The Stress Doc Letter
Cybernotes from the Online Psychohumorist ™
Aug 03, Sec. I
Fight when you can
Take flight when you must
Flow like a dream
In the Phoenix we trust!
Table of Contents
Offerings: Training Kit & Book; AOL Chat
Crisis Sequence Model
Main Essay: Resilience and the Art of Rejecting Rejection: Part
Main Essay: Resilience and the Art of Rejecting Rejection: Part II
Readers: Word Games; Wise Sayings By Wise Men; Lone Ranger and Tonto
Ladies Home Journal; News8Austin (Cable TV)/Web Sightings
1. Training/Marketing Kit: Want to strengthen your ability to lead or
market a stress workshop or any kind of speaking/training program? Consider the Stress Doc
Training/Marketing Kit, which includes both "how to" manual, 20-minute highlights video, and
articles, as well as the opportunity for phone coaching. For more info:
http://stressdoc.com/kitbook.htm or email.
2. Stress Doc Book:
From Stress Brakes and Shrink Rap to Safe Stress and Cool Moon
The Wit and Wisdom of the Stress Doc, Stress Doc Enterprises, 1995
90 page compilation of my former syndicated radio essays, pioneering songs in the field of
psychologically humorous rap music - "Shrink Rap" Productions - a creative visualization poem
and other humorous lyrics/poems. "Stress Brake" radio essays are short (300 words),
fast-paced and witty, covering such topics as stress, burnout, anger and conflict resolution, time
management, creativity, men's and women's issues, romantic relationships, codependency, etc. (They
make excellent fillers for newsletters.)
Price: $20 (which covers priority postage
Make check payable to: Mark Gorkin
Send check to:
Stress Doc Enterprises
1616 18th Street, NW #312
Washington, DC 20009-2542
3. Chat Group:
Stop by my
AOL/Digital City Shrink Rap (TM) and Group Chat DC
Support Chat, Tuesdays, 9:30-11pm EST DC Support Chat. It's a dynamic, lively, at times witty
and always warm, thoughtful and supportive problem-solving group. We raise questions and share our
ideas, hopes and experiences with each other.
A number of events have conspired, or inspired, me to resurrect an old
conceptual model from my Assitant Professor days at Tulane University. I'll be leading a "Managing
Anger and Preventing Violence" course in November under aegis of PESI Healthcare. And I'll be using
a "Crisis Intervention" perspective. The model was the theoretical foundation of a course I taught
for a decade -- Crisis Intervention and Brief Treatment. Also, this model will be used in a fall
workshop with the Metro-D.C. Association of Legal Administrators. The model was first presented by
Lynn Hoffman in Social Casework, "Uncovering the Precipitant in Crisis Intervention." (In
the late-70s, I believe.) I have expanded upon it. I think the model has wide-ranging
applicability as an intervention tool both with individuals and systems.
Crisis Sequence Model
The model involves the
sequential examination of past and present emotional conflicts, life events, and bio-psycho-social
reactions and interactions. A Crisis Sequence analysis provides both a historic and diagnostic
picture of a person and his or her environment during the build up to a heightened period of
vulnerability and subsequent eruption into a state of crisis. This model can also be a useful tool
for examining organizational systems in crisis.
Definition of Crisis: Crisis is a
heightened state of physiological and emotional vulnerability in the face of a critical,
ego-sensitive threat or problem. The individual has an acute need to regain a sense pf psychic and
situational control as well as mind-body equilibrium, that is, there is a need to reduce the
profound tension and disorientation and return to a more functional (if not pre-crisis) level of
adaptation. However, and most critical, this "no exit," threatening and critical issue seemingly
defies resolution and is momentarily overwhelming the person's coping resources and responses.
Core conflicts are the internalized, mind-body beliefs, pain,
memories, inner voices, etc. that evolve during the course of life, especially fostered by traumatic
experiences or critical losses in childhood and adolescence. These conflicts are also fueled as the
child (often unconsciously) internalizes the psychological and interpersonal pain and patterns of
the significant others in the child's life. Genetic or family predispositions also influence
foundational temperament. Such Core Conflicts include: separation anxiety and abandonment,
helplessness and rage, unresolved grief or trauma, clinical depression or anxiety traits, inadequate
self-esteem or sense of competence, immature bio-psycho-social identity. While very often generated
by childhood events, sometimes later experiences, for example, an abusive marriage, might exacerbate
core conflicts as well as create their own core issues.
