Book Overview of The Pond Beyond the Forest

“Until you make the unconscious conscious, it will direct your life and you will call it fate.”

Carl Jung

So often in parenting, we’re confronted with memories of our childhood as we watch our children encounter the world. If we’re not conscious of our unhealed emotional wounds, we are likely to pass them on to our children. As Jung said, “Until you make the unconscious conscious, it will direct your life and you will call it fate.”

In my memoir, The Pond Beyond the Forest, I confront the consequences of generational trauma as an adult survivor of childhood emotional neglect. My own unhealed attachment wounds led to a host of issues, including parental struggles, marital strife, and mental health challenges. Oblivious to the effects of hidden emotional wounds, I often allowed my emotions to get the better of me. I share my experience not only as a cautionary tale but also as a message of hope that it is possible to heal from childhood attachment trauma.

When I was twenty-two, I immigrated to America to escape Japan’s rigid society and a neglectful family situation that had landed me in a mental hospital at seventeen. I thrived in my new, healthier environment, felt stronger and more resilient, and my traumatic past seemed to be behind me. Later in life, however, motherhood didn’t come easily. I often felt burned out from overcompensating to provide my son with the love and attention I wished I’d received as a child. And when he entered high school and I tried to deal with his emotional outbursts and rebellious behavior, I saw mirrored in him aspects of my childhood anxiety and depression. The past I thought I’d left behind reemerged with intense flashbacks, and I grew increasingly preoccupied with saving him from my “fate.” As I became hypervigilant about his welfare, my husband, who was more hands-off about parenting, couldn’t understand my predicament and accused me of overreacting and micromanaging. My anxious preoccupation, coupled with a menopausal rollercoaster, took a heavy toll on us all.

Told with blunt honesty but softened with humor, The Pond Beyond the Forest offers a voice-driven narrative of motherhood, marriage, menopause, and mental health. It alternates between my journey as a mother and wife in Seattle and my troubled upbringing by emotionally distant parents in Japan.

In the memoir’s opening scene, I clash with my teenage son over bedtime. His emotional volatility overlapped with my menopausal irritability, which made our house ground zero for an adolescent-versus-menopausal Battle Royale. One morning as he and I argued on the way to school, he threatened to jump out of the moving car. That was when I realized we needed professional help.

I flash back to my childhood years in Japan. I grew up in a wealthy but emotionally hollow family and saw my parents and brothers so rarely it bordered on abandonment. Solace came in the form of my Japanese garden and the time spent with animals. When I turned sixteen, I participated in a life-altering summer homestay program in California with a loving and nurturing family. But on my return home, the disparity between my Japanese family and my American host family created an existential crisis. That led me into a period of soul-searching so intense that I ended up having a manic episode. Soon after, my family freaked out and threw me into a mental hospital.

Back in Seattle, after several months of family therapy, we gained valuable insight into parenting practices. My son also learned more about my childhood and came to appreciate the strength it had taken me to survive. 

Despite the temporary progress our family made, however, my life still revolved around my son, and I struggled to be the adult in the room. Whenever I felt overwhelmed by daily stresses, I regressed into a bunker-like mentality with mood swings and childish coping behaviors that threatened to ruin my life and family. Hoping for a brief period of convalescence, I traveled to Japan but was devastated to witness the estrangement among my Japanese family, which was too profound to heal. But I returned to my home in Seattle with a new perspective and a flickering hope: The friction at home in Seattle paled in comparison and our family still had a chance.

Then came my son’s disappointing college admission news, which I reacted to as if it were my own. My unhinged behavior was driving my husband away. At my lowest point, my husband and son found me curled up on the floor with the family dog. Urged by my husband, I saw a psychiatrist who diagnosed me with Generalized Anxiety Disorder. She also informed me that my erratic moods and behaviors had more to do with my hidden, unhealed traumas from childhood emotional neglect than with menopause.

I was getting the help I needed and thought my relationship with my husband was improving. But he had reached his limit and moved out. I had to face the harsh reality that in prioritizing the relationship with my son, I had neglected my marriage.

Our separation period served as a reset button to work through our marital problems. As I accepted responsibility for what had happened and changed my behavior, my husband did the same. Nine months later, he moved back in. I renounced my Japanese citizenship and officially became a U.S. citizen—largely as a symbolic act of leaving behind my toxic past, starting anew, and moving forward.

This journey helped me uncover the root cause of my problems through deep self-reflection and awareness. Cultivating greater self-awareness was the key that enabled me to heal much of my trauma and restore relationships, as well as to break the cycle of intergnerational trauma. I also learned to become kinder and more accepting of myself and others. And my journey wasn’t all doom and despair. I found refuge in the beautiful Japanese garden; In the psychiatric hospital in Japan, I had heartwarming interactions with both doctors and wardmates; I adopted a wallaby from a kangaroo farm in Arlington, Washington, to comfort me; I participated in the kotsuage (bone-picking) ceremony at my father’s funeral.

Neuroscience is learning that prolonged toxic stress during childhood can harm children’s brain development. By writing The Pond Beyond the Forest as a memoir, I seek to bring to life an in-depth longitudinal case study on the impact of attachment trauma resulting from childhood emotional neglect. My aim is to raise awareness and encourage conversation about this insidious and elusive mental health condition that often goes unrecognized even by its sufferers.

