We all know self-growth is good. But we rarely talk about the grief that comes with growth. As our perceptions shift, we experience grief because the person we used to be missed so much of what the new person we have become is now aware of.
Almost 20 years ago, when I was a Marriage and Family Therapist Intern, I was in a supervision group with a woman named Renee. Renee died a few years after we were both licensed. She was in her 40’s.
I didn’t know Renee well. I had been focused on learning and developing my skillset, and so I saw Renee as just another person in our group. Part of the problem was that this particular supervision group was based more on competition than support and cooperation. It supported each of our narcissisms — certainly mine. I was doing my best to be a shiny and talented new therapist.
At that time, I needed to see myself, and I needed to be seen far more than I was able to recognize and validate others. I was hungry for approval and recognition.
Why?
I had grown up in a family where life revolved around my father’s needs. He was the hungry one who demanded he be catered to. He had needed to find his specialness because he not only wasn’t affirmed as a child, but he had suffered a lot of harsh punishment growing up.
His needs hijacked the needs of the rest of us. As a result, my siblings and I were starving emotionally. We were not seen as the wonderful little growing beings that we were. Instead, we were hinderances and bothers. That environment sets up a need (certainly in me) to be seen, and for my own specialness to be recognized. My unmet narcissistic need became an undercurrent in my striving, and it blocked me from fully appreciating the beauty of others.
In a child, narcissism is supported by understanding that children need to say, “This is mine,” and behave as if the world revolves around them. Supporting this allows that child to grow up into an adult who enjoys themselves and their impact on the planet. As an adult, healthy narcissism means we can acknowledge and enjoy our creativity, our talents, and accomplishments. And at the same time, we have a concern and interest in others. There is a balance.
When this narcissism has not been supported as a child, we can grow up with a hunger to be seen and recognized, coupled with a sense of low self-esteem. While narcissism is healthy in a child and deserves to be supported, it is far less healthy in an adult when it is a hunger rather than a recognition of our self-worth and enjoyment of our abilities.
That hunger blocks our ability to take in others. It is similar to when a person, instead of listening to the person they are conversing with, is planning what they will be saying next. The focus is not on the connection between the two people but rather, on the self.
My grief erupted around Renee’s death. As I watched a tribute to her, I cried. She had a beautiful spirt. I could feel it in the pictures of her. I hadn’t fully seen her spirit when I knew her. I hadn’t been able to recognize who she was. I was so used to striving and attempting to fill my own needs, that I missed what was beautiful in her.
There is always grief when we pass through a gate of consciousness and see what we missed by being more closed previously. This is part of growing and seeing new perspectives and vistas — and understanding the limits of the previous stage of consciousness.
There are so many beautiful people. It is not so much about knowing them all and maintaining relationships but rather about recognizing their beauty. That is what I am grieving. I have missed appreciating so much beauty.
With Renee, it was not that I wanted to spend more time with her, it was just that I wished I had been more able to honor her beingness — her spirit, that I could have more fully recognized her value when I had contact with her.
I am grateful that the gates of consciousness have opened. I have so much more appreciation for others now. And I am so much less hungry to be seen. I am grateful for my grief, for it alerts me to my shift in consciousness and my growth. I can not only see but feel how much I have matured.
© Jennifer Lehr, LMFT 2019
Vitiligo (pronounced vit-uh-LIE-go) is a medical condition in which patches of skin lose their color. This occurs when melanocytes, the cells responsible for making skin pigment, are destroyed. Vitiligo can affect any part of the body, and it can occur in people of any age, ethnicity, or sex.
Affecting approximately 1% of the population, vitiligo can be an emotionally and socially devastating disease. Particularly frustrating to many is its unpredictable progression, which can be slow or rapid.
Thus far, there is no cure for vitiligo. But new hope is on the horizon, thanks to recent research that is improving our understanding of the pathways involved in this condition and potential new ways to treat it.
Vitiligo is generally thought to be an autoimmune disease, in which a person’s immune system mistakenly attacks its own body (in this case, it attacks melanocytes). In addition, the melanocytes of people with vitiligo appear unable to deal with the imbalance of antioxidants and harmful free radicals in the body, which results in cell damage and death.
While most people with vitiligo are otherwise healthy, there is an association between vitiligo and thyroid disease (either over- or underactivity of the thyroid). Less frequently, it occurs together with other autoimmune conditions, such as lupus or type 1 diabetes.
There are a number of treatments aimed at restoring color to depigmented skin. One of the oldest and most effective treatments is phototherapy (light therapy) with ultraviolet B (UVB) light. For this treatment, depigmented skin is exposed to UVB light several times a week, either in a clinic or at home.
Light therapy is often used in combination with topical medications that are applied to the skin. Topical treatments include topical steroids, topical calcineurin inhibitors (such as tacrolimus or pimecrolimus), or topical vitamin D analogues (such as calcipotriol and tacalcitol). Psoralen, a type of medication previously used in conjunction with phototherapy, has largely fallen out of favor. Topical medications may also be used on their own, without light therapy, although when the two treatments are used together, patients typically see better results.
If the depigmented areas are extensive, there is also the option of using topical medications to bleach unaffected skin, bringing it closer in color to the depigmented areas.
If medical treatments are ineffective, surgical treatment may be an option for certain people. Skin grafts can be taken from normally pigmented skin, usually from the buttocks or hips, and transferred to depigmented areas in more visible parts of the body.
Recently, several exciting studies have looked at a class of medications called JAK inhibitors as a possible new treatment option. JAK inhibitors target a type of immune communication pathway that has not been targeted before in vitiligo. These medications are thought to work by reducing levels of inflammatory chemicals that drive disease progression, and by stimulating melanocytes to regrow.
One study, published in JAMA, looked at the JAK inhibitor tofacitinib; another study, published in the Journal of the American Academy of Dermatology, looked at the JAK inhibitor ruxolitinib. Both reported promising results for repigmentation in people with vitiligo when the JAK inhibitor was used together with UVB phototherapy.
Though these initial studies analyzed small groups of patients, several larger-scale studies are underway to assess how both oral and topical JAK inhibitors may improve vitiligo. Preliminary data from these larger trials are showing promising results for repigmentation, especially on the face. The hope is that these results will eventually lead to FDA approval of JAK inhibitors for the treatment of vitiligo. For now, because they are still considered off-label by the FDA for use in vitiligo, these drugs are rarely covered by insurance for the treatment of vitiligo, and therefore can be quite expensive.
A diagnosis of vitiligo can be life-altering. Patients may struggle with self-esteem or depression, and they often have to deal with social stigma, due to misunderstanding about the contagiousness of the condition. As a result, people with vitiligo typically benefit from psychosocial support in addition to medical treatment.
If you have vitiligo (or know someone who does) and would like to learn more about support groups and other available resources, please visit the Global Vitiligo Foundation or Vitiligo Support International.
Follow me on Twitter @KristinaLiuMD
The post Vitiligo: More than skin deep appeared first on Harvard Health Blog.
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