medications work in some form or fashion to regulate serotonin levels. As for which one should be used with a patient, it is often a matter of finding the right medication and dosage with the least harmful side effects. One emerging medication to address depression is ketamine. Rather than targeting the regulation of serotonin, ketamine seems to aid in the regrowth of important synapses in the brain, improving brain neuroplasticity (Yale Medicine, 2021). Researchers are discovering that ketamine treatment coupled with CBT provides rapid and long-lasting positive change. Not only do ketamine and CBT together prove efficacious, but Maddux and Winstead (2016, p. 198) note that CBT coupled with other appropriate medication is more effective than either CBT or medication alone.

CBT and ACT are two well-known psychotherapeutic frameworks which help the patient to fundamentally change their underlying thinking to address negative perceptions of themselves and environment (Maddux & Winstead, 2016, p. 197-199). CBT encompasses multiple ways to help the patient alter the underlying thinking framework for how the patient processes events, as well as to couple their thinking to action. For example, people who suffer from MDD would be asked to recognize and write down their negative thoughts, along with the causes and effects which lead them to think this way. They would then be asked to assess and question those thoughts to ascertain if they truly match reality and rationality. Through this process, the patient begins to reconstruct their thinking narrative in a more positive and productive manner.

CBT is especially helpful in challenging and questioning hopelessness thinking in suicidal patients. In fact, studies have shown (Bryan, 2019) that versions of CBT for suicide prevention (CBT-SP) are so effective, that these specific forms of CBT have been recommended as standard care procedures for all suicidal patients. CBT-SP typically includes three successive phases. In the first phase, clinicians assess the risk of the patient and then collaboratively work with the patient to form a crisis and treatment plan. In the second phase, the therapist and patient work on revealing the dysfunctional thinking patterns and negative internal dialogues which lead to feelings and emotions related to helplessness, hopelessness, being trapped, and having no purpose. In the last phase, therapists and patients tie everything together by creating a plan to minimize relapse. Bryan (2019, p. 249) further observes the effectiveness of CBT-SP by stating that patients of CBT-SP were one-half to two-thirds less likely to attempt suicide when compared to treatment as usual.

ACT can be viewed as an extension and evolution of CBT (Maddux & Winstead, 2016, p. 198-199). While ACT is similar to CBT, it differs from its aim. ACT does not focus on minimizing the negative symptoms of depression, but to empower the patient with greater flexibility in their thinking. ACT helps the patient understand their core values and then proceed in a consistent manner with those values. ACT prompts the patient to pause and reflect on what they deeply value in life, and then to engage with their emotions and thoughts, rather than questioning them. By engaging with their thoughts and emotions through a comparison with their core values, the patient is able to discern gaps between who they are and who they wish to be, and then take specific and meaningful action. For example, ACT has proven to be quite successful with veterans dealing with suicide (Walser, et al., 2015, p. 30). It has shown that when a patient experiences suicidal ideation, the therapist would work with the patient to explore the patient’s core values, either through dialogue or a values assessment test. As the patient is confronted with ideas of death, they can accept those thoughts and pivot toward ways to pursue and fulfill meaning in their life by focusing on something they value.

Article Summarization: Strengthening the Therapist-patient Alliance

In the context of suicidal ideation, it has been observed that most suicidal individuals do not explicitly disclose through self-reporting. Foster, et al. (2021) note that only 24% reveal their suicidal plans through disclosure. The driving causes of hesitating to divulge their thoughts of ending their life are fears of judgement, hospitalization, and losing independence. Therefore, if therapists, clinicians and others who are in a position to help the patient can establish trust and openness in communication, they may be able to garner the patient’s confidence and assist them in getting the needed medication and therapeutic treatment. Foster, et al. (2021) argue that three specific aspects on which clinicians can focus to improve the therapist-patient alliance are: 1) awareness and management of countertransference of negative emotions, 2) deploying communication techniques which are empathic and 3) leveraging the patient’s subjective experience as feedback.

Countertransference occurs when the therapist experiences conscious or unconscious projections or judgements of the patient, which in some cases may interfere with the therapeutic process (American Psychological Association, 2018). Foster, et al. (2021, p. 258) note that therapists can exude negative emotions to an individual intent on ending their life. Quickly assessing countertransference is crucial to strengthening the therapist-patient alliance. The Therapist Response Questionnaire-Suicide Form is an innovative tool to rapidly assess countertransference and enables the therapist to secure supervisory coaching and support to manage countertransference.

Empathy is how one person relates to another, including focusing on commonalities as well as differences, which enables shared insight between individuals (Foster, et al., 2021, p. 259). Clinicians and therapists must have a life-long commitment to developing and mastering empathy in their practice, especially when working with suicidal patients. Besides continuing education and hands-on training seminars to learn and practice empathy, there are also tools which assist therapists to hone their empathy skills. The Empathic Communication Coding System (ECCS) assists in identifying opportunities for the therapist to practice a range of empathic responses. The ECCS aids in identifying the patient’s statements as emotion, progress or challenge and then suggests a range of potential ways a therapist could use empathy. For example, a widow may mention how she constantly thinks of her deceased husband, to which a therapist could respond with, “Are you thinking about death?” or with the more empathic response of, “It seems that these thoughts you are having are difficult. Has suicide crossed your mind?” Therapists who master the art of empathy will improve the chances of the patient opening up and being more receptive to treatment rather than suicide.

Lastly, when therapists form a solid alliance with the patient, they can leverage that trust to gain insight from the patient feedback. Gathering feedback from a patient who has attempted suicide or had thoughts of suicide can prove rich in understanding the paths leading to death as well as paths leading to recovery (Foster, et al., 2021, p. 259). Collecting this feedback and sharing it broadly enables the wider community to benefit from this untapped resource. Tools such as the Consultation and Relational Empathy assessment and Working Alliance Inventory collect data from the patient’s perspective. These feedback mechanisms reinforce patient autonomy as well as shed light on the subjective experience of the patient.

In sum, there are innovative ways and tools to facilitate greater collaboration between the therapist and suicidal patient. First, the therapist must be aware of and manage countertransference of negative emotions. Second, they must constantly improve their communication techniques by focusing on improving empathy. Lastly, they can tap into the patient’s subjective experience to use as feedback in the therapeutic process.

Conclusion

In conclusion, with the increasing trend of suicides globally, and the severe impacts they have on society, this essay endeavored to illuminate the reader on the topic of major depressive disorder, with an emphasis on the symptom of suicidal ideation and the diagnostic criteria indicating a risk for suicide. The essay then examined three methods of treatment in the forms of electroconvulsive therapy, pharmacological and psychotherapeutic avenues. It specifically addressed CBT, CBT-SP and ACT in the context of suicidal patients. Finally, the essay discussed the importance of the clinician-patient therapeutic alliance, along with a set of tools to enable the fortification of that collaborative effort. 

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders, text revision (5th ed.). American Psychiatric Association.

American Psychological Association. (2018). APA Dictionary of Psychology. Dictionary.apa.org. https://dictionary.apa.org/countertransference

Bryan, C. J. (2019). Cognitive behavioral therapy for suicide prevention (CBT‐SP): Implications for meeting standard of care expectations with suicidal patients. Behavioral Sciences & the Law, 37(3), 247–258. https://doi.org/10.1002/bsl.2411

Camus, A. (1979). The Myth of Sisyphus, and Other Essays. (J. O’Brien, Trans.). Penguin Books Ltd. (Original work published 1955)

Foster, A., Alderman, M., Safin, D., Aponte, X., McCoy, K., Caughey, M., & Galynker, I. (2021). Teaching Suicide Risk Assessment: Spotlight on the Therapeutic Relationship. Academic Psychiatry, 45(3), 257-261. https://doi.org/10.1007/s40596-021-01421-2

Hughes, P. M., Phillips, D. C., McGrath, R. E., & Thomas, K. C. (2023). Examining Psychologist Prescriptive Authority as a Cost-Effective Strategy for Reducing Suicide Rates. Professional Psychology, Research and Practice, 54(4), 284–294. https://doi.org/10.1037/pro0000519

Maddux, J. E., & Winstead, B. A. (2016). Psychopathology : Foundations For A Contemporary Understanding (4th ed.). Routledge/Taylor & Francis Group.

Moutier, C. Y. (2021). Innovative and Timely Approaches to Suicide Prevention in Medical Education. Academic Psychiatry, 45(3), 252–256. https://doi.org/10.1007/s40596-021-01459-2

National Institute of Mental Health. (2022). Warning Signs of Suicide. Www.nimh.nih.gov. https://www.nimh.nih.gov/health/publications/warning-signs-of-suicide

Walser, R. D., Garvert, D. W., Karlin, B. E., Trockel, M., Ryu, D. M., & Taylor, C. B. (2015). Effectiveness of Acceptance and Commitment Therapy in treating depression and suicidal ideation in Veterans. Behaviour Research and Therapy, 74, 25–31. https://doi.org/10.1016/j.brat.2015.08.012

Yale Medicine. (2021, July 30). Ketamine & Depression: How it Works - Yale Medicine Explains. Www.youtube.com. https://www.youtube.com/watch?v=nW21-AYY_fs 

PSYCH 406 (Psychopathology) - Trauma and Pathologizing the Norm

Abstract

This essay discusses the observation of Western culture’s fascination with trauma, along with the history of post-traumatic stress disorder (PTSD), and how that diagnosis has expanded its scope. It also notes that most humans are resilient in adversity and trauma. For those who suffer long-lasting effects of trauma and exhibit PTSD symptoms, they should seek professional help and support.