I hope readers with similar struggles find refuge in my book, feel less alone, and are inspired to embark on their own healing journeys.

Freefall: Writing Without a Parachute

The first time I experienced the weeklong Freefall Writing retreat was way back in June 2007 at Edenvale Retreat Center, an hour east of Vancouver, British Columbia. I was nervous during the entire three-hour drive from Seattle not only because it was a bit of a hike for me, who’d rarely driven long distances alone, but also because I had no idea what I was getting myself into. I heard the refrain of what a seasoned participant told me: “Go for it. You’d love it!” But my self-doubt also kept creeping in. I’d never considered myself creative and had no prior experience in creative writing except journaling. Nonetheless, I decided to take the plunge as I desperately needed something to reignite inspiration.

When the charming cottage-like building came into view, I breathed a deep sigh of relief. There was something very tranquil about the setting—the beautiful gardens and the property surrounded by the lush forest immediately put me at ease. Just go for the experience, and don’t let my self-sabotaging voice get in the way, I told myself as I parked my car.

After settling in a quaint cottage room, I headed to the lobby to meet the other participants. I learned that there were eight of us: four female Washingtonians, one male and three female Canadians, and our instructor, Barbara, another Canadian.

The workshop officially began after dinner on Sunday, followed by a brief meet-and-greet information session. Barbara told us to follow five simple-sounding precepts: 1) Write what comes up; 2) Don’t change anything; 3) Give all the sensuous detail; 4) Go where the energy is, “go fearward”; and 5) Observe the “Ten-Year Rule,” meaning, write about “well-composted” material that is more than ten years old. That was it. It sounded so simple, yet profound—almost Zen-ish. This method was supposed to help us learn to write from the larger Self, escaping the ego’s grip. But how? Energy? What energy? I felt like a scared little kid on the first day of school, overwhelmed by not knowing what to expect, let alone continuously writing creatively for several hours every morning.

The following day, after breakfast, our silent writing began. We were to keep writing until lunchtime at 1:00. During this writing session, my Inner Critic ran amok and kept bothering me: “Who are you to think you can write?” I had to confront the deadly combination of academic writing background and the fierce inner critic that had grown so powerful over the past ten years while beating myself up as a mom. I became so frustrated at one point that I wrote a scathing letter of criticism to that vicious Inner Critic. By the end of that writing session, all I’d produced was the scathing letter and a short piece about my dog, Shelly, and losing her to heart failure while living in Minnesota. When dropping off my writings at Barbara’s office to be evaluated, I felt discouraged, comparing mine to the others’ prolific works. I also felt lost, as I didn’t know what I was doing.

After lunch, we had some spare time before the 4:00 seminar, so I mingled with fellow Freefallers and also walked through the forest with some of them. I was somewhat relieved to discover that I wasn’t the only one struggling to figure out Freefall.

The seminar consisted of discussions and exercises on creative writing, followed by nearly two hours of listening to Barbara read anonymously some of our works she’d handpicked to share with the group. This period was nerve-racking as we braced ourselves to find out whether we were following the precepts accordingly. At the end of each piece, we shared constructive, supportive comments, and she went on to the next piece. While Barbara’s storytelling voice was so beautiful and pleasant to listen to, I couldn’t relax the whole time; What if she never reads mine? Does that mean my writing is terrible?

Though she did read the short piece I wrote about my dog Shelly, I wasn’t so happy as I anticipated another torture session awaiting me the next day. Feeling discouraged, I had a chat with one of the more experienced writers. She was very supportive of what I’d written and encouraged me to keep going. Two more writers joined us, and the topic of our discussion drifted to whose works were read and why some of our works were not.

By the end of the second day, I almost gave up and went home but decided to talk to Barbara about it first. I teared up as I told her that every time I started writing about my motherhood experiences, I would break down and cry because they were just too painful to recall.

“Maybe this isn’t for me,” I said, sighing.

She understood why those experiences were still too raw, and reminded me of the fifth precept (the Ten-Year Rule) and suggested writing something else instead.

“Like childhood, maybe?”

I thought for a moment, “Yes, I could do that,” I said, looking at her as if she were my Divine Mother.

“Okay, do that. You are doing great. You managed to slip through the net of Inner Critic in your writing today. Just keep going, be fully present in the moment, and go from one thing to the next, scene by scene, moment by moment, and you’ll get there.”

Her support and encouragement were just what I needed at that moment. They boosted my energy, empowering me to tackle another grueling writing session the following day.

Surprisingly, the third day was when the magic started to happen. As I recalled my childhood and immersed myself in the writing process, I lost track of time. I also cried for my childhood self, which I found tremendously cathartic. It felt as if writing became my ally, opening up a new pathway for self-discovery and walking along beside me. When it was time to stop, I wanted to keep going. It was surreal. Is this what Barbara was referring to as “an unmistakable shift into a deeper level”?