These issues may seemingly lie
dormant until sufficient life stressors hit or the person experiences a major biochemical or
hormonal shift, e.g., adolescence or menopause. (Of course, psychosocial stressors invariably
interact with physiological states.) Also, while not conclusively documented, mid-life may be a
stage where numbers of people experience life-work and mind-body transitional tensions or crisis
This is the stressor event that initiates the Crisis
Sequence. This event can be a material and psychic blow, for example, losing a job or not getting
an anticipated promotion. The event can be a surprising development, that is, suddenly learning
that a relatively young parent, or a parent in seemingly good health, has had a stroke or heart
Also noteworthy is the potential presence of background hazardous events, for
example, having a child or spouse in the military, and wondering if the significant other will be
stationed in a war zone. The Hazardous Event may commence when the individual is sent off to
combat. These background hazards often have a strong situational component.
stressors may not be jolting, but they do chronically gnaw at the individual. For example, working
the graveyard shift for a year as a stress and violence prevention consultant for the US Postal
Service was definitely a background hazard, and occasionally foreground as well. (And my
post-assignment elevated blood pressure was concrete evidence. Before this tour of duty, my blood
pressure had always tested normal.)
For a more complete picture of the crisis sequence, it's
useful to get information on significant, novel, or surprising, and disruptive occurrences three-six
months, six-twelve months, and, even one-two years prior to the Hazardous Event.
This is the subjective, mind-body reaction to the Hazardous Event. In
broad terms, there is a threefold reaction:
a) threat (anxiety, obsession)
b) loss (grief or
depression, loss of control, rage, or helplessness) and
c) challenge (heightened arousal,
vigilance, and readiness for purposeful action).
Heightening the intensity, painfulness, and
confusion of the Vulnerable State is the fact that Core Conflict issues tend to get stirred under
prolonged threat or loss as well as chronic stress and hypervigilance conditions. For example, a
person who was physically or sexually abused as a child may find working for a domineering or
demeaning supervisor particularly hazardous and threatening.
Coping: No Crisis
If the individual can manage the Hazardous Event and productively cope with the Vulnerable State
emotions, then the Crisis Sequence usually terminates at this point. The individual may have gained
some resources or skills in the process. However, if stress management and coping attempts are
marginally successful or, worse, dysfunctional, then the person will continue along this crisis
pathway, increasingly susceptible to a crisis-triggering stimulus.
This is the event that precipitates or sets off a full-blown crisis: intense disorientation or
agitation, profound sense of helplessness or hopelessness, feelings of rage and shame, as well as
fears of being emotionally exposed or just totally "losing lt." What also can be confounding for
the individual in crisis is that a Precipitating Event can appear to be rather trivial -- the
proverbial "straw that broke the camel's back." What has been overlooked or denied is the pressure
that has been building on the individual over an extended period of time. In this smoldering
context, a broken copy machine might be enough to trigger a fiery outburst or to push the crisis
candidate over the edge.
Also, at this point, the Core Conflict floodgates (that is, the
psychological defenses keeping at bay or out of everyday consciousness Core Conflict issues and
pain) have burst open. This "break down" often leads to emotional flooding and intensifies the
crisis "sturm und drang."
A key point is that this dramatic and
acute state of disorientation and turmoil is time-limited, usually lasting one to six weeks. The
mind-body cannot tolerate indefinitely this profound rupture, confusion, or helplessness, and acute
stress, if not panic condition. Crisis is a "no exit" challenge; something must be done. This fact
helps explain why the Chinese depict "crisis" with the symbolic characters of "danger" and
"opportunity." The "danger" of crisis is potentially fourfold:
a) the individual is confronted
by a psychologically, if not physically, overwhelming or acutely threatening situation which demands
b) he or she lacks adequate resources to manage or cope with this chaotic disruption
or disaster, whether mostly perceived or frighteningly real,
c) the flooding of Core Conflict
emotions and pain adds to the profound disorientation, helplessness, loss of control, and/or
d) the individual often chooses self-defeating, if not destructive, behavior to
shut down the crisis, that is, depressive withdrawal, anxious avoidance, or addictive numbing and
escape, e.g., excess drinking, gambling, compulsive shopping, impulsive sexual activity, etc. This
maladaptive coping response only exacerbates the dark mood and mental (or physical) state of the
Conversely, it is just the
dangerous aspect that sets the stage for the growth potential of crisis. As we've seen, the person
feels trapped while habitual problem solving is proving fruitless, yet he or she must take some
action as tension keeps climbing. Now, this individual may feel compelled or desperate enough to
reach out for new and more productive sources of help. Allowing for greater dependence in times of
crisis is critical. Reaching out during these turbulent times and trials for needed resources or a
different perspective, for emotional nurturing, and novel problem-solving skills and strategies is
the "opportunity" side of crisis. Taking these productive steps yields a more solid and supported
situational foundation and mind-body equilibrium. And, again, this achievement tends to occur
within the one-to-six week crisis problem-solving and adaptation window.
