Lisa Find Love

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It is late on a Friday night in the emergency department as I lead the mother into a small family room off the hallway. She is here with her son, who is now sitting in the locked psychiatric wing of the ER. We sit down on the threadbare couches.

“Tell me,” I say, “what’s been going on.” Out pours a tale of a successful young man, off to college, his bright future ahead of him — then the gradual deterioration, the precipitous decline. Now, instead of sitting in an auditorium at graduation, the mother tells me, she is sitting in the ER, holding back tears. This is not the future she envisioned for her child.

Mothers of those with mental illness share a special burden that they rest of us can only begin to imagine. They have raised and loved a person, but that person seems to have disappeared. In her book, Cutting the Soul: A Journey into the Mental Illness of a Teenager Through the Eyes of His Mother, Theresa Larsen offers us an intimate look at the experience.

At fourteen, Larsen’s son Matthew had a “subtle” intelligence. “Sensitive and kind,” he “had high expectations and unrealistic goals,” taking advanced classes and serving as the sweet older brother for his little sister. Over the course of a few months, his mood began to sink. Sometimes he isolated himself; other times, he seemed like the Matthew his mother knew.

Then one day, he came to her, apologizing. “Mom, I cut my hand,” Larsen recalls him saying. “… Don’t be angry with me please. I was messing around with my pocket knife and I cut my hand. I didn’t mean to cut it this deep.” It was the cry of a confused, distressed boy, and set both Larsen and her husband, Erik, grappling for words as they clean his wounds.

“Were you trying to kill yourself?” Erik asked.

Matthew flatly denied it. But while the cuts were not so deep as to require an immediate trip to the ER, Larsen realized they represented something far deeper. After a trip to their pediatrician, she sought out mental health treatment for her son. Thus began a disastrous series of psychiatrist visits that would make anyone in the profession cringe and want to offer her an apology.

The cutting continued. “I couldn’t help it,” Matthew told his mother. “I don’t know what to do.”

Larsen intersperses Matthew’s own journal entries from the time, giving us a glimpse into his thought process. “Only a single action can relieve me of my misery, but it has been forbidden,” he writes. “Like a match it takes a few strikes to spark my courage.”

Desperately, Larsen continued to seek answers. After trying to avoid medications for Matthew as long as possible, she realized she had to. “I needed the prescription to work,” she writes, “or Matthew’s illness was going to destroy our family.”

Matthew continued to deteriorate. His self-harm progressed to suicide attempts, his thoughts devolved into psychosis. He was hospitalized, then in residential treatment. After cutting himself with a sharp plastic object he found while in residential treatment, he writes, “This is actually the first time I wanted to cut to kill. An attempt to murder myself. I wish it worked. Damn it. … The pain I cause my parents. They hurt because of me. I cry knowing how much hurt it causes them to see me like this. I must stop! I must! I will, damn it!” But he cannot stop, and it is quite some time before he or his family find relief.

These journal entries, alongside Larsen’s own words, show us both what the son and the mother have gone through. Brushes with others with mental illness — a young man who tried to break into their house; a shooter at their daughter’s school — all made Larsen wonder what the future held for Matthew. In therapy herself, she asked, “How do I cope with Matthew dying?” As a mother, she writes, “Constantly waiting for my phone to ring with more bad news, kept me in a state of perpetual crisis.”

Larsen honestly depicts the tight-rope of fear and worry that parents in her shoes must traverse every day, balancing their own needs and those of the family at large with those of the mentally ill member.

“Maybe you need to redefine what normal is,” one of Matthew’s therapists offered at one point.

As I saw with the mother I spoke with in the ER, having a mentally ill child means redefining many things. For anyone who has had a mentally ill family member, you know there is rarely (never?) a happily ever after ending.

There is, however, a happier for now.

For Matthew and his family, the new normal, while maybe not the original plan, is one filled with hope and possibility. “Reach out and grasp hold of everything you once knew,” Matthew writes in his journal. “A love for this contentment festers inside you. Unlock the potential your life now holds.”