When Barbara read my childhood stories, many in the group had tears in their eyes, and one of them grabbed a tissue to wipe hers. Their feedback was kind and generous. The tone of group interaction set by Barbara was so nurturing and compassionate that I felt as if wrapped in a warm blanket of loving energy. I couldn’t remember the last time I’d felt this happy—to be seen, heard, accepted, and valued for who I was and what I’d gone through. Over the previous ten years since becoming a mother, I’d neglected to care for myself while overcompensating, trying to become the best mother I could be to my son, and ended up feeling like I was absolutely nothing. I was immensely grateful for this powerful experience that provided the most potent antidote to that negative state of mind I’d long been trapped in.

The rest of the retreat went just as well. By the time the workshop came to a close, together with excellent, wholesome meals prepared by the staff at the center, my body and soul felt nourished and well cared for, even energized despite fatigue. I bonded with the other writers and we hugged each other repeatedly before departing.

There was something spiritual, magical, and healing about this experience. I felt connected to everything and everybody, and my perspective shifted, becoming more positive and expansive. And above all, I returned home happy and exhilarated. Maybe that’s what it feels like when we transcend our ego and start to see things from a higher perspective. I know it would take constant mindfulness to maintain this bliss, and I lost it while driven by life, but I know it’s there when I need it.

I’ve since participated several more times in the weeklong Freefall Writing retreat at Edenvale. Each time, I discovered something new about myself and writing. But by far, it was during the very first retreat that I’d achieved the most significant breakthrough. I wrote three chapters in my memoir, The Pond Beyond the Forest, inspired by the pieces I’d produced during that retreat. Without this experience, I probably would have written nothing, let alone a 68,000-word book.

For more information about Freefall, visit www.freefallwriting.com and read: “Writing Without a Parachute: The Art of Freefall” by Barbara Turner-Vesselago (Jessica Kingsley Publishers, 2016).

Docho (conformity) vs. Kyocho (cooperation)

Docho (conformity) vs. Kyocho (cooperation) 

Recently, I saw a YouTube video(1) 1 by two Japanese women (married to Swedish men and residing in Sweden), who compared and contrasted between docho (comformity) in Japan and kyocho (cooperation) in Sweden. In their thought-provoking discussion, they contended that although both societies value group harmony and their group-focused behaviors may appear outwardly similar, their underlying mechanisms are qualitatively quite different. I couldn't agree more.

They alluded to "the Law of Jante" (the mindset portrayed in the satirical fiction by Aksel Sandemose) as a widely accepted Scandinavian code of conduct that stresses humility and the importance of collective accomplishments and well-being rather than individual achievement, and that children are trained from early on to put this value into practice at school.

As I investigated further into this topic, I learned that Scandinavians are known to be fiercely individualistic and pragmatic, and yet at the same time collectivist-minded. From the perspectives of group-oriented Japan and individual-oriented America, that seems paradoxical; but Nordic countries seem to have figured out a happy medium by striking a balance between collectivism and individualism that works for them.

This is food for thought. I don’t mean to look at them only through rose-colored glasses; but given that both Japan and America often tend to swing to unhealthy extremes that increase life dissatisfaction, those Nordic societies might be presenting an alternative hybrid model, a way of life that might lead to greater happiness and contentment.

The rules within their individualistic collectivism that promote social harmony and stability include: putting collective well-being ahead of the individual’s; being modest about one’s achievements; and focusing on what will help one’s community as a whole. There seems to be a fundamental belief and trust that if people are generally happy and satisfied with their lives, they would naturally become intrinsically motivated to reach out and help others. And the individual contribution to the common good would, in turn, benefit the individual. This positive reciprocal cycle might be a contributing factor to their overall societal happiness.

Dichotomy between Docho and Kyocho

Before moving to the subtopic of the dichotomy between docho and kyocho, it is important to mention that I’m well aware of my own bias. As someone who’d experienced less-than-ideal situations growing up in Japan, it’s not possible for me to see things from a neutral perspective, especially these days when Japan’s social problems (e.g., school refusal, hikikomori, bullying, and suicides) have grown considerably worse.

Docho (conformity):

·    Oppressive and rigid control to promote group harmony/”cooperation” (the word, docho atsuryoku = peer-pressure-induced conformity is used to connote negativity, when one’s behavior is driven by fear of ostracization)

·    Groupthink: expects everyone to be the same, think alike and in total alignment, making those who deviate a target of sanction

·    Self-control is the dominant mode of thinking and behavior

·    Hierarchical

·    Passive

Kyocho (cooperation):

·    Softer approach toward group harmony (encouraging intrinsic motivation to work together)

·    Each person’s ideas and opinions are valued and taken into consideration before coming to mutual agreement on things/more flexible in finding compromise through mutual respect

·    Conducive to willing and spontaneous cooperation governed by rationality and pragmatism

·    Self-regulation is the dominant mode of operation

·    Egalitarian

·    Active

I saw a similar dichotomy at the micro level, with two contrasting Japanese preschools I’d observed during an ethnographic study for my doctoral dissertation. Against the backdrop of educational reform movement spearheaded by the government to promote creativity and individuality in students, I investigated preschool teachers' and administrators' interpretations of the concept, jihatsusei (spontaneity/initiative), and how they implemented them in practice, because at the preschool level jihatusei was considered as the foundational cornerstone for the future development of creativity and individuality. I’d chosen three schools, A, B , and C, and the most marked difference was between School A and School C.