Introduction

For many movie-goers, the summer is a great time to head to the silver screen and watch action, drama, and intriguing stories play out in spectacular visuals and chest-thumping sounds. This year, audiences are anticipating the third installment of the Deadpool series. For the uninitiated, Deadpool is an antihero known for his sharp sarcasm and dark humor. For example, in a scene from the first Deadpool movie (Miller, 2016), when he meets his girlfriend, Vanessa, the two enter a back-and-forth banter about the trauma and rough childhood they’ve endured. While this essay won’t recall the entire repartee, one of the less dark and non-sexual exchanges gives a good sense of the dialogue. At one point, Deadpool quips his bedroom was a hall closet, to which Vanessa volleys back she had to sleep in a dishwasher box, to which Deadpool replies, “you had a dishwasher?” (Miller, 2016). While dark and humorous, this represents the zeitgeist of modern culture’s romanticization of trauma .

In a recent Psychology Today article (2022, January 4), Robin Stern wrote regarding her observations of many examples of how society, particularly Western society, has become enamored with stories of trauma. From a conversation she had with her trainee about how she couldn’t get enough details of her clients’ trauma, to books by Bessel von der Kelk and Paul Conti  on bestsellers lists and to a documentary by Gabor Maté, all are examples of how the topic of trauma is having a significant cultural moment. However, Stern and others have wondered if there is a misunderstanding of what trauma is. Are people truly experiencing trauma, or are they simply experiencing stress, grief, or big life events ? Maddux and Winstead (2016, p. 162) in the chapter on trauma and stressor disorders note that there is “larger debate [regarding the] pathologizing of normal human suffering and the overdiagnosis of disorders .”

This essay will discuss the phenomenon of society’s romance with trauma and the issue of pathologizing normal behaviors (Harrist & Richardson, 2014). It will then pivot to a discussion on what constitutes real, clinical trauma and two psychosocial models of the etiology of post-traumatic stress disorder (PTSD) (Maddux & Winstead, 2016). Lastly, the essay will contend that many people suffer significant stress and emotional events, however, most are resilient and will recover (Bonanno, 2021). For those who truly suffer trauma, they too will largely recover, but for those who meet the criteria of PTSD, they should seek professional help.

Pathologizing Normal Behavior

Harrist and Richardson (2014) discuss many ways in which seemingly normal behavior has been pathologized in Western culture. They note how melancholy and despair may actually be perfectly normal responses to the instable world in which we live, yet modern science attempts to solve these responses with pharmaceuticals . They further wonder why hoarding is considered a mental disorder when people fill their house to the roof with junk but people who “amass billions of dollars while other people starve” are not pathologized (Harrist & Richardson, 2014, p. 202). But more importantly, they discuss the roots and genesis of the PTSD diagnosis.

They cite an article published in the British Medical Journal of how the old diagnoses of battle fatigue and war neurosis were replaced by PTSD. The early supporters of the PTSD diagnosis were also part of the anti-war movement during the Vietnam War. Under the new diagnosis of PTSD, war veterans could receive unique medical care. But more importantly, PTSD fundamentally changed the way soldiers were viewed and treated. Instead of the focus being on the unique history of the soldier and his psyche, PTSD “legitimized their victimhood” and the PTSD diagnosis was perhaps more of a statement against the nature of war than anything else (Harrist & Richardson, 2014, p. 203). This change was a pivotal moment as the diagnosis expanded in scope for the next several decades to explain not only battle trauma, but also “symptoms of distress following disturbing events, even ones relatively commonplace or just witnessed, not directly experienced, by individuals” (Harrist & Richardson, 2014, p. 203).

Returning to Stern (Psychology Today Contributors, 2022, January 4), she describes why PTSD and related disorders have seemingly expanded their scope. The experiences people share of  trauma are often remarkable and fascinating and “have a strong emotional charge” especially when compared to more normal experiences of people from overprotected and isolated lives. There is an aura about traumatic stories and people who live through those experiences are imbued with a type of fame and fascination. Others wish to share their own stressful experiences to gain traumatic credibility. But as Harrist and Richardson (2014) warn, while people may indeed experience big emotional events, the trauma of soldiers, war victims, and victims of sexual violence, to name a few, should not be “trivialized.” Definitions matter and delineation must be made clear between normal behavior in response to a significant event, and clinical trauma that people suffer from living through horrific events.

Clinical Trauma and Psychosocial Etiology Models of PTSD

While there have been changes to the PTSD entry between the DSM-4 and the DSM-5, such as moving it from an anxiety disorder to the newly created category of trauma- and stressor-related disorders, the key features of PTSD remain relatively the same (Maddux & Winstead, 2016, p. 165). The traumatic experiences must be related to death, the threat of death, significant bodily injury, or sexual violence. Victims may either experience these events directly or they may indirectly experience them such as when a close family member directly experiences it and then conveys the details of the horrific event to the victim. Stemming from one or more of these experiences, the victim should demonstrate intrusive memories, dreams, or psychological and even physiological effects from reminders of the traumatic event. They will avoid any reminders of the event and may begin to have cognitive distortions, memory loss, emotional distress, and  even detachment. From there, they will develop and exhibit strong response arousal, careless behavior, hypervigilance, or experience problems with concentration or sleep. The victim must suffer many of the above symptoms for more than one month after the event. Underlying all these symptoms is the victim’s inability to process or integrate the traumatic experiences into their life. In turn, they are left with less than adequate coping mechanisms.

Based on a sample of people in the United States, it is estimated that over 60% of men and 51% of women experience trauma (Maddux & Winstead, 2016, p. 163). The majority of those adapt and do not experience long-term maladaptive coping mechanisms. As for why some people might cope well and adapt to a traumatic experience while others do not, there are many etiological theories that explain why some suffer PTSD. This essay will only touch on two: cognitive and emotional processing .

The cognitive etiological model theorizes that the individual’s beliefs and knowledge about himself, the world, and other people are maladaptive and weak, and when the individual experiences a traumatic event, their beliefs and conception of safety, are crushed (Maddux & Winstead, 2016, p. 169). They are unable to process the events and make meaning out of the experience. In fact, Harrist and Richardson (2014, p. 207) note that in a highly individualistic culture, many people don’t experience “shared meanings and coping strategies” and are thus left to their own devices to cope with trauma. In turn, they become overwhelmed and experience PTSD.

The emotional processing etiological model is based on the theory that the individual creates fear structures to deal with dangers in their environment. However, when these fear structures build excessive responses, the individual becomes inflexible in learning how to modify their responses (Maddux & Winstead, 2016, pp. 170-171). For example, a person with PTSD will demonstrate avoidance behavior, which in turn prevents them from tapping into and updating  their fear structure in a way that would enable them to successfully adapt to an event. 

As briefly noted, most people who suffer a traumatic event are able to make meaning out of the experience, adapt, and recover from the stress of trauma. In all this discussion on trauma and PTSD, it has been broadly observed that humans are quite adaptable, even when confronted with the worst of trauma.

The Resilient Human

Maddux and Winstead (2016, p. 163) produce a chart that visually demonstrates that even with the traumatic events of sexual and non-sexual assaults, people are able to recover and adapt well after the event. For sexual assault victims, 70% report PTSD symptoms one month after the event. That percentage continues to drop over time, going as low as 30% one year after the event. For non-sexual assault victims, 40% report PTSD symptoms one month after the event with a declining trend over time, going to 10% at the one-year mark. Overall, the data suggest there is a “natural recovery curve” (2016, p. 162), in which most victims can make a strong recovery. Only a small minority of victims experience PTSD .

All of this data supports the claim that perhaps by pathologizing and stigmatizing many big, emotional, stressful events, as a whole, society may be undercutting the process of recovery . To lend greater support and care for a victim, pathologies are created, and focus is placed on the symptoms, rather than successful and creative coping mechanisms. There is also a significant individualization and rights-based view of modern pathologies. Harrist and Richardson (2014, p. 204) note this paradigm “underestimates and tends to undermine the creative capacity of people to cope with, and even at times find meaning in, suffering and traumatic experiences.”

Harrist and Richarson (2014, p. 204) continue their discussion with examples of two non-Western cultures that do not pathologize not only big, emotional, stressful events, but not even trauma. Researchers and counselors went to Sri Lanka after the 2004 tsunami and worn-torn Afghanistan and realized people exhibited symptoms not on the PTSD list and when they tried to provide individualized grief counseling, the isolation “actually [exacerbated] fears of loss or disturbance of one’s role in the community.”

Returning to Stern (Psychology Today Contributors, 2022, January 4), she contends our judgment becomes impaired when we become captivated by stories of trauma . By immersing ourselves in our own emotions, we may overlook the needs of the person telling his or her traumatic story. Most importantly, we underestimate our resilience and fail to recognize our true strength. She goes on to discuss some broad observations from one researcher who has studied this topic for many years. She quotes George Bonanno who says, “Most people are resilient …some people are traumatized; some people recover. There are different trajectories.” In fact, in one of Bonanno’s more recent articles entitled The Resilience Paradox (2021, p. 2), he and other researchers reviewed 67 studies to better understand “outcome trajectories” of people who endure a potentially traumatic event (PTE). He writes, “two thirds of the participants showed the resilience trajectory. Thus, not only is resilience to PTEs common, it is consistently the majority outcome.”

In sum, many studies and researchers have noted that the human is resilient in the face of big, emotional, stressful events and even traumatic events. While trying to determine the root cause of why some suffer PTSD and others do not, researchers are finding that PTSD is fairly rare. For those who do suffer many of the symptoms of PTSD for months after the traumatic event, they should continue to seek support from clinicians, counselors, and a support structure.

Conclusion

In conclusion, this essay examined the phenomenon of society’s romance with trauma and the issue of pathologizing normal behaviors. Western culture seems to be experiencing a cultural moment with its fascination of hearing others’ traumatic experiences. While many people do experience big, emotional, stressful events, they are most likely not suffering clinical PTSD. PTSD is reserved for people who experience events related to death, the threat of death, significant bodily injury, or sexual violence. Furthermore, they develop long-lasting, maladaptive coping mechanisms. There are many theories of the etiology of PTSD, of which two are emotional processing and cognitive. Ultimately, many people suffer significant stress and emotional events, however, most are resilient and will recover. Even for those who truly suffer trauma related to death, bodily and sexual violence, they too will largely recover, but those who meet the criteria of PTSD and who have lasting effects, they should seek professional help and support from their family, friends, and social networks . 