Cutting the Soul: A Journey into the Mental Illness of a Teenager Through the Eyes of His Mother
CreateSpace Independent Publishing Platform, December 2014
Paperback, 348 pages
$14.99

As holiday and other family gatherings draw near, so does the pressure to be gracious, forgiving, happy and “normal.” Our expectations of ourselves and sense of others’ expectations can fuel internal conflict and guilt — particularly in situations involving ruptured relationships with parents or others.

Most of us know that holding onto anger and grudges is toxic to mental and physical health, as well as relationships. Alternatively, forgiveness can lead to better health and well-being, and even increase overall kindness. Forgiveness means letting go of anger, resentment, and the need for vengeance or justice. Paradoxically, when we forgive, we feel more empowered, freer, and less controlled by other people, allowing us to reclaim jurisdiction over ourselves and our lives.

Why, then, in some cases, can’t we just forgive?

Well, forgiveness is not so simple. We cannot just decide to forgive and command ourselves to make it happen through sheer force of will. Forgiveness can become especially loaded when family, cultural, or religious expectations threaten to shame or scare us into taking the high road. But forgiveness doesn’t work when we force ourselves to do it out of moral principle, guilt, fear, or self-doubt. Further, forced or superficial forgiveness can backfire. Rather than set us free, it can create insidious anger, resistance, and passive-aggressive behavior alternating with depression, guilt, and shame.

Forgiveness is most complicated when the person who harmed us denies that anything happened, normalizes it, or denies the impact it had. In fact, forgiving a spouse who fails to take responsibility and repeatedly offends has actually been shown to have negative — not positive — effects, increasing victimization and lowering the forgiver’s self-esteem (McNulty, 2011).

There can be no forgiveness if “nothing happened,” if the other person is not first held accountable in our mind, and if the offender’s position has overtaken the affective reality of our subjective experience. Forgiveness is not sustainable in the absence of significant self-reflection that establishes a cohesive, consistent sense of what happened and the impact it had on us.

The problem of denial becomes particularly relevant when the harm inflicted involves implicitly or explicitly blaming the victim, is invisible to others, and difficult to prove. Examples include sexual abuse and childhood psychological maltreatment: a pattern of making the child feel worthless, unloved, endangered, or only of value in meeting others’ needs (Spinazzola et al., 2014).

In these situations, the offending person’s position of denial and blame is often internalized alongside the truth of our own experience battling to be heard. This dual track leads to wavering between defending our right to be angry and secretly feeling guilty, ashamed, and self-critical. Both sides are played out internally without resolution or integration.

In this way, the mind-bending effect of past trauma is repeated later internally, reinforcing a dysfunctional family dynamic in which there is confusion about who is doing what to whom. When emotional manipulations and distortions are disowned and hostility disguised as caring, it’s easy to lose track of what’s really happening. Blame is projected onto the victim, who internalizes and holds the guilt instead. Particular personality characteristics of the offending person can protect him or her from feeling guilty or responsible, for example: self-centeredness, blurred boundaries, lack of self-awareness, possessiveness, inability to take responsibility for one’s own feelings and behavior, tendency to misinterpret other people’s intentions, and pathological certainty of being “right.”

Anger and refusing to forgive can serve a self-protective function by creating a necessary boundary between oneself and the other person when it is not otherwise possible. Anger allows for emotional and psychological separation by creating a tangible enough barricade between ourselves and the offending other to prevent us from being overtaken by their feelings and perceptions.

Anger here can have a soul-saving function, both as a signal that there is something wrong and a protective barrier while we come to know and embrace the truth of our experience.

Alternatively, ongoing anger can also be a sign that we are still hooked in a self-defeating pattern of trying to get validation and emotionally affect the person who hurt us. Staying emotionally entangled, whether in the relationship or in our mind, protects us from the grief and loss that comes with letting go.

When forgiveness fails, it’s not a sign of weakness, but often a warning from an authentic voice inside of us fighting not to lose the integrity of our self-experience. Struggles with forgiveness are commonly caused by unacknowledged communication from inside ourselves that need to be put into words and understood. Until we translate and process the message, it will persist in alerting us, like an unopened text, and frustrate our efforts to move forward.