School A was headed by a feisty eighty-year-old female director full of Spartan spirit, who took great pride in her heyday when she was involved in drafting an older version of curriculum guidelines. She was still operating a didactic, teacher-centered and academic-oriented curriculum that had been deemed inappropriate by the then-ongoing governmental reform movement (stressing student-centered learning through play).

One morning, the director gathered all students in a large circle at the school gym, scattered cards with numbers written on them in the center, and had students march around in circle as she read math problems. The students then ran to grab cards with the right answer. That scene broke my heart because, in addition to having to solve the equations quickly, they had to rush and compete for the cards. Not many of them seemed to be having fun with this “game.” At this school, not only students, but teachers, too, seemed intimidated and stressed out by the overbearing director. One veteran teacher told me he’d never really thought about nor paid attention to students’ individuality. Another teacher complained to me in private that, though he dared not voice his dissent, he disagreed with the director’s tendency to fix students’ artwork if they weren’t up to her standard.

This was the somewhat military-ish type of school I also attended as a child and was familiar with. Throughout my Japanese schooling, the Spartan spirit of ganbaru (work hard) and gaman (persevere) was inculcated. These were overused slogans I heard over and over, and became deeply ingrained in my psyche. While that might have helped me to become disciplined, it also made me passive and timid, and took fun out of learning. Group activities were something I reluctantly participated only because I had to.

School C was headed by a middle-aged man who was also an artist. The curriculum at School C was free flow, mostly involving play and social activities, such as capitalizing on "playing shops" initiated by a small group. The teachers allowed it to spontaneously evolve into much larger and more elaborate schoolwide activities that continued to develop over many days. Kids seemed genuinely motivated to improvise new games each day to contribute to the ongoing “shops,” and learned to exchange, negotiate and calculate.

The contrast between School A and School C was striking. The demeanor of students in School A appeared well disciplined, quiet and obedient, and their facial expressions very stern and serious. Students in School C, on the other hand, were rather loud and lively, smiled a lot and seemed to be really enjoying themselves. The School C director said he valued individuality in each student, but it must be also compatible with group harmony and cooperation. And the types of individuality that are disruptive to the group must be redirected with corrective feedback.

A Japanese researcher Moriue (1992)(2) describes two different types of group dynamics by using a metaphor of soybean products: tofu vs. natto. In the process of making a block of tofu, individual soybeans are crushed and compressed into an amorphous product, whereas for natto, fermented soybeans come together to form a cohesive whole with each soybean retaining its shape. I observed the contrast firsthand between School A and School C group dynamics, and believe that children’s learning experiences were remarkably different. And to some degree, these contrasts can apply to the docho and kyocho dichotomy (described above).

I would conjecture that these different group dynamics, as well as teaching principles and practices, would likely influence how culturally prized values such as empathy, kindness, and consideration to others are taught. What if teachers are so busy and preoccupied with teaching academics that it might leave little room for kids to really learn how important those humane values are?

It’s been a conundrum to me how the society that emphasizes those values can also produce monster children with hateful bullying behaviors that at times push victims to suicide. Is it because students are so stressed out at home and/or school that they need to take it out on others simply as a stress release? Is the “pressure-cooker” academic environment the culprit for having produced those heartless students, or is it because those humane values are so heavily institutionalized, only externally and unilaterally enforced that they’ve become apathetic or rebel against them? Japan’s toxic work culture with no work-life balance has long been well known, and workplace bullying is also rampant. One that sometimes makes me lose faith in humanity.

In order to build a better society, we have to start from the bottom. It is my hope that more Japanese schools will learn to become like School C, where each student’s individuality, dignity and integrity are valued, and where students learn to treat each other with genuine respect, kindness and consideration, and become intrinsically motivated to cooperate together towards the common good. And by incorporating what Scandinavian societies seem to have gotten right–with a softer and more flexible approach to group dynamics, and striking a better balance between group and individual—Japan might be able to gradually improve many of the social maladies it is now facing.

1) Nord-Labo 北欧研究室 (Nov.27, 2021): www.youtube.com/watch?v=-w3V1YUCTE0

2) Moriue, S., & Imai, K. (1992) Shudan te Nandaro [What is a group?]. Kyoto: Minehluva   Shobo.

Reflection on CPTSD (Developmental Trauma) Part 2: Hikikomori (shut-ins)—A Mental Health Crisis in Japan

Sometimes I wonder what might have happened to me had I stayed in Japan. Might I have joined the ranks of the million-plus hikikomori (shut-ins withdrawn from society) that exist in Japan today? This is an unsettling thought. It’s difficult to dismiss the hikikomori issue simply as someone else’s problem because I think I can understand their plight, at least partially.