References

Bonanno, G. A. (2021). The resilience paradox. European Journal of Psychotraumatology, 12(1), 1942642–1942642. https://doi.org/10.1080/20008198.2021.1942642 

Harrist, R. S., & Richardson, F. C. (2014). Pathologizing the Normal, Individualism, and Virtue Ethics. Journal of Contemporary Psychotherapy, 44(3), 201-211. https://doi.org/10.1007/s10879-013-9255-7

Maddux, J. E., & Winstead, B. A. (2016). Psychopathology : Foundations For A Contemporary Understanding (4th ed.). Routledge/Taylor & Francis Group.

Miller, T. (Director). (2016, February 8). Deadpool. 20th Century Fox.

Psychology Today Contributors. (2022, January 4). 5 Big New Trends | Psychology Today. Www.psychologytoday.com. https://www.psychologytoday.com/us/articles/202201/5-big-new-trends  

PSYCH 406 (Psychopathology) - TikTok and Diagnosis

 Abstract

This essay discusses the trend of self-diagnosis for mental disorders by people consuming social media, such as TikTok videos. It then examines the complexity of proper diagnosis while discussing the challenges the DSM-5 faces in providing clear guidance on diagnosis. Lastly, it addresses the risks of self-diagnosis and steps people can take to not succumb to those risks.

Introduction

In the summer of 2022, my family was about to enjoy a much-needed vacation. But before we began the 1500-mile drive, we were slightly concerned about a noise from the family van. The van was dropped off at the local mechanic who regularly changes the oil in all our vehicles. Later in the afternoon, the mechanic called back and said the van would need a $7000 repair and even suggested buying a new car might be cheaper. Shocked by this diagnosis, we took the van to another mechanic we knew from buying a used car. After a day, this other mechanic said he had seen this problem in vans many times before and it would cost less than $500 to repair. Of course, we went with the second mechanic and the van is still working great to this day.

The risks and dangers of misdiagnoses can be significant, even for a mechanical car that is relatively less complicated than the human brain. In the case of our van, the misdiagnosis would have cost us significantly and the problem would still not have been fixed. However, for humans, the risks and dangers of misdiagnosing a mental condition can be even more substantial. 

With the widespread availability of information online and the broad reach of social media, the practice of self-diagnosis and sharing one’s story online has presented new challenges to the mental health community. The framework for diagnoses, including the use of the DSM-5, is intended to facilitate common understanding and nomenclature for psychologists and psychiatrists, as well as aid in predictions and information sharing and even guide therapeutic practices (Maddux & Winstead, 2016; David & Deeley, 2024). But despite significant research and debate, the DSM-5 is not perfect, which fact underscores the complexity of diagnosis. Even so, many unqualified and untrained people self-diagnose because of ease of access to the DSM-5 and because they hear others discussing their symptoms of disorders on social media. This practice has led to problems such as definition dilution and perceived absolution of responsibility for one’s actions (Cassata, 2024; David & Deeley, 2024). While self-diagnosis may have its place, individuals who choose this route should always seek professional assistance and remain open to the possibility that their self-diagnosis could be incorrect.

Self-diagnosis of Mental Disorders Via TikTok

Juliana Dodds (The Project, 2022) did not feel understood. In a search for answers, she turned to watching content on social media, including TikTok. When she heard others’ stories, she felt they could fully explain her perspective. Many people, like Juliana, are looking for answers as to why they act the way they do. For some people, the discovery of social media influencers explaining their symptoms becomes a launching point of self-discovery, which leads to a conversation with their psychologist and may confirm the diagnosis. However, not all cases are as straightforward as watching a video, talking to a therapist, and receiving confirmation of a diagnosis. Others may feel validated after watching social media, but when discussing the issue with a psychologist, and after being tested multiple times, the self-diagnosis is incorrect. Some patients become convinced they have a specific mental disorder despite what the psychologist says. Juliana falls in the latter category, and although her doctor diagnosed her with complex post-traumatic stress disorder, she is convinced she has attention-deficit/hyperactivity disorder.

The trend of self-diagnosis stemming from social media has become so pervasive, that a recent study was conducted to understand how accurate or inaccurate these influencers are. Cassata (2024) reviewed the study conducted by Drexel University’s A.J. Drexel Autism Institute and found that less than a third of the most popular autism-related content included correct information and that over 40% of those videos “were completely inaccurate.” The study further noted the extent of the misinformation, stating that many egregiously inaccurate videos had been viewed close to 150 million times. While the power and reach of social media grants millions of people access to potentially valuable information, which may kick-start them on the path to recovery, it nevertheless remains vitally important that proper diagnosis is applied. Often the diagnosis process takes time and can be very complex.

DSM-5 and Complexity of Diagnosis

The DSM-5-TR (American Psychological Association, 2022) contains over 1,000 pages of text, criteria, definitions, tables, and statistics. Countless hours of research and debate underlies the wide-ranging scope of mental diagnoses enumerated in the manual. In the section entitled “Use of the Manual” the authors both describe the extensive assessment that should be performed, as well as warn readers of the dangers of “simply [checking] off the symptoms” (p. 21, 2022). Indeed, case formulation should include a detailed clinical history and a succinct summary of the social, psychological, and biological factors that may have contributed to the development of a particular mental disorder. Even after all factors have been considered, ultimately, clinical judgment is critical in determining the relative severity and significance of an individual's signs, symptoms, and diagnosis.

Despite the numerous hours of research and effort poured into the DSM-5, a review of its history proves that this resource is not perfect. While great strides have been made to make it the valuable resource it is today, forthcoming editions and revisions will face difficulty in basing future additions on empirical support as well as managing the shift from a categorial model to a dimensional model (see Maddux & Winstead, p. 100, 2016).

With many research questions left unanswered, some take the approach of advocating for the addition of a disorder to garner attention so that empirical data could be collected on the disorder, as was the case with “severe irritability in youth” (p. 101, 2016). While perhaps a worthy cause, this practice has the risk of defining a disorder that does not truly exist. As to the shift in classification, more are beginning to recognize the consistent failures of the categorical model, and therefore the DSM-5 has begun the shift toward a dimensional model. Shifting to a dimensional model will allow for a continuum of mental disorders based on severity, frequency, or intensity, and will allow clinicians to provide a richer diagnosis as well as improved pathways to treatment.

In sum, the numerous considerations that should go into a diagnosis are guided by years of clinical training, as well as countless hours of research and debate to produce the DSM-5. Even with the critiques the DSM-5 faces, this situation further underscores the importance of a proper diagnosis by trained and qualified clinicians, and self-diagnosis from watching a TikTok video is fraught with peril.

Risks and Proper Use of Self-diagnosis

Virtually anyone can access the DSM-5. While obtaining this resource is easy, its use in diagnosing a disorder requires hours of training and practice. Many people will read the DSM-5 and begin to draw conclusions that they exhibit the hallmarks of a particular disorder. They may even take the added step of sharing their story on social media. Others follow proper channels and seek an expert to determine if the disorder warrants an official diagnosis. Two major risks of self-diagnosing are definition dilution (Cassata, 2024) and perceived absolution of responsibility for one’s actions (David & Deeley, 2024). While self-diagnosis, whether through reading the DSM-5 or watching a video on social media, may be the catalyst for the individual to get the help they need, they must not stop there. They ought to consult an expert and seek professional help.

One major risk of self-diagnosis is definition dilution. This means as more untrained people improperly explain a diagnosis on social media, the viewers of those misinformed videos also jump to inaccurate conclusions. The viewers, in turn, spread the misinformation, as well as become convinced they have a particular disorder. When a viewer visits a trained clinician and hears they may have a different disorder, the patient may become upset and even believe they are being gaslit (Cassata, 2024).

Another major risk of self-diagnosis is the perception that the patient is absolved of the responsibility for seeking a cure because fundamentally the self-diagnosing patient believes the symptoms they exhibit are normal and do not constitute a disorder. David and Deeley (2024) observed that self-diagnosis stems from “grass roots movements” such as the neurodiversity movement, which seek to “[reframe] several diagnostic categories as (mere) variations of normality” and even propose that these are not disorders (p. 1057, 2024). Once this concept (that a disorder is normal) is accepted (either individually or socially), the individual could assume an attitude that “the world needs to accommodate him and ‘his autism’” and he need not search for a cure or alter his behavior in any way (p. 1058, 2024).

There is room for allowing the potential for self-diagnosis, with several caveats. If a person has sought professional help and if in the course of exploring all possibilities, the patient discovers information on social media, and most importantly, if they discuss what they’ve learned with their trained mental health provider, then perhaps social media has a place in the diagnosis process. The Internet has connected billions of people. For some who may have limited resources and time, perhaps social media content might fast-track the diagnosis process. But the importance of not succumbing to naïveté cannot be emphasized enough. The patient should always keep an open mind when consuming social media and should generally be willing to trust trained experts. Cassata (2024) interviewed a trained clinician who wisely stated, “Social media, in and of itself, is not the enemy … the real threat seems to be our unquestioning, naïve relationship to social media and our belief that diagnoses can be self-made without consulting a professional.”

Conclusion

In conclusion, with the widespread availability of online information and the broad reach of social media, self-diagnosis and sharing personal stories online have posed new challenges to clinicians, psychologists, and therapists. The diagnostic framework, including the DSM-5, is designed to create a common understanding and lexicon for psychologists and psychiatrists. It also aids in making predictions, facilitating information sharing, and guiding therapeutic practices. However, despite extensive research and debate, the DSM-5 is not perfect, which further highlights the complexity of diagnosis. Nonetheless, many unqualified and untrained individuals self-diagnose due to the ease of access to information and exposure to stories influencers share on social media. This practice has led to issues such as the dilution of diagnostic definitions and the perceived absolution of responsibility for one's actions. While there may be a space for self-diagnosis, those who go down this path should always consult professional help and always keep an open mind that the self-diagnosis may be wrong. 