Our brains keep track of our subjective perceptions, storing an implicit or visceral narrative often felt in our bodies. Before healing can happen, we have to tolerate and accept our feelings and refrain from silencing the vulnerable part of ourselves that holds our authentic experience. Empathic understanding of the injured part of ourselves is necessary to satisfy our unmet need for validation. Doing so releases us from having to keep a tenacious grip on our feelings as a means of holding on to our true self.

When we heal, we have greater flexibility and more options because we’re no longer controlled by feelings and memories taking center stage. But letting go of anger can potentially feel unsafe and complicating because it involves redefining our relationship with the offending person. However, forgiveness does not negate that the offending behavior happened, nor imply that it was deserved or defensible. Further, it does not force us into anything or dictate whether the recalibration takes place only in our inner world, or whether it crosses into our real-time relationship. Resolving anger and letting go of grudges can restore inner peace, wholeness, and a sense of freedom, reducing our susceptibility to the effects of judgment regardless of the boundaries we decide are best for us.

References

McNulty, J. K. (2011, June). The dark side of forgiveness: the tendency to forgive predicts continued psychological and physical aggression in marriage. Personality and Social Psychology Bulletin, 37(6), 770-783.

Spinazzola, J., Hodgdon, H., Liang, L., Ford, J. Layne, C. M., Pynoos, R., et al. (2014). Unseen wounds: the contribution of psychological maltreatment to child and adolescent mental health and risk outcomes. Psychological Trauma: Theory, Research, Practice, and Policy, 6, S18-S28.

Unforgiving man photo available from Shutterstock

Regardless of whether you knew your partner had obsessive-compulsive disorder before you married, my guess is life together hasn’t always been easy. Neither my husband nor I have OCD (our son Dan does) so I’m not writing from firsthand experience, but rather from my own observations and years of connecting with people who have OCD.

For the person with OCD, issues might include feeling as if your spouse doesn’t care enough or support you enough. Perhaps he or she gets easily frustrated with you, and doesn’t even begin to understand how tormented you are and why your lives (and possibly the lives of your children) have been turned upside down because of obsessive-compulsive disorder.

For the spouse of someone with OCD, maybe you feel as if your husband or wife is being selfish, following OCD’s directions with no regard for you or your children. Perhaps you feel your spouse isn’t trying hard enough to get well, and you resent him or her not only for all the slack you’ve had to pick up around the house, but also for allowing OCD to obliterate whatever joy you might still have in your lives.

You are both emotionally and physically exhausted.

To make matters worse, couples who deal with OCD might feel isolated, as it’s not the easiest subject in the world to talk about with others. If couples do reach out for help, either individually or as a couple, well-meaning friends and relatives might take sides or offer bad advice. OCD is tough to understand. Add all this to the fact that social lives tend to be negatively affected when OCD is in the picture, and you likely have two people who feel alone.

But you’re not alone. You have each other. Remember? For better or for worse.

From what I’ve seen, couples who have thrived despite OCD see themselves as a team. They work together against OCD, not against each other. What this means is that if you’re the one with OCD, you need to commit to getting proper treatment, which includes exposure and response prevention (ERP) therapy. Part of that treatment is accepting the fact that your spouse and your children will no longer accommodate or enable your OCD.

If you are the spouse of someone with OCD, you need to learn everything you can about obsessive-compulsive disorder, and even occasionally accompany your partner to his or her therapy appointments, if appropriate. Also, it’s very important to learn the correct ways to respond to your spouse when he or she is dealing with obsessive-compulsive disorder. One thing I know from personal experience is we cannot rely on our instincts when dealing with OCD. We want to naturally reassure and comfort our loved ones, but, in terms of OCD, that’s the opposite of what we should be doing.

I know I’m making it sound easy, but as most of us know, the truth is, OCD is messy. Progress is rarely linear, and there will be many ups and downs. Still, it is possible to overcome OCD. Open communication is important for couples in general, but even more so when dealing with OCD. It’s not uncommon for misunderstandings to arise. Cognitive distortions often come into play, and OCD will twist and turn things around every chance it gets. Couples need to be as open and honest with each other as they can possibly be.