Not surprisingly, my
critical intervention mantra for responding to individuals in crisis: "Strike when the ego is
hot." If a person can reach out for help, and can engage in emotional grieving, he or she is more
open to making significant behavioral changes and adaptations at these crisis problem-solving
moments, than at less stressful times. As Nobel prize-winning author Albert Camus, noted: Once
we have accepted the fact of loss, we understand that the loved one obstructed a whole corner of the
possible, pure now as a sky washed by rain.
And there is a crisis learning curve.
Effective coping with an initial crisis sequence often helps prepare an individual for positively
responding to hazardous and critical events and for managing subsequent crises or post-traumatic
Crisis Problem Solving and Post-Traumatic Coping
intervention, here are five strategic tips from my article, "Traumatic Stress/Crisis Intervention
Techniques and Tips," written in the shadows of 9/11. That horrific event certainly threw all of us
into a vulnerable tailspin, if not into full-blown crisis.
1. Strive for Realistic
Control. Discourage the person from trying to achieve an absolute sense of control of his or her
external environment, as this will invariably leave one feeling more at risk. Personally, taking the
Amtrak train up to NYC three days after the Twin Towers terrorist attack, while initially a bit
unsettling was, ultimately, an anxiety-reducing, confidence building step. The Serenity Prayer is
also relevant here:
Grant me the serenity to accept the things I cannot change, the
courage to change the things I can and the wisdom to know the difference.
Sources of Support. Encourage individuals to find sources of support when feeling the need for
nurturance or reassurance. Are there supportive/nurturing resources available at home, at work,
through church, with friends - in person, over the phone, on the Internet; is there an online or
offline support group available?
3. Take Some Concrete Action Steps. Encourage the
person to focus on two or three actions steps that would help the individual feel a small but
significant degree of enhanced safety and security, that is, a greater sense of control. For
example, one woman stated that getting a gas mask for her and her cat and stocking up on bottled
water would help her feel better. (I declined asking what the cat would think of her plan.)
4. Explore the Need for Counseling. Let people know about the counseling option. If in the
next few weeks the person feels stuck in one of the grief stages or the post-traumatic symptoms are
not subsiding, professional guidance is indicated. One woman approached me after a recent
organizational grief session. Some personal "past issues" had surfaced briefly. She shared having
recently met a terrific guy and didn't want her baggage to mess things up. After exploring her
workplace mental health insurance coverage she will be calling for an appointment; a classic example
of a proactive crisis problem solving response.
5. Communicate Optimism. Reaffirm that
post-traumatic stress is natural, that crisis can heighten a person's problem solving capacity,
enhance a person's communal circle of support and that the grief process may be a catalyst for
potent healing and growth producing energy.
As I once penned: Whether the loss is a key
person, a desired position or a powerful illusion each deserves the respect of mourning. The pit in
the stomach, the clenched fists and quivering jaw, the anguished sobs prove catalytic in time. In
mystical fashion, like Spring upon Winter, the seeds of dissolution bear fruitful renewal.