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders, text revision (5th ed.). American Psychiatric Association.

Cassata, C. (2024, April 11). Autism: TikTok Leading People to Inaccurate Self-Diagnosis (J. Peeples & J. Seladi-Schulman, Eds.). Healthline. https://www.healthline.com/health-news/autism-self-diagnosis-tiktok

David, A. S., & Deeley, Q. (2024). Dangers of self-diagnosis in neuropsychiatry. Psychological Medicine, 54(6), 1057-1060. https://doi.org/10.1017/S0033291724000308 

Maddux, J. E., & Winstead, B. A. (2016). Psychopathology : Foundations For A Contemporary Understanding (4th ed.). Routledge/Taylor & Francis Group.

The Project. (2022, December 6). Dr TikTok: People Using TikTok To Self-Diagnose Neurodivergent Conditions Such As ADHD Or Autism. Www.youtube.com. https://www.youtube.com/watch?v=qhx7PnHZ7cY&ab_channel=TheProject 

Phil 416 - Hegel’s Master-Slave Dialectic in Psychotherapy

Hegel’s Master-Slave Dialectic in Psychotherapy

Hegel’s three-part, recursive dialectical process provides a framework for explaining the reality of many things. One specific application called, the “master-slave dialectic” elaborates on the individual’s “development of self-consciousness” in terms of desire, recognition and alienation (GIVENS and NUMBERS 200). While this dialectic process may be applied and have practical use in a client-therapist setting, in some cases of therapy it may not be practical given that some psychoanalytic work is not linear and in fact the dialectical process expends more effort for smaller returns (Kronemyer).

The dialectic process is a dialogue or discussion of ideas, between people or even within oneself, which volleys back and forth, and pivots into additional ideas after which the process repeats with subsequent ideas. In each cycle, the first step in the discussion is a proposal or an idea. This introductory idea may be called the thesis or “the moment of the understanding” (Maybee). Following the thesis, the dialogue is met with a reactionary, opposing idea, in which the principal idea is negated. This reaction could be called the antithesis or the “negatively rational moment” (Maybee). However, this second movement does not entirely negate the first, rather it sublates it, which means it “both cancels and preserves” and pushes toward the third moment (Maybee). This third moment is “speculative or positively rational” in which it secures “the unity of the opposition” of the first and second moments and can be termed the synthesis (Maybee). Hegel’s dialectic is usually applied in areas which pertain to the individual or in social environments. One specific example is Hegel’s master-slave dialectic and its application to psychotherapy.

In Hegel’s Phenomenology of Spirit, the dialectic is used to explain an individual’s “development of self-consciousness” through the ideas of desire and recognition which is “also termed the master-slave dialectic” (GIVENS and NUMBERS 200). In this dialectic, the thesis is desire, as an individual eats and drinks to survive and, in general, yearns for “fulfillment and growth” (200). While pursuing this desire, the individual is confronted by other individuals who also desire the same things, and in this meeting, the individuals seek “interpersonal acknowledgement” and “recognition” (200). The antithesis of desire is recognition, in which the individual moves from self-sustainment “to a struggle to the death for recognition” (205). This conflict metaphorically reaches a pitched battle in which life is risked and one party yields and the other “emerges as the victor” (206). The yielding individual accepts the role of “slave” in order to survive and the victor assumes the role of “master” and “wields power over the slave” (206). Lastly, the synthesis of desire and recognition for the slave evolves into alienation, where the slave is estranged from freedom, and works for the master. Yet in this alienation, the slave “through labor, attains freedom, self-awareness, and the power to transform the natural world” (208).

Practical application of psychotherapy via the master-slave dialectic can be used in each phase of the evolution. One specific application in psychotherapy occurs viz-a-viz recognition and alienation, in which the client suffers “anger, frustration, and self-loathing” in an effort to “obtain recognition from” the therapist (211). While the therapist may be viewed as assuming the role of master, she nevertheless “resists the role” and instead seeks to facilitate the process wherein the client reaches escape velocity and is able to break free of alienation (211). In the client-therapist relationship, the client receives the recognition he desires “without punishment” from the masters of modern society such as “schools, prisons, hospitals, clinics” and “anonymous organizational structures” such as corporations (209, 211). Through recognition the client transforms himself and no longer feels alienated but adapts and discovers new freedoms. This rudimentary example indeed demonstrates the applicability of Hegel’s dialectic to explain some reality in the arena of psychotherapy, however, others disagree that it can be utilized to explain reality, even in this field.

David Kronemyer, who works in the Department of Psychiatry at ULCA noted in a letter to the editor of The Journal of Clinical Psychiatry that Hegel’s dialectic “has proliferated to numerous other contexts, many involving psychiatry; for example, the migration from psychoanalysis to behaviorism to cognitive therapy” (Kronemyer). But at a lower, practical level Kronemyer does not view the dialectic as applicable. For example, while validation of the client may be viewed as the thesis, and the antithesis may be understood as change, he contends “the process of therapy is evolutionary—a ‘random walk’ incorporating (nonexclusively) flexible thinking, adaptive behavior, and emotional awareness” (Kronemyer). In other words, successful therapy often does not always follow the Hegelian dialectic process and is much more haphazard than iterative. And to underscore his point even further, Kronemyer summarizes, “Holding two opposing thoughts in your mind at the same time is far more effortful than holding two complementary ones. Clinicians should divest themselves of the concept of ‘dialectic’ and focus instead on emotional regulation” (Kronemyer).

In conclusion, Hegel’s iterative dialectic process provides a structure for exploring the reality of things. The “master-slave dialectic” is one particular avenue to apply the dialectic especially in the arena of the maturation of the individual’s self-consciousness. The ideas of desire, recognition and alienation provide a construct for the client and therapist to successfully help the client evolve and develop his self-consciousness. While this dialectic method can be applied practically in psychotherapy, other experts in the field do not think it is as applicable, given that psychoanalytic work is not linear. Indeed, the dialectic may lead the client and therapists down paths that ultimately do not address the root of emotional disturbances. 

Works Cited

GIVENS, JOEL, and MEGAN NUMBERS. “Of Human Bondage: The Relevance of Hegel’s Dialectic of Desire and Recognition for Humanistic Counselors.” The Journal of Humanistic Counseling, vol. 55, no. 3, Oct. 2016, pp. 200–14, https://doi.org/10.1002/johc.12034. Accessed 3 Oct. 2019.

Kronemyer, David. “Just What Is ‘Dialectical’ about Dialectical Behavior Therapy?” The Journal of Clinical Psychiatry, vol. 78, no. 3, Mar. 2017, pp. e310–10, https://doi.org/10.4088/jcp.16lr11394. Accessed 1 May 2019.

Maybee, Julie E. “Hegel’s Dialectics (Stanford Encyclopedia of Philosophy).” Stanford.edu, 2016, plato.stanford.edu/entries/hegel-dialectics/.

The Year of the Copperhead (the 500th post)

This will be quite a long post.  Feel free to set aside some time to read this; or take a few days to digest it.  It is also an emotionally heavy post.  It may not be an enjoyable read for everyone.  However, in my opinion, it is a worthwhile post and if I'm able to pull it off, you will walk away from it with a stronger dose of humility and a stiff reality check about life.

Job

Job and His Friends by Ilya Repin (1869)

It all began for Job when he lost his oxen and donkeys and servants by the hands of some thieves.  One servant escaped with his life and was able to tell Job (Job 1:13).

Not a moment had passed when another servant came to Job and informed him that fire from heaven (asteroid?  volcano?) had burned all his sheep and servants, except for one, who, escaped with his life and was able to tell Job (Job 1:16).

Immediately after the second servant shared the bad news, a third servant showed up on the scene and informed him that his camels were stolen and his servants killed by a raiding party.  Again, this servant escaped with his life and was able to tell Job (Job 1:17).

No sooner had the third servant finished informing Job, a fourth servant came to tell Job his sons and daughters were enjoying a feast at the eldest brother's home when a tornado formed, ripped through the home and sent the roof crashing onto his children, killing all of them.

If the story is to be believed, in one day, Job lost 7000 sheep, 3000 camels, 500 yoke of oxen, 500 donkeys, a large number of servants, 7 sons and 3 daughters.

As if to add insult to injury, Job contracted painful sores on his head and feet (Job 2:7).  Later, Job's friends came to try to comfort him.  But his pain was so extreme, his friends could only sit with him in silence (Job 2:13).

Upon further reading in the Book of Job, we also learn he was mocked and scorned by friends and neighbors and even by his wife.

I'm not going to debate the historicity of Job's story, but rather I want to focus on the question: could it have happened?  Indeed the scale of Job's trials is large, but each of those events have happened to other people.  And if you still don't think what happened to Job could happen to others, there are plenty of examples of hard times which exist all around us today.  They existed 50 years ago; they existed 100 years ago and they will exist in perpetuity.

If It's Happened to Someone Before, It Could Happen Again and It Could Happen to Me

Some stories stick with me.  I often come back to them.  These stories rattle around in my head often.  Not much needs to be said.  I think I can provide the headline and you can imagine the rest.

My grandmother lost her 15-year old son to a tick.  She lost a young baby boy too.  My sister-in-law and my niece both lost a baby.  Friends and other relatives have had still-born children.  My aunt lost one son to stomach cancer and another son to Lou Gehrig's disease; both died in the prime of their lives while my aunt lived well into her 90's.  A nephew took his own life as a teenager.  A mother in our community, backed out of her driveway and accidentally ran over her young child; the child died.  A wife lost her husband after he had a motorbike accident - her young son saw his father crash the bike on the street and witnessed him die.  I was in a restaurant one afternoon.  A mother and her young daughter had just ordered before me and sat down with their food.  I ordered mine and the cashier had tears in her eyes.  She told me that the mother/daughter just lost their husband/father - he had died recently.  The daughter was really too young to understand the situation.  Another wife in the community, lost her healthy, strong husband to a stroke.  He was around age 40.  Their boys lost their dad; my son lost his soccer coach.  My father-in-law - my wife's father ... he died too young and unexpectedly.  More on that later.