Maybe the best thing couples can do is remember why they married each other in the first place. Both those people still exist, though they might be currently hidden by OCD and all the damage it has caused. But relationships can be repaired, and as you take one day at a time and move toward recovery, couples might find their marriage becomes even stronger than it was before.

Teamwork photo available from Shutterstock

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Americans are a giving people. Last year, we donated more than $358 billion to charity. The overwhelming majority of American charities are responsible, efficient, and passionate about their missions. But sometimes, our donations are wasted through poor management or, worse, fraud. When that happens, everybody loses: The needy are deprived of funds that otherwise would have helped them, the government misses out on money that should have been taxed, legitimate charities are bypassed, and donors become hesitant to give.

Most of the charities mentioned in this article have not preyed on the kindness of the charitable. But to a one, their actions have raised real questions about how some organizations operate. Here are four practices that need changing.

Money Mugged: Cancer Fund of America
Until recently, you might have received a telemarketing call on behalf of the Knoxville, Tennessee–based Cancer Fund of America (or one of its three affiliates: Cancer Support Services, the Breast Cancer Society, and Children’s Cancer Fund of America), boasting of the organization’s work “in the forefront of the fight against cancer.” The charity provided “direct aid,” the pitch continued, to people “anywhere in the United States” suffering from “over 240 types of cancer.” Its charter includes driving cancer victims to chemo appointments, paying for their groceries, and providing pain medication to suffering children.

So you wouldn’t know, then, had you donated money to the group, that only 3 percent of your gift would have gone to “direct aid,” according to the Federal Trade Commission. And, according to a fraud case filed by the FTC and law enforcement partners from all 50 states, none of that direct aid consisted of driving people to chemo or doling out pain meds.

Instead, Cancer Fund of America distributed “gift boxes” filled with Little Debbie’s snack cakes, hotel-size shampoo samples, and batteries. The only drugs the charities distributed were those they received as gifts in kind, which were shipped to developing countries and were often not cancer meds; in fact, some were inappropriate for cancer patients, according to the complaint.

What happened to the other 97 percent of the donations? According to the FTC, much of the money was spent on the charity’s staff—principally the founder, James T. Reynolds Sr., and his extended family and friends. A trip to Disney World (with a paid babysitter in tow). A trip to Vegas. College tuition for several employees. Ten cars. Dues for a dating website. A luxury cruise. Apart from the perks, more than twice the amount that was spent on children with cancer went to pay the salaries of Reynolds’s children, in-laws, fellow churchgoers, and friends, who were hired without regard to their qualifications, says the FTC. Reynolds’s son, for example, received nearly $371,000 in 2010 as CEO of the spin-off group Breast Cancer Services.

According to the FTC’s complaint, the groups “operated as personal fiefdoms characterized by rampant nepotism, flagrant conflicts of interest, and excessive insider compensation, with none of the financial and governance controls that any bona fide charity would have adopted.” The fraud allegations pertain to the activities of the defendants from 2008 to 2012—a four-year run in which they raised $187 million from unsuspecting donors. How did they get away with it for so long?

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Tracy Thorleifson, the FTC’s lead attorney on the case, points out that the federal government’s hands are tied when it comes to charities fraud. “There is no federal law that prohibits a charity from lying to consumers to get money,” she says. Cracking down on fraud is generally left up to the states and their patchwork of laws.

Because it lacks jurisdiction over charities, the FTC sought to prove that Cancer Fund of America and its affiliates were not charities at all but rather corporations whose real purpose was to enrich their leaders. In June, without admitting wrongdoing, two of Cancer Fund of America’s affiliates agreed to a settlement in which the organizations would be shuttered and their executives would pay restitution. (Reynolds declined to comment on the case, and litigation pertaining to Cancer Fund of America itself, and Reynolds personally, continues.) But that might not be the last we hear of the Reynolds clan. “They could set up shop again tomorrow,” says Sandra Miniutti, CFO of the watchdog organization Charity Navigator. “It’s pretty scary.”

In 2011, Reynolds’s estranged wife’s daughter-in-law, Jula Connatser, who once worked for Cancer Fund of America, founded her own nonprofit, called the American Association for Cancer Support. It was not named in the FTC’s suit but is reportedly under investigation by the state of Tennessee. As of now, it has not been accused of wrongdoing and is operating freely in Knoxville.