Part I of this II-part series has the Stress Doc outlining five of ten
strategies for trumping rejection with resilience. Recommendations range from the existential and
psychological to the commercial and virtual. Are you ready to confront your "Intimate FOE?"
the Art of Rejecting Rejection: Part I
Five of the Stress Doc's "Top Ten" Rejection Busters
The online mental health resource, The Bright Side ™, requested an article on dealing with
"rejection." The piece is for the Society of Composers and Lyricists' publication, The Score,
whose members are frequently on the cutting edge, and not just in the creative sense. Most
composers are freelancers who submit their work on project after project only to be rejected over
Well, the timing couldn't have been better for this assignment. Once again, I'm an
unrequited author. This time a mid-sized Boston publishing house turned down my 200-page
Practice Safe Stress book proposal. As relayed by my advocate, the acquisitions editor,
according to the publisher: "There are too many stress books out there." However, the editor made
a counter offer: submit a proposal for a breezy, humorous, magazine style "how to" book on
recovering from burnout. While initially skeptical of this superficial approach, that is, the
People Magazination of our society, the desire to obtain a publisher prevailed.
furious weekend, I pulled together a thirty-five page proposal, including a 2x3 matrix of prevention
and recovery activities -- from a week of cruising to brief coaching. One matrix category consisted
of three types of activity: work, love (including self-nurturing, hence the cruising), and spirited
play. The second dimension involved how quickly the action could become operational -- short-term
or mid- to long-range. Anyway, now both the editor and publisher "loved" the proposal: "It's
perfect; don't change anything."
As my brother would say, "Despite having no expectations…I'm
still usually disappointed." The familiar result: an email from the editor with the subject
heading, "Disappointing News." This time it was the bookseller who declared, "Too many burnout
books on the market." Thanks a lot, fellas! (I'm still holding on to the rationale that, despite
my best efforts, the proposal wasn't dumb enough.)
To my surprise, after a day of moping
around, and a good night sleep, I was back in the saddle, at least with my book manuscript. It was
full speed ahead to self-publish. As for the burnout-lite proposal, presently my attitude is time
will heal and it will also tell.
The Making of Resilience
Contributing to my
capacity for bouncing back was having been burned before, grappling with the psychological fallout,
along with gaining some hard-edged coping skills. (Now some might claim that a moderate dosage of
Wellbutrin provided the cushion that helped break the depressive fall. In my book, hardly a
A resilience training experience occurred three years ago. At that
time, I was anticipating publication by AdviceZone.com. I struggled for six months with the
editorial process, and never was truly satisfied with the editorial relationship or with our final
product. But again, "To hell with it; I want to be published."
Alas, this dot.com was a
dot.bomb, and the book project disintegrated. After a period of meltdown mourning, two positives
emerged. The first involved reworking the less than satisfactory manuscript into a product that I
felt proud of…whether it was published or not. Second, I realized, akin to my former radio and
television days, when it comes to publishing, "I no longer count on nor discount any possibility."
Years of disappointment in trying to get a book published -- from being approached by a New York
City agent as well as another editor of a large house -- has developed some psychic calluses.
And while not as prestigious as a book, over the years, having hundreds of articles appear in
online and offline (i.e., hard copy) publications is a source of affirmation as a writer. This fact
helps soothe the frustration of the as-yet fulfilled title and role of "book author."
speaking of role, in Hollywood-like script fashion…as one door closes another door or, at least, a
window of opportunity, begins to materialize. (But is it more smoke and mirrors as I stumble
through this labyrinthine, not so fun [publishing] house?) Just last week, PESI healthcare, a
national training company soon to be promoting Stress Doc-led "Managing Anger" seminars, expressed
interest in marketing my products. And my PESI contact will explore with the Powers That Be the
option for publishing my manuscript.
"Top Ten" Rejection Busters: I-V
rejection and resilience hot off my mental press, here's a strategic blueprint for experiencing,
integrating, and rebounding from rejection -- "The Healing Art of Rejecting Rejection: Part I":
1. Embracing the Journey. While getting the book published (in my case) or
obtaining the compositional contract for the next project is, of course, the end goal, make sure the
process of writing and creating is truly compelling. You have to love what you do; you must have a
critical mass of belief in yourself and the belief in the necessity and vitality of your work to
withstand the "slings and arrows." Being a creative entrepreneur often means periods of "dark
night of the soul" angst and financial uncertainty.
And you cannot not just believe; you must
breathe in what you do. One takes in air through writing and composing; sparks are fanned into
passionate fire. For you, when it comes to creative expression, is there "no choice?" Be honest:
do you compose to capture your (and life's) melancholy and joy, to quiet the relentless gnawing, to
relate the obscure and the obvious, to transcend hurt and humiliation, and to release the music
within? In fact, eventually, rejection itself becomes a moving life force:
Phoenix to rise from the ashes
One must know the pain
To transform the fire to burning desire!