Hikikomori means the state of being shut in, and today also the individual being afflicted by it. Those hikikomori refuse to leave their parents’ homes, sequestering themselves from society and family, and confining in a single room for more than 6 months, often for years, even decades in extreme cases. “The 80/50-problem” (soon to be “60/90-problem”) has become a focus of media attention and refers to situations in which aging parents in their eighties keep supporting their shut-in children entering their fifties, wherein the entire family is isolated from society and lives in poverty as a result. And once their parents pass away, those middle-aged shut-ins are left with no means of support and are unable to take care of themselves.

According to Tamaki Saito—a Japanese psychiatrist who coined the term, hikikomori, referring to the condition and a leading expert in the field—the number of hikikomori is probably much higher than the government's estimate of 1.15 million, approx. 1% of the population (541,000 between the ages 15 and 39; 613,000 between ages 40 and 64; and the vast majority of them are men). He estimates it is more like 2 million and speculates that the number will continue climbing, eventually topping ten million (nippon.com 09/17/19). This is a dire social problem in Japan, and an accurate number is impossible to ascertain because both hikikomori and their families feel ashamed, so they keep their situations secret.

The hiring freeze following the burst of the bubble economy in the early 1990s created a swath of young adults who couldn’t land jobs. Like failing at college entrance exams, failing at job searches likely fed into a sense of defeat and shame, and might have devastated vulnerable individuals. And in Japan, once derailed from their desired paths, it can be extremely difficult to start over. Japanese society offers fewer second chances than western societies. This partly explains why the number of hikikomori is largest among the ages from 40 to 64.

Another upticking trend is futoko, refusing to attend school. In 2018, the government reported 164,528 such students (in elementary and junior high school)—a significant jump from the previous year of 144,031 (bbc.com 12/23/19). And this number is expected to keep rising. The futoko syndrome is said to pose a high risk as a precursor to hikikomori.

The UNICEF Innocenti’s Report Card published in 2020 ranked Japanese schoolchildren the second from the bottom among 38 participating countries in their mental well-being, while ranking them at the top in physical well-being. The students’ poor life satisfaction, rampant school bullying and the high suicide rate contributed to this dismal ranking. Some researchers point their fingers at the rigid education system, “exam hell” and excessive competition to get into prestigious colleges, and at the narrow definition of “success” as detrimental to the students’ mental health.

There may be many possible reasons for people becoming shut-ins and for students refusing to attend school. For example, the conformist society of Japan can be really tough to navigate for those who don't (or can't) fit the norm. The sociocultural values and expectations may feel oppressive, intolerant, unforgiving or punitive, and suffocating for those who stick out, as in the old Japanese saying, "The nails that stick out get hammered down." Keeping a low-profile is therefore a survival strategy. The social system also emphasizes shame to reinforce conformity.

But notably, one of the most common denominators for those troubled adults and youths is said to be family dysfunction. To build a healthy foundation, it is essential for a child to have a safe haven at home, where the child can return to, unwind, rejuvenate and recharge after “battling” in the harsh world. Without a nurturing home environment, the reality of that world may take a heavy toll on a child’s psyche. And if parents fail to teach certain culture-specific skills necessary to operate in intricate social interactions in Japan, such as the ability to switch between honne (one’s true feelings and thoughts) and tatemae (diplomatic façade), life can become doubly challenging.

Values such as humility, self-reflectiveness and self-sacrifice that are prized and inculcated early on, when taken literally and deeply internalized, may pose a risk of developing into self-deprecation and low self-regard. In addition, some other feelings and behaviors that resemble complex PTSD—such as perfectionism, negative thinking patterns, toxic shame and guilt, difficulty saying no and setting boundaries—seem to be also culturally reinforced (maybe even encouraged) in Japan.

Japan is a beautiful country with so many wonderful cultural traditions. When taken together all the aforementioned factors, however, it would be surprising if such a sociocultural climate doesn’t create a fertile breeding ground for all kinds of mental health conditions. But, because of the “shame culture” and a heavy stigma surrounding mental health issues, those who are afflicted opt out of seeking the help they need to live happier and more fulfilled lives. They choose instead to hide out and suffer in silence. And the longer they withdraw, the harder it becomes for them to reintegrate into society.

Hikikomori are perhaps canaries in the coal mine, reflecting dysfunctions in a society that needs serious reform.

Reflection on Complex PTSD (Developmental Trauma) Part 1

I recently discovered that my often-puzzling cluster of symptoms seems to precisely fit the definition of “complex PTSD” (CPTSD), which is sometimes called developmental trauma as its origin is often traced to repeated or prolonged toxic stress (such as due to physical or emotional abuse and neglect) experienced during the formative years. A frequent stress response during the critical period of brain development can fundamentally alter the architecture of the developing brain, which in turn can make the child particularly vulnerable to future stress, and potential lifelong struggles may ensue. CPTSD is, therefore, as much neurological as psychological.

This diagnosis seems to explain why my brain and body tend to immediately kick into survival mode and go into overdrive when I experience stressful life events. Other trademark symptoms include, but are not limited to: an inability to relax and switch off the fight-flight-freeze-fawn response even long after stressful events have passed; negative automatic thinking and cognitive distortions such as all-or-nothing thinking and catastrophizing; toxic shame and guilt; a vicious inner critic; and a sense of unworthiness and powerlessness. 