Money on Mute: The American Red Cross
Even the best nonprofits can fail the public by not being up-front about how they’ve spent donors’ money. When a 7.0-magnitude earthquake struck Haiti in 2010, killing some 100,000 people and leaving more than a million homeless, Americans were quick to open their wallets, many reaching for their favorite charity, the American Red Cross, in the same way they’d reach for Coca-Cola when they wanted a soda. After the acute phase of the disaster, other groups whose coffers were full began turning away money, but the Red Cross continued fund-raising aggressively, ultimately pulling in $488 million worth of donations, more than any other organization. A year after the disaster, as part of its Haiti relief, the charity announced that it expected to spend $100 million on “construction of permanent homes and community development projects.”

Four years later, NPR and ProPublica made this stunning accusation: Despite having spent nearly half a billion dollars, the American Red Cross had built a grand total of six new homes in Haiti. The Red Cross has since explained that those six homes were a modest pilot project and that when faced with the on-the-ground realities—a cholera outbreak, the nation’s confounding land-title system, corruption, security issues—the group had changed its plans. But by now, donors and the public were demanding details about exactly what had gone on in Haiti—and the American Red Cross was not satisfying the clamor.

Instead of opening its books, the charity has disclosed its spending only in broad categories, without getting down to the specifics (a spokesperson told Reader’s Digest that it hasn’t provided a more granular breakdown because of lack of public appetite for such detail).

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Much of the group’s spending on shelter in Haiti was on projects carried out by distributing funds to nearly 50 partner aid groups (including Habitat for Humanity and Save the Children), each of which took a cut for administrative costs. As ProPublica and NPR reported, in one case, the American Red Cross forwarded $6 million to the International Federation of the Red Cross (IFRC) to subsidize rent for people who had been living in tents. IFRC took out 26 percent for “administration,” and on top of that, the American Red Cross took its standard 9 percent for “program management.” In another case, the American Red Cross took a full 24 percent for costs incurred while managing another group’s efforts.

So was all this money well spent? Misspent? Who knows? Under tough questioning from Sen. Charles Grassley, the organization has reportedly offered some specifics about its Haiti programs but requested that its testimony not be made public, citing contractual obligations with its partner organizations. Grassley has complied with the request but noted, “It’s hard to see how disclosing the dollar amounts given from the Red Cross to the individual organizations and how those organizations spent the money would harm anyone.” Still unknown is how much money the Red Cross transferred to other organizations, how much was budgeted to each project, and the number of people those projects assisted.

“One of the things with charities that you hope for is transparency,” says Eileen Heisman, CEO of the National Philanthropic Trust. “I think the Red Cross is basically a good organization, but in this particular situation, it very much looks like they need to answer more questions.”

Money Morass: Community Charity Advancement
Operating costs are an expensive fact of life for charities. But some try to hide the real price. Community Charity Advancement, a Pompano Beach, Florida–based charity, says its mission is “to provide health-care services, products, and related assistance to those in need in the U.S. and Central and South America and to provide support to breast cancer research; also assisting victims who have lost their homes to fire.” (It does business under several names to accommodate such versatility.) Its 2013 tax filing shows that a staggering 91 percent of its spending went to overhead—administrative and fund-raising costs—and that a meager 9 percent went to its actual programs, according to Charity Watch.

But at least Community Charity Advancement is open about how inefficient it is. Other groups are more subtle. Accounting rules allow them to bundle certain fund-raising expenses in with program costs—if the fund-raising efforts can be somehow construed as supporting their missions.

“It can get kind of funny,” says Daniel Borochoff, president of Charity Watch. A charity might “say the fund-raising that interrupted your dinner is a program service because they ask you to pray for people who are suffering in the Sudan, or ask you to fly a flag and show you’re patriotic. Then they can magically turn the cost of that solicitation call into a program service.”

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Such techniques can have a major impact on how effectual charities appear to be. The Police Protective Fund claims to spend 48 percent of its expenses on its mission (“to promote officer safety through education”). But according to Charity Watch, when you move the joint fund-raising and program costs into the overhead category, you see that only 7 percent goes to that cost. The rest is operating cost.