Finally, do you write to open your own Pandora's Box, to help confront your "Intimate FOE":
Fear of Exposure? Do you know that the last of the escaping furies -- hope -- resides within?
So the process must be as sustaining as the prize. The unconventional journey becomes your true
destiny, for destination success or salvation, if not ephemeral, often proves short-lived. The
artistic way involves breaking up or breaking out of the career and life puzzle. (And sometimes
burning out or breaking down comes along for the ride.) As the 20th century giant, Pablo Picasso,
observed: Every act of creation is first of all an act of destruction. No one said the
journey was easy. Still, the flexibly focused mind is forever on the edge of "breaking away."
2. Distinguishing Rejection Regression from Burnout Blues. Rejection hurts, alas, not
the end of story. When the "no" shuts down an important project or anticipated contract, one on
which expression, excess pride, peer status, and/or security have been riding, then swelling streams
of emotions -- shock, sadness, shame, anxiety, and anger -- may coalesce into a raging river of
While not wanting to give false reassurance, there really is an up side.
Acknowledging and patiently grappling with the pain while accepting some TLC -- Tough Loving Care
and Tender Loving Criticism -- is what transforms grief into rebirth and growth. As I once penned:
Whether the loss is a key person, a desired position, or a powerful illusion each deserves the
respect of a mourning. The pit in the stomach, the clenched fists and quivering jaw, the anguished
sobs prove catalytic in time. In mystical fashion, like spring upon winter, the seeds of
dissolution bear fruitful renewal.
However, if the project has become a near holy quest,
that is, not just a goal, but a "my entire self-worth is on the line" goal (what I call an "egoal"),
then you are vulnerable to greater disruption. Ironically, at some point, two of your artistic
aptitudes -- passion and persistence -- may contribute to your undoing or, at least, to a state of
disabling exhaustion. Remember, "There's a fine line between vision and hallucination."
Imagine for a moment you are a NASCAR driver and your mind-body is the racecar. If you keep
relentlessly driving and pushing without taking a pit stop (at minimum to regroup), you likely will
blow a fuse, if not an engine or tire. As I've previously written (The Score, Summer 2003),
one is ripe for "The Four Stages of Burnout":
1) Physical, Mental, and Emotional Exhaustion
Shame and Doubt
3) Cynicism and Callousness
4) Failure, Helplessness, and Crisis.
Complicating the "Burnout Blues," is prolonged stress. Chronic tension often awakens those critical
demons whose shrill and judgmental voices are seeping through the cracks in your defensive armor.
Now you will absolutely have to take time for the pain and the grief. Seeking some short-term
therapy is wise. (And having a friendly pit crew couldn't hurt either.)
Efforts, Results, and Revenue Dreams. The "Burnout Blues" doesn't only occur from frequent
rejection. It also can develop when you keep playing it safe -- when, for example, you do the same
narrowly focused writing or composing over and over. (Would this be to avoid possible rejection?)
Eventually, your niche of success can have you stuck in the ditch of excess. I call it the Bjorn
Bored Syndrome (BBS), for the late-70s to early-80s Swedish tennis great, Bjorn Borg, who suddenly
burned out on the circuit. Despite the glamour and money, after five consecutive French and
Wimbledon Championships (along with the hours of monotonous, numbing practice) the thrill was
gone…and so was Bjorn. He was a victim of BBS: "When Mastery times Monotony provides
an index of Misery!
The Stress Doc moral: Fireproof your life with variety.
And this maxim works both for preventing mind numbing exhaustion and for better coping with
rejection. For me, diversification involves a professional mix of writing, speaking, training,
consulting, and a small therapy practice. Many won't have such an array of options. But even one
other role, or an additional source of reward and/or revenue, can soften the blow. This added role
can be in your field or far a field, just as long as it provides some combination of:
a) a new
learning curve or an environment that allows for relaxation and rejuvenation,
and/or recognition for you, any team members, and/or your audience, and
c) some psychic
gratification, if not a tangible reward.