Armed with this new understanding, I began the last session with my psychiatrist in May 2022, shortly before her retirement. When I began seeing her in January 2016, I’d been experiencing multiple distressing events and was feeling at the end of my rope. She diagnosed me with generalized anxiety disorder (GAD) back then. Although I became more stable and my symptoms were in remission over the past few years, I still kept up quarterly meetings as she needed to monitor my progress and to make sure I keep taking my meds. She told me that I have “PTSDish” symptoms from childhood trauma, and that I should stay on medication until retiring to my grave. She'd been a great psychiatrist and I really liked working with her; but I also started to wonder why she'd never once mentioned the term “complex PTSD” (CPTSD), so I brought it up towards the end of our session.

            "You diagnosed me with GAD several years ago. But after writing my memoir and learning from the internet, I'm beginning to think my symptoms might be more in line with complex PTSD. Would you agree with that?" I asked.

            She paused for a moment and said, "I think you are right," as if it were an afterthought.

That was my lightbulb moment. If even a seasoned psychiatrist like her could overlook this, I thought it is a sign that the mainstream American mental health professionals haven’t yet fully embraced the entity of CPTSD. It is in fact not included in DSM-5 even though it’s been recognized by the UK and the World Health Organization as a diagnosable disorder.

The concept (and term) of “complex PTSD” was first introduced in 1988 by Dr. Judith Herman, a Harvard psychiatrist. The Adverse Childhood Experiences (ACE) study­–the seminal collaborative research conducted on 17,000 participants by the CDC and Kaiser Permanante from 1995 to 1997–further cemented Dr. Herman’s argument and helped raise wider awareness of the strong association between childhood adversity and its long-term impact on physical and mental health in adult years. (CDC has a website dedicated to prevention of ACEs.)

The Covid pandemic has exacerbated the mental health crisis globally, and the data from the 2020 Household Pulse Survey by the U.S. Census Bureau have revealed that one-third of Americans now show signs of clinical anxiety and/or depression, with young adults, women and the poor hit the hardest. In Japan, more people (women in particular) died from suicide in the month of October alone than the total number of Corvid-related deaths in 2020. But both countries are woefully unprepared to meet the skyrocketing demand for mental health services. And when it comes to CPTSD, most people, even doctors, don’t seem to have even heard of it.

Like many other disorders, CPTSD is a stress-related spectrum disorder, and symptoms vary widely depending on how the individual’s nature interacts with different environmental factors. All these symptoms, from mild to severe, if undetected and untreated, deprive those complex PTSD sufferers of years (even decades) of joy and happiness in life. With awareness and help, however, these symptoms can lessen considerably. There are many treatment options such as Dialectical Behavior Therapy (DBT), Cognitive Behavioral Therapy (CBT), Eye Movement Desensitization and Reprocessing (EMDR) and NeuroAffective Relational Model (NARM) therapy. But no one-size-fits-all approach would work for everyone, because complex PTSD is, well, very complex. And all these established approaches appear to be in their inception stage when it comes to determining effectiveness to treat CPTSD.

There are also many potential obstacles to finding appropriate help. First, there is simply a dearth of well-qualified, trauma-informed therapists who know how to treat developmental trauma. And trying to find a good match with one that ticks all the boxes is like searching for a needle in a haystack. Affordability is another obstacle.

Fortunately, there's much information available on the internet including YouTube videos by mental health professionals and laypeople alike. The ever-growing YouTube channels on this topic seem to indicate that there's a clear movement trying to fill the gap, educate the public, and offer advice and support to those who suffer from CPTSD. I've found some of them quite informative and helpful in understanding this mental health condition and what’s been ailing me for all these years. This is a powerful positive step in the right direction. On a side note, however, it doesn’t feel quite right to see an unlicensed layperson offering a series of workshops or one-on-one coaching sessions (based largely on his/her own experiences) with inordinate fees and turning it into a big business. It seems like capitalizing on the vulnerable population desperately in search of help.

Still, we have much to hope for as science is learning that our brains remain plastic throughout our lifetimes, and that rewiring of our brains is quite possible at any age. I believe each sufferer is on a unique healing journey to discover what would work best to heal, and that will require commitment, patience and perseverance, likely involving some trial and error. But I believe the efforts will be well worth it and eventually be rewarded with deeper self-knowledge and greater self-awareness and acceptance.

Besides basic self-care (such as a healthy diet, exercise and good sleep), yoga, meditation, mindfulness practices, and engaging in creative activities are said to be beneficial. What I've personally found helpful more than anything else is writing. When I started writing my memoir many years ago, I did know I had something important to share (e.g., intergenerational trauma and how childhood emotional adversity can cause lifelong repercussions), but knew absolutely nothing about complex PTSD. It was the byproduct to discover that the process of putting my thoughts on paper and giving voice to my innermost feelings was actually helping me reprocess and reorganize chaotic memories of the past experiences. And that, in turn, has enabled me to develop new perspectives and relate to the past in ways that are more constructive and conducive to healing. Although my habits and maladaptive coping strategies learned in childhood may never go away entirely, I’m hopeful that I can stave off the debilitating influence of complex PTSD symptoms and better handle life’s stressors by continuing to practice self-care, gratitude and self-compassion through mindfulness and finding humor in daily life.