A young child at our church beat cancer with treatments.  I hear the treatments are pretty tough.  Another young mother in the community recently told me how her young son is enduring cancer treatments.  A couple of months ago on Facebook, I read of parents laying to rest three of their children after they suffered from juvenile Batten disease.  Another story from my sister-in-law goes that her neighbor's young daughter was sitting at the table during dinner and began to complain that she felt like throwing up, but could not.  She then slumped over and died from a burst appendix.

I read The Republic of Pirates a while back and will never forget one story.  I summarized the story previously: one example the author used to illustrate how bad a sailor's life was, was about this young boy who the captain beat quite savagely for 17 days!  He beat him, whipped him, made him eat his own stool and when the boy finally spoke, he asked for something to drink.  The captain ran to his quarters and then returned with a cup of his own urine and made the boy drink it.  The boy finally died.

The first part of Vikor Frankl's book Man's Search for Meaning, details the horrors of living in a Nazi concentration camp.  Lots of horror stories from WWII and concentration camps haunt me.

I still remember following the news about and feeling anxiety for Elizabeth Smart and her family, when she was kidnapped and raped over a span of nine months.  I also remember the horror when the news broke on the Ariel Castro kidnappings - gut wrenching.

In September 2017, I watched Otto Warmbier's parents describe seeing their son for the first time since being released from captivity in North Korea.  Their account is harrowing (see here).

September 11, 2001 and 2012 will always be vivid in my mind.  From 2001, the images of the planes crashing into the towers as well as the images of the man and people leaping from burning buildings, still chills me to the bone.  And then in 2012, seeing Ambassador Stevens' bruised, smoked, body being dragged in a street in Benghazi, makes me shudder.  Then there are the mass shootings: Columbine, Sandy Hook, Virginia Tech, Aurora Colorado, Orlando night club, D.C. Sniper, Ft. Hood 2009 & 2014 ... Las Vegas ... the list goes on and on.  These are just the ones that have stood out in my memory.  Not to mention the other terror attacks in London, Barcelona, Norway, Russia, India ... all over the world.  It truly is endless the list of terror attacks and mass shootings.

Weather happens; and anywhere you live, nasty weather can pop up.  Tornadoes, hurricanes, strong wind, abundant snow, ice storms, flooding, drought.  Our family has lived through tornado warnings in Dallas and Houston.  Just weeks after we left Dallas, a tornado ripped through our old neighborhood.  Then in 2011, after enduring a searing, hot summer drought in Houston, my kids had to hunker down in their school when a tornado tore across our community in November.  Then there are the major natural disasters.  To name a few that remain in my conscious: Mt. St. Helen's, Indian Ocean Earthquake & Tsunami of 2004, Japan 2011, Katrina, Ike, Irma, Maria, Harvey ... more on Harvey later.

Of course we can't forget about wild animals and their interactions with humans.  Some of those interactions are still fresh in my mind.  My sister fainted when a rattlesnake slithered over her foot.  Mountain lion attacks in California and cougar sightings in a business park in Utah.  I don't have too many details, but I seem to recall my brother going on a bear hunt in Alaska and killing one!  I might need to ask him about that someday.  Living in a forest affords many opportunities to see wild animals.  Several years ago I battled armadillos who tore up my grass and yard, digging for grubs and such.  I think I killed about half a dozen armadillos that year.  Our neighbor was walking her two schnauzers in the park next to our home when she happened on a coyote.  The coyote attacked her small dogs leaving them nearly dead.  The neighbor escaped with no injuries.  My wife, one day, just finished a walk and was getting the mail when a coyote emerged from the forest and was eyeing our schnauzer.  We often see deer and buck on our walks.  One baby deer got stuck in our backyard.  She couldn't escape and when my wife went to investigate, the doe tried going though a small opening between our fence and side of our house.  She got herself wedged really tight and was crying.  Jill pulled the fence down (it was sagging already) so the deer could escape.  Raccoons are quite the characters and have taught us the need to always keep garbage in the garage and to not put the garbage out until the day the trash gets picked up.  Every night on my home camera I see raccoons walking through the driveway and back yard.  Possums also frequent our neighborhood, but are far less bothersome than raccoons.  Bats come out at dusk.  In the summertime you can see them swooping through the air eating insects.  One morning on a walk, I had one swoop around me several times.  It really freaked me out how often and how close it came at me.  On another occasion, a bat swooped on my wife and I while we were on a walk.  People have been bitten by bats and contracted rabies.  Some have died.  Every winter, we get turkey vultures.  They come from the north and roost on the roofs and trees.  It is very similar to Alfred Hitchcock's The Birds.  The most destructive wild animal in our area are feral hogs.  They will absolutely ravage a yard - like a plow.  Grass, plants, bushes - all are devastated by hogs. We even have alligators near our home.  I've only ever seen one alligator in the lake near our home.  And I was only able to see it through binoculars.  Then there are the snakes: the garter snakes, yellow-bellied rat snakes, tree snakes, king snakes, and then the venomous ones: moccasins, rattlers, corals and copperheads.  I've seen one dead rattlesnake; one water moccasin, four corals and countless copperheads.  More on copperheads later.

Markets and keeping a career can be volatile.  Of course many know of the Great Depression in the 1930s.  Growing up, I often heard my parents discuss how they were dealing with tough times in the late 1970s and early 80s.  I read an op-ed of a man who was laid off in 2004 after working with a major company for 25 years - too young to retire, too old to get another job ... it was the same company I work for today.  Enron was eye-opening.  We have friends who worked for Enron ... one day they were well-to-do, the next they had no retirement savings or pension to draw from.  The Dot Com Bubble ... I narrowly escaped that while some of my friends I graduated college with did not.  I often think of a manager named Rich O'Connor.  He was a senior manager who interviewed me.  After I landed the job and after working a few months for the company, I was shocked to hear that Rich, who was about to retire, drove home one day, pulled into the driveway, experienced a heart attack and died.

You see?  Who needs the Book of Job when you have all these stories to draw from?  If any one of these things happened to someone (and they veritably did), then it could happen to me and you.  That is an important lesson to remember.

A Word About Copperheads

We live in a cul-de-sac near a heavily forested park.  We get snakes in our yard quite a bit.  Most are harmless, but we do see the occasional venomous snake - it's almost always the copperhead.  Usually, the time of year we see the snakes is between the end of April and beginning of May.

Our first encounter with a copperhead was in 2013, when my daughter left the back door ajar.  My wife walked in the kitchen, she noted the door was slightly open and a copperhead was slithering in!  She quickly shut the door and pinched him between the door and the door-jamb.  When I got home a few minutes later, I took some hedge clippers and lopped his head off.  It was quite a shock at the time.

Ever since then, we've encountered the occasional copperhead in the garage and in the yard.  Heavy rocks, shovels, brooms, rakes, pellet guns - all effective for dealing with copperheads and snakes in general.  A friend of mine, who deals with and likes snakes, came over one time when we had a copperhead in our garage, and dealt with it.  He took it home and skinned it.  Copperheads don't lay eggs, rather they are one of the few snakes who deliver live babies.  He told me the one he caught in our garage had babies in her.

Copperhead bites aren't 100% lethal.  Usually, people who have been bit by a copperhead suffer pain and tissue damage.  I've done a fair amount of research on copperhead bites and have seen the damage that can be done (images.google.com search: copperhead bite ... don't click the link if you're squeamish).

Coming across any snake in your yard or in the wild can cause your heart to skip a beat or two.  But like anything, the the more you become accustomed to it, the less "shock" you feel.  For me, I always experience that rush of adrenaline, even after the many snakes I've encountered.  I'm minding my business and then - poof - there is a snake sitting there in the garage, or driveway or yard or walking path or street.  There is never an announcement with copperheads (unlike the rattle of a rattlesnake).  He's just sitting there.  There is not much one can do to prevent a copperhead from showing up in your path.  You just have to acknowledge he's there; know he's venomous and then have the courage to deal with him.

The Year of the Copperhead

I've dealt with more copperheads in 2017 than any prior year of my life.  Coincidentally, 2017 has been the wildest year of my family's life, in terms of unexpected events.  Indeed we've experienced lots of challenges, but we've had a lot of wonderfully memorable times too.

Things started off rather mildly and would not otherwise garner my attention, except by looking back on the whole year.  During the first week of January, after coming off a very enjoyable and peaceful Christmas break, our youngest came down with some type of nasty stomach virus.  She was in an abnormal amount of pain, could not sleep at night and really could not eat anything.  My wife had to take her to the ER and our poor daughter needed an IV.  It was a little worrisome at the time, but after about a week, she got to feeling better.

About that same time, I was on an early morning walk and decided to jog a bit.  It was early in the morning and dark and I did not see a bump in the sidewalk and I took a nasty tumble.  I banged up my knee and shattered the screen on my iPhone.  Not a particular great start to the year.

On top of these two events, my wife and I noticed that a small leak under our bathroom vanity had turned into a larger leak.  We finally decided that replacement of the vanity was needed, besides fixing the leak.  After consulting with our friend who is a home designer, we decided we should proceed to not only fix the leak, but upgrade the bathroom.  And while we were upgrading the master bathroom, we decided to fix one of the upstairs bathrooms, which had been leaking on and off for the last eight years.  And while we were at it, we decided to remodel the powder room bathroom next to the kitchen.  Over the course of the next nine months, we met on and off talking about and designing these three bathrooms.