Overhead alone is not a sufficient basis on which to evaluate a charity. A number of oversight groups point out that for a charity to be effective, it must invest in its people and its infrastructure—after all, nonprofits compete for executive talent against the private sector, and no one believes that a choice to work for a nonprofit should be a vow of poverty. Instead, judge groups by how much work they get done: Did they feed 10,000 homeless people last year? Did they counsel 500 pregnant teens?

But even the “overhead myth” busters concede there are reasonable limits to how much it should cost to operate a charity. “For organizations that deliver services, whether those services are provided by a for-profit or a nonprofit, the norm for overhead is 25 to 35 percent,” says Tim Delaney, president of the National Council of Nonprofits.

Money to the Middleman: Optimal Medical Foundation

When a nonprofit fund-raising caller interrupts your dinner, even though he or she may speak of “our mission” and “our work,” there’s a strong chance that that person has never even met anyone from the charity he or she is asking you to give to. In fact, the person you’re talking to most likely works for a decidedly for-profit enterprise: a third-party fund-raising firm that skims a hefty cut off every dollar raised for the charity that hired it. Thousands of charities use third-party solicitors, and their commissions can be so exorbitant—from 65 to 95 cents of every dollar raised—that they leave very little for the nonprofits to apply to their actual work.

Take the Association for Firefighters and Paramedics, which paid a fund-raising firm nearly 90 cents for every dollar it raised in 2012. Or Optimal Medical Foundation, which also does business as the Association for Breast Cancer Research and the Childhood Disease Research Foundation. According to an investigation by the Tampa Bay Times and the Center for Investigative Reporting, the Michigan-based group raised $7.8 million from 2003 to 2012 through solicitors—and paid the third-party solicitors who raised it $7.6 million over the same period. As a result, only 3 percent of funds went toward the organization’s stated mission of supporting research into cancer and childhood diseases. Even the National Rifle Association of America paid a fund-raising firm called Info­Cision $59 for every $100 it raised on its behalf in 2013, according to New York State’s attorney general.

Third-party fund-raising is perfectly legal, and many legitimate charities use it simply because it’s cheaper than having full-time fund-raisers on staff. Still, most of us would be reluctant to give if we knew that the lion’s share of our donation was being diverted to a for-profit business. For that matter, the charity itself would rather have you donate directly instead of having the telemarketer siphon off the bulk of it. “That cost,” concedes Michael Gamboa, president of the Association for Firefighters and Paramedics, “is a difficult thing to deal with.”

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States can require telemarketers to disclose that they work for a third party—but not all states do. And some telemarketers will lie. Unfortunately, the only way to know how big a cut the third party gets is to dig up the nonprofit’s records—something few of us are going to do. But that point is largely academic anyway. “More of the money is going to the telemarketing firm than to the charity itself,” says Charity Navigator’s Miniutti. What more do you need to know?

Giving to charity should not be fraught with such pitfalls. Still, it would be irresponsible to stop donating just because some groups are corrupt or inept. As Delaney of the National Council of Nonprofits says, legitimate charities are “the first responders for our nation’s most challenging and critical social ills.”

So give … but carefully.

How to Donate to Charities Wisely 

1. Be proactive. Identify the causes you care most about, then do research to find the best charities carrying out that type of work. This keeps you on the offensive rather than in a defensive “point of sale” posture in the face of heart-tugging pitches.

2. Give a few large gifts instead of many small ones. Don’t be guilt-tripped into giving to every worthy cause. Developing your own “portfolio” of charities gives you more sway within the organizations and makes you more inclined to give carefully.

3. Never give over the phone in cold-call situations. Instead, if you’re interested, keep your donations out of the hands of telemarketers by donating via the group’s website or mailing a check.

4. Perform due diligence. Look into the group’s finances, and once you give, follow up to find out how the money was spent.

5. Take advantage of these watchdog groups. Before making a donation, check out the charity at these websites: Charity Navigator, Charity Watch, and the National Association of State Charity Officials.

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