In my next blog post, I will muse on how my overadapting to certain sociocultural values and expectations while growing up in Japan might have reinforced and perpetuated some of my CPTSD symptoms.

Fish Dream

I’m five years old, and bring home a goldfish in a plastic bag of water. I ask my father where I can put it, and he suggests an empty aquarium that’s long been sitting in the basement. I go down to the basement and release the fish into the tank. But the tank seems too small, and I’m unsatisfied. Then the idea pops into my mind that the fish would be much happier in the big pond beyond the forest. So I scoop it up into my bare hands, and embark on the path to the pond. On the way I accidentally drop the fish, and it gets stuck in the mud. It flops around, gasping for air. After a brief moment of panic, I lift it out of the mud, and resume the path to the pond. When I get there, I release the fish. Though it struggles at first, it soon rights itself and swims away.

A Gift from Nikki: What My Dog’s Final Months Taught Me

(This essay originally appeared on CanineCancerUK.org, but the website has since been taken down.)

Nikki after surgery

The last three months were an especially difficult journey for me as I watched our beloved golden retriever Nikki battle cancer. Losing pets has always been one of the toughest things for me to cope with, and this was my first experience to lose a dog to cancer. But this heartbreaking experience taught me invaluable lessons, and I feel that I have developed more compassion and have grown stronger emotionally and spiritually for it.

In October 2007, we discovered that Nikki had developed two types of cancer (mast cell tumor and sarcoma) simultaneously. For ten days following this initial diagnosis I cried off and on throughout each day even before finding out how bad her case might be. Then more bad news followed; on the day one of her mast cell tumors was surgically removed, we discovered through an X-ray the cancer had already metastasized to her lungs. Her cancer was so advanced that there was nothing we could do to save her life. Aggressive chemotherapy or radiation therapy at that point would have been just palliative at best, while severely compromising her quality of life. So we made a conscious decision not to seek the cancer treatment and just let her enjoy her remaining time with us. We knew that her cancer was bad, but didn’t know how long she could live. I didn’t realize until I began providing hospice care for her in the last months of her life how excruciating and stressful of an experience it was to live with and care for a dying dog. As I became preoccupied with caring for her, I put my entire life on hold.

Shortly after her diagnosis, I gathered information on cancer in golden retrievers, and found that a staggering 60% die from cancer, and that it is their #1 cause of death. Cancer is on the rise among dogs in general, but this genetic predisposition seems to be particularly prominent among goldens. As common and popular as goldens are, surprisingly most people seem to be unaware of their high cancer risk. I tried to learn which environmental causes (diet, lack of exercise, over-vaccination, microchip, etc.) might possibly have contributed to her metastatic cancer, but there appeared to be very little research done in this area. Through an internet CanineCancer support group, however, I felt supported and comforted to know that there are many others who had been, or were going through similar heartbreaking experiences.

I passed through at least three of the “Five Stages of Grief” in a very quick succession. First, I was shocked and devastated, and then I was angry at life thinking that it was conspiring against us. I also blamed myself for not being able to detect her cancer sooner. As I grieved, I felt many regrets and started to beat myself up with thoughts like, “I should have taken her for more walks and given her a better diet. I am unworthy of her love and did not deserve her.” Every morning I would wake up to be relieved that she was still breathing. It broke my heart to see a vivid contrast between the incision from the removal of a tumor that was healing beautifully, and signs that her cancer was progressing rapidly, such as bloody urine, difficulty walking, vomiting, etc. At times I was reluctant to touch her, afraid to find more new scary looking bumps spreading and growing throughout her body. It was so distressing to witness this entire process of her deterioration.

One day when I saw her taking things in amazing stride, being in the moment, and living each day to the fullest and with dignity, I suddenly realized that it was NOT OK for me to get stuck in this distraught and grief-stricken state of mind. I had to be strong for her and my family so that I could take better care of them, especially of her. This awareness helped me shift my gears to start embracing this very intense, fast-moving “spiritual training” journey. As I immersed myself into the moment, I became more mindful of daily experiences, and accepted them for what they were and then let go of negativities (no more coulda, shoulda, woulda). I started to feel less guilty and hold fewer regrets, and stopped blowing things out of proportion by ruminating or dwelling on sorrow. I then remembered what an acquaintance told me once: “Don't’ try to figure out why “bad” things are happening to you, nor see each experience as either good or bad, you are just living life.” Indeed, when I interpreted life events by filtering their meanings through preexisting “negative”memories, I allowed my conditioned mind to control how I would experience life. That would prevent me from living in the moment and experiencing things for what they were. I thought, “Aha! So this WAS a sure formula for despondency and depression!”