Later in January, my in-laws came to visit us in their new COW (Casa on Wheels).  They stayed for a few weeks and we had much fun with them.  I helped my father-in-law get the TV antennae working, took them on a tour of my work's new campus, watched the kids play basketball games and band and orchestra concerts.  They were gone for about a week to go on a cruise to Mexico, then they returned and stayed until our HOA finally sent us a letter saying their COW needed to be moved from the cul-de-sac.  My mother-in-law flew back to their home and my father-in-law took a long road trip, meandering through Texas, New Mexico, Arizona and Utah.

One weekend, we were able to go visit him at the beach next to Galveston (his first road-trip stop of many).  It was a beautiful day on the beach.  The kids got to play in the ocean and my wife and I and him were able to relax and talk.  He fired up the grill and we all ate hamburgers and chips.  A truly memorable experience!  We were so sad to say goodbye to him when we drove back home.

February was unusually warm in 2017.  Instead of typical highs in the 60s, we experienced almost half of the month in the low to mid 80s.  On Saturday February 25, we enjoyed a morning watching our youngest play a basketball game.  Then in the afternoon with not much else to do, I decided to give some of our hedges a trim.  My 12 year old son came out to help me.  After trimming about 4 bushes, we began the clean up.  We took 1 or 2 wheel-barrow loads to the forest.  Working on filling up the 3rd, I reached down to pick up a scoop and got pricked.  I knew there was a thistle-like weed in the pile and at first I thought it pricked me, but then a moment later, I saw the copperhead slither off.  I yelled out, "I got bit by a copperhead!"  I moved my son away from the pile, we went inside, I cleaned the bite and then asked my 15 year old son to go with me to the emergency room.  My two younger kids stayed home.

I drove and had my son look up symptoms of a copperhead bite.  I wanted to know what to expect in the next few minutes to hour.  After ensuring I wasn't going to pass out, I had him call my wife.  She wasn't answering her phone.  He kept trying.

We drove to the local ER at town center.  After talking to the desk attendant, she informed me that they were not equipped to handle copperhead bites.  She said I should go to the main hospital ER 4 miles away.  We got back int the truck and drove to the main hospital ER.

By the time we walked into the ER, the pain was spiking.  They immediately admitted me; stuck an IV in me. At around 1:30pm or so, the pain was excruciating. It felt like a railroad nail entering my palm and exiting out my middle knuckle on the back of my hand. I went into a bit of shock and they gave me morphine. I still felt the pain, but I was more calm at that point. By 2:20pm, the anti-venom was ready. Of all the hospitals in the area, our main hospital is the one place that has anti-venom on hand. It takes about 45 minutes to prepare it (CroFab). I was told the amount they gave me cost about $10K. An hour later, the anti-venom was doing its work and the swelling stopped.

I stayed in the ER until they could get me a room in the ICU. I was about to go to the ICU at 5pm, but someone needed the room more than I did. So I waited in the ER wheelchair from 5pm to 9pm. My wife was there the whole time, so it wasn’t so bad. By 9pm, I was in a bed in the ICU. I took a couple of Tylenol that night for pain – the pain was not so bad by then.

By Sunday morning, I could make a quasi-fist, but the doctor did not like that the swelling still had not gone down enough.  He said they were keeping me in for one more night. All day Sunday, it slowly got better. My skin on the back of my hand went from very tight (could not even see one single wrinkle), to just a normal swell (similar to a sprain). I could make a complete fist Sunday night and by Monday morning, I was texting with just my right hand (although that ‘a’ was a little hard to get to on the keyboard).  The hospital discharged me and I went home,

While I was in the ICU, several nurses were concerned about my heart.  I had a heart flutter / irregular beat sometimes. It was not constant, but would come and go. It started in 2007. I went to a cardiologist in 2007; went through the gamut of tests and was given a clean bill of health – was told to keep working out. Over the last 10 years, I just lived with it; sometimes it was more noticeable than others. I tried seeing a cardiologist in 2016, but the scheduling never worked out and I dropped it.

Saturday night and Sunday morning, the nurse saw what my heart was doing. The doctor was able to arrange for a cardiologist to come visit me and look at my heart. They did an echo cardiogram on me Sunday afternoon. The cardiologist said it was not a major concern and that a cardiac ablation would most likely fix it.  Later in March, I saw another cardiologist and went through some additional testing.  We decided that a cardiac ablation would be the best course of correction.  The procedure was scheduled for July.  More on this later.

After the copperhead bite, I became a bit of a local sensation at work and in my community.  Lots of people wanted to know the details; other people would tell of a story of some dude getting bit by a copperhead and I would say, "that was me."  At work, I had multiple opportunities to present my story and share a safety minute on yard safety and what to do in the event you are bitten by a venomous snake.  In some circles and conversations, my co-workers suggested the snake bite provided positive exposure for me in front of senior management, thus helping boost my career.  I can't fully discount the notion.

I stopped doing major yard work in February and hired a lawn guy.  The first time he came out, he found (I think) the copperhead that bit me.  He killed it.  Thus ended the life of the first copperhead I encountered in 2017.

The copperhead bite wasn't the only event in February that I will never forget.  A couple of weeks before the bite, I celebrated my birthday on a Friday night by going to the high school basketball game.  Our team was having a pretty good year and they were facing their main rival.  It was a somewhat close game through 4 quarters, but our team made a strong push to the end and put themselves in a position to win it.  And win it they did - in fashion!  It was one of the best birthday presents I've received.

53-52 over atrashcocita #gomustangs @chaselovins_ with the final second game winner!!!! @KingwoodBBall GREAT GAME. pic.twitter.com/i7xlvl4NzD

— conner derelioglu (@connerd45) February 11, 2017

As wild as February was, a calm March was welcomed.  Our oldest was able to go with her band to New York City and perform in Carnegie Hall.  The rest of the family enjoyed time off from school during Spring break.  And our family spent some time at the Houston Rodeo.  April was equally quiet, as we enjoyed the warming of spring and the anticipation of the school year wrapping up.  We attended practice events for the end-of-year school programs and choir plays.  My 2nd son and I started a chess club for him and his friends.  And my wife and I enjoyed long spring walks under sunny blue skies.  My oldest son also started his spring-summer basketball league and we were able to travel to a lot of his games and watch him play.

Around the second week of April, I was on one of the greenbelt trails and there on the right side sat a copperhead!  I was able to find a rock and throw it skillfully onto its head.  Thus ended the life of the second copperhead I encountered in 2017.

My current assignment at work is highly cyclical.  For the vast majority of the year, I assist management in developing an outlook for the current year's budget as well as a plan the next year's budget.  There is a lot of work and planning involved.  Every March, the process begins again and gradually heats up until we finish in September.  May is really when the work begins in earnest.  On Monday May 8, after wrapping up a full agenda from our team meeting, I walked back to my desk full of enthusiasm.  I had a lot of work to do that day and week and I was energized to tackle my to-do list.  I had been sitting at my desk no less than 10 minutes when I received a phone call from my mother-in-law.  She could barely speak through tears.  My father-in-law passed away at the young age of 66.  She wanted me to go be with Jill, as soon as I could, so that when she heard the news her father passed away, she would have someone with her.  The news was shocking, to say the least.  I packed my things at work, told my team and manager and then drove home.  I called Jill, but I knew she was teaching her class.  When she called back, I told her she just needed to excuse herself from work and meet me at home.  She asked what was wrong; again I told her to meet me at home.  She asked, "is it my dad?"  I had to tell her at that point - yes.  Silence.

She was at home when I walked in.  Then the tears came.  We spent all morning and afternoon talking, crying, mourning and discussing how best to tell each of the kids when they got home from school.  We told the kids and there were more tears and mourning.

Jill flew home immediately and then about a week after that, the kids and I drove home for the funeral.  The funeral was lovely and tearful.  The burial was on a cold, rainy day in Idaho.  Jeff was a great man and I still miss him as does everyone else.  My last time talking to him was about a week after the copperhead bite.  I was at home when he called me.  I told him all about it and he listened and asked questions.  Then he told me of his adventure he was on.  He was still working his way through west Texas at this point.  He stopped at some RV park that had a nice swimming hole.  He said he'd get in the water and all these small fish and minnows would kinda swarm around him.  It was comical the way he told it.  I miss him.

After we had returned home from the funeral trip, towards the end of May, on a Saturday night, I was walking to my truck around 11pm to go pick up Emma from a friend's home.  There next to my truck in the garage on the driver's side sat a copperhead.  This one truly caught me off-guard and seeing him so close to the truck I get into every day really threw me off and my heart was pounding.  I got the shovel and crushed his head.  Thus ended the life of the third copperhead I encountered in 2017.

June and July were quite busy, but very enjoyable and memorable.  My youngest and I took a quick trip up to Idaho for my parents' 60th anniversary.  We got to commemorate them, play lots of golf and eat delicious food.  Then a couple of weeks later, the whole family drove up to Utah to attend my niece's wedding.  We got to spend lots of time with family and play more golf and eat lots more delicious food.  At the end of June, my oldest passed her driver's test and earned her license to drive.

July brought to completion a 10-year ordeal with my irregular heart beat.  My cardiac ablation was scheduled for the first week of July - everything went as planned.  The only really memorable part was during the pre-op when they were poking me with all those needles.  It was early in the morning and I had been fasting for quite some time.  The nurses were having a hard time finding veins.  After about 4 or 5 pokes, my wife went limp and passed out!  All attention that was on me was diverted to her until she felt good enough to get up and out of the room!  She survived and I turned out just fine ... it took them 7 pokes to finally get 3 IVs in me.  The cardiologist said it was a very routine procedure and everything went well.  The arrhythmia has finally abated and I have never felt better in a long time.  Quite frankly, the toughest part of the whole procedure was the removal of the catheter and then trying to get my digestive system flowing again.  But things sorted themselves out and I fully recovered.

Once I fully recovered, I started testing my legs and heart, by starting my daily long walks again.  One of the very first walks I took was on a stormy July afternoon.  As I often do on my walks, I snapped a picture and posted it to Instagram.  As I look back on that day, those ominous clouds probably foretold a lot more than I realized.  About 40 days after that picture was taken, our lives would really be turned up side down.