Not surprisingly, the Stress Doc's second and
complementary "variety" maxim for "rejecting rejection": Don't put all your ego eggs in one
4. Getting Out of the Be All and End All Box. For writers and artists it
can be hard letting go of a path or a project. So much time as well as energy, ego, and effort have
already been invested -- the "sunk costs" phenomenon. To let go can feel shameful; it's a failure
or defeat. As many a successful person has learned: One may have to retreat partially to
advance eventually. Okay, let's get practical: What about part-time work? Clearly this option
can seem double-edged. The downside: it's taking you away from your calling. Conversely, having
some structure in the day, as well as some predictable income, can lower stress levels. There's a
chance to retreat, recover (from exhaustion), and regroup.
Now, with a more patient
perspective, being refueled and re-funded, options will likely appear. You may be ready to get back
into the race for rejections. The more efficiently you get "no's" out of the way, the more
effectively you can target a more responsive market.
But perhaps most important is this
cognitive shift: accepting the fact that for most individuals -- creative and otherwise -- the
journey toward success and achievement tends to evolve when traveling aboard the train making
frequent local stops, with resultant meandering, getting lost, yet having a chance for
experimentation, and gaining hard-earned wisdom. Goal achievement rarely occurs simply by jumping
on a high-speed express. (See previous dot.bomb reference.)
5. Coming to Grips with
Commercial Virtuality and Cyber Reality. Along with my recent being taken for a roller coaster
ride with the book publishing company, several years writing and delivering essays on cable and
public television, as well as for commercial and public radio, have honed a cautious, if not
somewhat cynical, attitude. Without belaboring the obvious, the commercial media often opts for a
low, if not the lowest, common denominator. There can be a reluctance to risk backing novel or
unusual perspectives and approaches. The bottom (feeder) line: Will it sell?
today's wired and web-based world provides unprecedented opportunity for getting work out through
alternative avenues -- from burning and distributing CDs to creating websites and blogs (interactive
forums) that help spread the words and sounds. (I won't get into Napster issues here.) For
example, I'm writing these articles for The Score because the Business Development person of
The Bright Side ™ found my website -- www.stressdoc.com -- and a coast to coast partnership
Another valuable web development was having List-A-Day.com select my
monthly Stress Doc Newsletter as its web publication of the day. They made my day,
especially when noting my insightful and fun "psychohumor" essays. It's nice to be read and to have
essential aspects of your work be truly seen. (Email email@example.com for the free
One more encouraging anecdote. This year, the BBC in London interviewed me.
They were looking for a stress expert. The radio program manager's selection was based on my site's
originality and the quality of content; according to this manager, it wasn't as "commercial" as the
sites of larger stress reduction companies.
And as affirming as the awards or the recognition
is the genuinely appreciative feedback from readers -- whether it's for sharing my own trials with
depression or highlighting strategies for overcoming dysfunctional organizational dynamics. (A
number of readers share select articles with their deserving managers or top management.) While it
took awhile, I've come to believe that my words can truly touch a heart and mind and, sometimes,
even a soul.
Clearly, the big business marketplace and corporate commercialism are not the
only arbiters of value and arteries for success.
Here are two final quotes for transcending
the regressive and rejecting mindscape. The first approximates the words of the radical and
innovative poet, e.e. cummings: To be nobody but your self in a world night and day trying to
make you like everybody else, is the hardest fight you will ever fight…And never stop fighting!
And another inspiring Stress Doc slogan: Go web young cyber-ite!
offerings next time. Hopefully, these five healing strategies will make it easier cutting rejection
down to size and facilitate retreating and rebounding, while also helping you to…Practice Safe
Mark Gorkin, LICSW, "The Stress Doc" ™, a psychotherapist, an
international/cruise speaker (Celebrity Cruise Lines) and syndicated writer, was recently
interviewed on BBC radio. The Doc is America Online's "Online Psychohumorist" ™ running his weekly
"Shrink Rap and Group Chat" on AOL/Digital City. See his award-winning, USA Today Online "HotSite"
-- www.stressdoc.com (recently cited as a workplace resource in a National Public Radio feature on
"Bad Bosses"). Mark is also an advisor to The Bright Side --
www.the-bright-side.org -- a
multi-award-winning mental health resource. Email for his monthly newsletter recently showcased on
List-a-Day.com. For more info on the Doc's "Practice Safe Stress" programs, email firstname.lastname@example.org
or call 202-232-8662.
(c) Mark Gorkin 2003
Shrink Rap Productions