We finished July with some fun.  Our youngest child turned 11 and we had lots of friends over for a party.  There was lots of good food, goodies, face painting and swimming.

August gave us two events that we will never forget.  The first event had been anticipated for quite some time: the moon eclipsing the sun for all of North America to see.  My brother, being an astronomy aficionado, knew this day would be here ten years ago.  And he knew it would pass directly over central Idaho.  He made a deal with a lodge owner that he could have a reservation for the normal cost.  The lodge owner agreed.  As August 21 approached, my brother reminded the lodge owner of the agreement, as the prices of hotels all across Idaho skyrocketed due to demand.  The agreement was kept and my brother and his family enjoyed front row seats to the eclipse.  As for me, I was at work and observed the many people on campus trying to catch a glimpse of the eclipse.

One day after the eclipse, right after lunch, I received an email from my manager.  The title of the email, "Undead Hurricane Harvey."  The previous week, back to August 13, Harvey was investigated and then entered the Gulf of Mexico, where the consensus was he was going to die in Mexico.  Then came the email, which quoted a respected weather blogger.

"I think the best case scenario for this weekend is scattered showers and highs in the low 90s.  In the worse case scenario, we have the potential to see some widespread flooding.  Some of the global forecast models have painted rain bullseyes of 10 to 15 inches of rain over parts of the Houston metro area.  Although it is too early to have much confidence in that, this definitely shows the potential for heavy rainfall if Harvey reforms (even into a weak tropical storm) and moves into the central Texas coast.  If heavy rains do come, right now they're most likely from later on Saturday through Monday for the Houston area."

There it was - the beginning of what was to become a series of events that would change our lives forever.

My wife's worries kicked into high gear (thankfully) as she scrambled to buy water and extra food in case we needed to hunker down for the hurricane.  We figured we would get lots of rain and possibly lose electricity for a few days and then things would return to normal.  All day Friday, Saturday and Sunday, we watched Harvey lumber across south Texas and inland.  Then he stopped and headed towards Houston.  All that time, he moved ever so slowly with Houston on the "dirty side" of the storm - meaning we got pummeled with rain.  We thought we'd get a foot or so of rain.  But it didn't stop at 12 inches.  And with every forecast, the amount of rain predictions kept going up.

Sunday afternoon, my son and I walked out behind our home towards the lake to see how far up the water had come.  It was pretty high.  Not as high as the water from the previous spring flooding.  I didn't worry.  In Spring 2016, the water was much higher and I felt confident that nothing would come of it.  But we still discussed "what-ifs".  One of which was, "what if the water comes into our street?"  Our response was, "we'll begin moving things upstairs."

Monday August 28 at 6am, our doorbell rang.  It was our neighbor who came to warn us that our cul de sac had water in it.  I moved all our cars up to the top of the street, where the elevation was 20 feet or so higher.  Then we set about moving all the important things we had to the upstairs.  That took all day.  And as we moved things upstairs, I kept monitoring the water as it crept from the street, to our curb, to up into our driveway.  I used chalk to mark the water line and note the time of day.  It was moving up our driveway inches per hour.

Later in the day on Monday, another friend of ours and his buddy, came and scoped out how high up our house is and how long it would possibly take for the water to reach the inside of our home.  By their estimates and leveraging the East and West fork monitors of the San Jacinto, they said the water might get right up to our doorstep and then recede.  At that point, I figured the worst we would get would be an inch to few inches of water in our home.  So we put the furniture on cans and blocks.

Still more friends came to help us move a ton of food and things, from our place to a friends home.  We figured it would be better to get the kids out while there was light.  With them settled comfortably in a friends home, my oldest son and I hunkered down in our home, hoping the water would recede.

At 6pm on Monday, the water had reached my AC units in the back yard.  At that point, I decided to shut power off to the home.  My son and I then went over to our next-door neighbors, who are on a little higher ground.  We all watched the news and monitored the river levels.  Lake Conroe Dam was releasing a lot of water and the East and West forks continued to rise.

By 11pm on Monday, the water was right up to our door step.  I was still holding out hope.

Two hours later, at 1am Tuesday August 29, water entered our home.  My son and I were still at our neighbors and ended up falling asleep there.  Three hours later at 4am, our neighbors woke us up and said water was coming into their home too.  We needed to get out before we all got stuck.  My son and I went back to our home, waded in the water inside our home (about up to our knees), got our bags, threw them into the kayaks and then paddled up the street and put our stuff in the back of my truck.  Then we went back to our neighbors and helped them get up the street.  I took their cat, who was in his little kennel.  He was scared and freaking out.

Tuesday August 29 was filled with checking on neighbors, helping them put stuff upstairs (as the water was getting close to entering their home too), helping people who tried to drive through the water, dropped off food and clothes for people who were rescued and also checking in on our home.  I lie not - it was tragically depressing walking in our home with water everywhere.  It is a helpless feeling.  My wife broke down in tears and all I could do was to tell her things would return to normal.  When I had the chance that afternoon, I placed a phone call to get our flood insurance claim started.

Wednesday August 30 was the beginning of a long, slow rebound.  The positive news: a phone call from another friend telling us that the water was out of our home!  This was shocking as we figured it'd be days before the water receded.  We drove over to our place, waded down the street (water was still in the street) and checked it out.  We snapped lots of pictures and took video.  It was a start - we could at least get into our home.  Other friends' homes also were empty of water.  The mucking began.  We helped our friends muck from around 10am til 2pm.  Then focus shifted to our home.  From 2pm to 10pm, we mucked, ripped out wet drywall (what a funny expression!) hauled out debris, ripped out doors ... all that.  It was a long day.

From Wednesday August 30 til about Sunday September 10, the daily routine was, get up, eat, muck, eat, muck, eat, muck, sleep.  There were so many homes to muck and so many needed help.  Between keeping things moving along at our home and helping others, we were always busy.  I was especially proud of my oldest son, who worked so hard during these days.  He had a lot of friends whose homes were flooded and he spent a lot of time not only helping us, but helping them.  My other kids did a lot to help too.  They each helped in their own way and they did their best to keep a positive attitude.  The work didn't stop after September 10.  It continued on for the whole month of September, but for our family, we began to focus more on making plans and coordinating work to get our home repairs moving.

For the kids, school got off to a rough start.  They had barely began the school schedule when Harvey hit.  Our kids' high school got hit really hard with the flooding and the entire student body would not be able to use the school.  The school had two options: 1) disband the high school and farm the kids out to multiple schools or 2) pick one of a few awkward schedules and share a high school building with another student body.  Parents and students opted to share the high school with another student body.  Our two older kids began their new schedule of commuting 45 minutes and starting school at 11:30am and getting out at 4:30pm and then commuting 60 minutes back home (extra time due to normal rush hour traffic).  Their days were long, but they learned to adjust.  The middle school and elementary school were not impacted in our area, so our two younger kids were able to go to school with a normal schedule.

The second half of September, we got so much done.  With the help of my pool guy, we turned our pool from brown to blue.  The pool, by my count, had about 15 fishes in it.  After 20 lbs. of shock, they were all floating the next day.  Then we drained, filled, and backwashed repeatedly.  When it got fairly clear, we cleaned the filters and then the pool really cleared up.  My cleaner broke from all the extended use, and I ended up buying a new one.

Contractors began arriving and soon walls were up and floated and mudded.  The dust ... oh the endless dust!  We began working ideas for remodeling the house with our contractor.  What was going to be a 3 bathroom remodel project turned into a whole home remodel.  One of the main ideas was to knock out the wall dividing the kitchen and dining room to make the space more open.  We also worked on re-designing the kitchen layout as well as the office (our oldest son's room).  Plumbers, electricians, carpenters and laborers came.  They knocked out walls, ceilings, re-piped, re-wired, jack-hammered, busted pipes, fixed pipes, moved pipes ... all of it.  During all this flurry of work, one quote from C.S. Lewis kept popping into my head:

Imagine yourself as a living house. God comes in to rebuild that house. At first, perhaps, you can understand what He is doing. He is getting the drains right and stopping the leaks in the roof and so on; you knew that those jobs needed doing and so you are not surprised. But presently He starts knocking the house about in a way that hurts abominably and does not seem to make any sense. What on earth is He up to? The explanation is that He is building quite a different house from the one you thought of - throwing out a new wing here, putting on an extra floor there, running up towers, making courtyards. You thought you were being made into a decent little cottage: but He is building a palace. He intends to come and live in it Himself.

Perhaps that quote soothed my anxiety a bit, in the sense that there is a directing mind over a home remodel just as God is at the helm of a soul remodel.  And perhaps all of 2017 and the seeming chaos of it all, is similar to what C S Lewis is talking about.  It's quite painful to see your home flooded, gutted, ripped up, hammered, chiseled, dirtied and stomped on so much.  But in keeping the greater vision in mind, the whole ordeal is quite bearable - the greater vision being:  knowing that everything will be better than before - more sound - more suited - more loved.

On September 29, I arrived home from work and found a dead copperhead sitting in my driveway!  I asked the workers about it and they said they found it in our garage and killed it.  He was moving a mirror in the garage and the snake lunged at him.  They just killed it and threw it in the driveway for me to see.  I told them it was venomous and he was lucky it didn't bite him!  Thus ended the life of the fourth copperhead I encountered in 2017.

October brought a wind of optimism.  Walls were up, all the debris and garbage were hauled off, we had a plan to move forward and things seemed to be moving along.  Sure, there were bumps and stalls, but overall, a lot of progress was made.

While on a walk on October 4, I came across another copperhead on the greenbelt.  Not sure if I used a rock and branch this time, but I was able to deal with him as well.  Thus ended the life of the fifth copperhead I encountered in 2017.

The highlight of October was seeing the wall between the kitchen and dining room removed and in it's place, a grand cedar beam arch.  On October 18, a big 16 foot cedar beam (16' x 12" x 8") was delivered to our home.  The truck driver, me and one other dry-wall worker helped lift the massive thing off the truck and into the house.  I've never helped lift something so heavy!  The two other smaller beams were much easier to move.  The next day, the carpenter and his crew came.  I pulled up a chair and observed the crew install two temporary trusses on each side of the wall.  Then they tore down the wall.  Next, they cut the cedar beam to size and hefted the big log up.  They quickly put temporary supported beams under it and then they put up the two cedar beams up to form the arch.  That whole exercise took perhaps 3 hours.  The end result was impressive.  Our home was much more open and the smell of cedar wafted through the home.

A few days later on October 22, while on a quiet Sunday morning walk, I found a smallish copperhead in the gutter.  He wasn't moving much and I though he might already be dead.  It was a cool morning too, so that may have been a reason he wasn't moving too much.  But I poked him and he moved.  This time, I found a strong wire from a yard sign and was able to sever his head.  Thus ended the life of the sixth copperhead I encountered in 2017.  He would be the last copper head I came across in 2017.

At the end of October, the day before Halloween, my wife and I get a call from our oldest.  She was a passenger in her friend's car had been in a fender bender.  OK, I thought.  No big deal.  I told my daughter to tell her friend that she needed to exchange insurance information and then drive home.  Then more details emerged.  The car wasn't drivable.  The airbags deployed.  The glass shattered and my daughter got some scratches.  The windshield was massively cracked and buckled.  It wasn't just a fender bender; it was a full blown accident.  Her friend was driving them home from school and was "distracted" and when she looked up, she intended to stop, but got the accelerator and brake mixed up and they slammed into the car in front of them going 35-40 mph.  The car they hit, in turn, hit the car in front of him.

On Halloween, I took my oldest to the neighborhood clinic to have her checked out.  After a check-up and some quick x-rays, it was determined she is just fine,  After two days, she and her friend were back to normal.
Leading up to Thanksgiving in November work continued on the home.  Jill and our contractor were about to take a whole day to visit some kitchen cabinet stores to get ideas for kitchen design when Jill's friend showed her pictures of her new kitchen.  We quickly learned of a carpenter who could build custom cabinets for quite a reasonable price.  Many, many hours later and after lots of discussion and talking of ideas, we had a kitchen design.  We were able to provide the design to the carpenter and get a quote and found it quite reasonable.  Furthermore, he would be able to build closet space for Ben, a bookcase in the living room and hallway and our master bedroom closet and rebuild our stairs.  After seeing some of his work, we were quite impressed and excited to see him start.

Progress on the home continued.  November marked three city inspections (structural, electrical and plumbing).  Thankfully, we have a great plumber, who discovered a gas leak next to the furnace in the attic.  All the walls, except the living room, were finished ahead of the tile guy and carpenter.

For Thanksgiving, my wife's friend offered her home to our family, since they would be out of town the whole week.  It was a much needed break from school, work and reconstruction and it was the first time our whole family was under one roof since August 28.

Jill's friend's home was right across the street from some other friends of ours.  These friends bought a fixer-upper and had been working on it for the last few years.  We took a tour of their home and realized they had been living in a construction zone for a few years, while we will only have to live in a construction zone for a few months!  Naturally, we decided to have Thanksgiving dinner together in their construction zone!  It was quite comical eating in their mostly finished dining room and then watching football on a small TV in the living room with no floor or ceiling!  That night, we drove out to the lake and watched the sun set.  It was a perfect cap to a great day of gratitude!

At the end of Thanksgiving week, we had about a third of our floor tiles cleaned and then had our washer, dryer and second fridge delivered.  We set up our son's bed and made a space for him.  At that point, we were able to get most of the family moved back into our home.  Our eldest stayed with a neighbor, but all the other kids were able to move back into their rooms, while Jill and I used our eldest's room.  We also had the damaged fireplace removed and a new one installed.

Our carpenter showed up the last week of November and began work on the kitchen.  He and his crew were able to fabricate and install much of the kitchen.  Also during this week, work started on repairing the upstairs bathroom.  This bathroom had been leaking on and off since we first bought the home in 2009.  The plumber installed a new shower pan and filled it with water to ensure it did not leak.  After a few hours, I noticed it was leaking through the ceiling.  It was leaking so much, there was a bulge in the ceiling.  I lost it.  On a Saturday night at 11pm, I took a hammer to the ceiling, ripping a massive hole and let all the leaked water out.  I put a bucket on the floor to catch most of the water.  The next day, I told our contractor and plumber that I wanted the ceiling ripped out and the bathroom ripped out and then put it completely back together.  I did not want the ceiling put back together until the bathroom was fully restored and functioning and we verified there were going to be no more ceiling leaks.

With the start of December, we had a few sit-down meetings with our designer and discussed how we were going to push this project across the finish line.  Bathroom tile, in the master bathroom, powder room and upstairs bathroom needed to be completed.  The kitchen needed to be completed.  Base boards and crown molding needed to be installed.  Kitchen tops and bathroom sinks and tops needed to be finished.  The plumbing and toilets needed to be installed and finished out.  And all of that needed to be done before we painted.  We also worked to get quotes on painting the kitchen cabinets, walls, molding and base boards.  Having talked to neighbors, we learned that we simply could not be in the house while painting was on-going - the fumes are too strong.  So we planned to get as much done as possible and then let the painting crew take over while we left town for Christmas break.

December 8 brought a welcome change of scenery.  After a few days of cold, dreary rain, Houston got a skiff of snow!  We woke up on Friday December 8 to snow on the cars and ground!  Our youngest son's birthday was that same day and he got quite a special present with the snowfall!

The tile guy, electrician, drywall crew, plumber, and granite guy worked for three weeks to get things ready.  Things still didn't go quite smoothly.  After getting the bathroom vanity and sink roughly set up, we realized Jill's faucet (which already had the plumbing and tile in place) was too low.  So they had to rip out a few wall tiles and adjust the plumbing.  Jill's kitchen vent hood had also been set up, but afterwards, she realized that it was set at 24 inches high when it should have been 36 inches high; so they had to undo that work and move the vent up and put things back together again.  And one other little minor detail was that there was no outlet for where the microwave would be placed; so they had to figure out a way to deal with that.  Lots of minor and major issues needed to be dealt with along the way in the rebuild process.  But by December 16, things looked pretty good and we were ready to leave town and let the painting begin.

While painting and trim out finished up, we spent our time with family and friends in the cold North.  We got to go to Temple Square; we watched some Weber State basketball; we played lots of basketball; watched the new Star Wars movie a few times; went shopping and got ready for Christmas; spent time with family; ate lots of good food and relaxed.  And despite all the good times, 2017 still had to try our patience when everyone in the family came down with flu-like symptoms during the first few days of our vacation.  Thanks to good insurance, we all were able to see the doctor just down the street and 4 out of the 6 of us were prescribed Tamiflu.  We got our rest and did our best to recover before Christmas day.  For the first few days of the trip, we only got inches of snow and even what little we got, melted.  But on Christmas Eve, we got several inches of snow and on Christmas Day, we got to play in it!  It was a great way to finish out a very tough year.

As I look back on all that has happened this year, a few quotes come to mind.  The first is a quote I referenced in a Facebook Live video I recorded back in September.  It is from Marcus Aurelius and is one of my favorite quotes:

Be like the rocky headland on which the waves constantly break. It stands firm, and round it the seething waters are laid to rest. 

'It is my bad luck that this has happened to me.' No, you should rather say: 'It is my good luck that, although this has happened to me, I can bear it without pain, neither crushed by the present nor fearful of the future.' Because such a thing could have happened to any man, but not every man could have borne it without pain. So why see more misfortune in the event than good fortune in your ability to bear it? Or in general would you call anything a misfortune for a man which is not a deviation from man's nature? Or anything a deviation from man's nature which is not contrary to the purpose of his nature? Well, then. You have learnt what that purpose is. Can there be anything, then, in this happening which prevents you being just, high-minded, self-controlled, intelligent, judicious, truthful, honourable and free - or any other of those attributes whose combination is the fulfilment of man's proper nature? So in all future events which might induce sadness remember to call on this principle: 'this is no misfortune, but to bear it true to yourself is good fortune.'

We are artists in this life and the material we have to work with are other people and their actions and events in general.  How we react to them is the paint on our canvas.  We get to choose how we react mentally and physically.

The second quote is from Seneca and although in the negative form, the point is still valid:

I judge you unfortunate because you have never been unfortunate; you have passed through life without an antagonist; no one will know what you can do - not even yourself.

Again, the perspective is not to view these events as good or bad, but to view them as material to interact with and to prove your virtues of wisdom, justice, temperance and courage.

Epictetus used Hercules as an example of someone who was defined by his adversity:

What would have become of Hercules do you think if there had been no lion, hydra, stag or boar – and no savage criminals to rid the world of? What would he have done in the absence of such challenges?

Obviously he would have just rolled over in bed and gone back to sleep. So by snoring his life away in luxury and comfort he never would have developed into the mighty Hercules.

And even if he had, what good would it have done him? What would have been the use of those arms, that physique, and that noble soul, without crises or conditions to stir him into action?

I don't look at the Year of the Copperhead as an unfortunate year.  Rather, I look upon 2017 as a year where I and my family were able to face what life threw at us with a "stiff upper lip" and react with all the required virtues - especially courage.  Moving forward, we will forever be defined by the challenges sent our way and how we reacted to them.  Personally, I am extremely grateful for what has happened this year.  Never before have we had more opportunities to teach our children how to approach, view and manage adversity.  I sincerely hope they will remember this year for the rest of their lives; and more importantly, the lessons they've learned in dealing with tough times.

I hope you've learned something from this post.  Writing it was a very cathartic experience for me and helped me to continue to put life in the proper perspective.  Feel free to leave a comment or reaction and share how adversity has helped you become a better person.