Each day was bittersweet, but still I tried my best to live in the present so that I could savor and cherish each and every moment I had with her. I immensely enjoyed spending lots of time cuddling up and spooning with her while giving her favorite gentle tummy rubs. And oh, how I loved her smell that was so earthy and comforting—her ears smelled like roasted mushrooms, her paws slightly burnt aired popcorn, and her fur just like hay. As I snuggled up to her, her calm warmth and gentleness instantly vanished any negativity and uplifted me. I took her for many walks and car rides everywhere I went. I switched her to a cancer diet (high protein, low carb and no grain), and provided homemade gourmet dog meals each day with all kinds of high-quality meat, along with supplements and Chinese herbs (prescribed by our holistic veterinarian) to strengthen her immune system with the hope that she might be able to fight off the cancer. As her appetite steadily declined, I bought at least two dozen kinds of special dog treats for her to try, as well as regular people food and just about anything else, desperately trying to entice her to eat something.

Although she had been very stoic and did not communicate to us how much suffering she was enduring, her body manifested many physical signs of distress. There were metastatic tumors all over her body. Her labored breathing indicated dysfunction of her lungs, and swollen legs that her heart was not pumping her blood properly and perhaps a lack of protein for she was not eating much. Her appetite steadily declined and she ate almost nothing at all during her last weeks.  Then sadly, she was no longer interested in going for a walk—an activity that she used to love so much.

As her breathing became even more labored, my husband and I finally made the agonizing decision on one weekend in January to put her down at the vet, and scheduled the appointment in five days. However, she quickly deteriorated over that weekend, so we decided to put her to sleep sooner, on Monday. I was undecided whether I would accompany her to the vet, but my husband suggested that I should say good-bye to her at home, because it would be too traumatic for me otherwise. On Sunday night before going to bed, I sat next to her and caressed her. Tears kept falling onto my hand as I gently stroked her head. Then all of a sudden she lifted up her head and started licking my tears away fervidly, showing me her affection and more life force than I had seen in a while. I tried to keep my tears in check while kissing her and whispering into her ears, “What a sweet dog . . . I love you so much.  Good night . . .”

On Monday morning, I thought she might be awfully uncomfortable for not having peed since Sunday afternoon despite having drunk a lot of water, so I pushed her to go outside even though she was very reluctant. It took her a while, but I helped her get up and she finally went. But perhaps because she was so close to the end, it must have used up all of her remaining energy. As soon as she came back inside, she plopped down on her bed in the entryway and gasped for air. I helped her lie down, but could not remain with her then as I had to get ready to take my son to school. I asked my son to stay with her in the meantime and say good-bye to her because she would be gone by the time he returned from school. I was gone for less than 5 minutes, but by the time I came back to check, her eyes and mouth were wide open with her tongue drooped onto her bed. She was very still and quiet: I heard no more hard breathing, and her chest was no longer moving. My son didn’t know what was happening, but nonetheless looked sad and scared as he stared at her. I rested my hand on her chest and shouted, “Nikki! Nikki! Oh, my God, she…  she has just DIED!!” I trembled as I picked up the phone immediately to call my husband at work to let him know about her passing, and he said that he would come home right away. My son had stayed with her for the whole time and had even taken the very last pictures of her. He was on the verge of crying. “She opened her mouth real wide, and then her tongue just hung down on one side,” he said and tears filled up in his eyes. We both stared at her lifeless body lying in her bed for a moment, gave her a hug, and cried uncontrollably while hugging each other before heading out to school.

While driving my son to school, the idea crossed my mind briefly that I might have actually accelerated her passing by forcing her to go out and pee. But soon I realized that it was in a sense a blessing that she did not have to go to the veterinarian’s. She was always terrified to go there, and I did not want to see her being traumatized to the last minutes of her life. Besides, who knows, even just the sight of the office might have shocked and killed her. It would also have been much more traumatic for us to end her life with an injection. I was deeply saddened, but was at the same time somewhat relieved that her suffering was over.

Later I saw flashbacks of her quirky adorable habits that used to make us laugh: her signature style of sitting totally flat like a bear skin rug with her hind legs totally relaxed looking like a run-over frog’s, and of sleeping with a plush snow goose held in her mouth like a pacifier. It was her favorite toy, so beat-up and stained that it looked more like a dirty imposter chicken in the “Foster Farm Chicken” commercial than a snow goose. It was a bittersweet moment, and I started to miss her terribly already.

I believe that there is something mystical about animals, and Nikki was certainly no exception. I wouldn’t be surprised if she knew what might happen to her next, and if she might have even chosen her own timing, where and how she wanted to die. She fought very bravely to the end. It was almost surreal when she exited so quietly and peacefully while lying down in her own favorite bed at home, one day short of her eighth birthday. There was something about the way of her passing that seemed so serene, sacred and gentle. The way she went with grace and dignity seemed quite fitting for her, who shared with us her devotion, love and compassion.

The three months since her diagnosis felt very short, but long at the same time. As difficult and heartbreaking as it was, I am grateful for the period that she gave us—an opportunity to show her how much we loved and cared for her. The time also helped us prepare emotionally to say good-bye. I can still burst into tears at any moment whenever I see other goldens on a walk or pictures of them at grocery or pet stores. (The problem of this breed is not only their genetic predisposition to cancer, but also their popularity that I can’t avoid seeing them everywhere.) Some friends and relatives sometimes tell me, “That’s why we don’t have pets. We don’t want to go through the type of agony you’ve gone through.”  But I always respond, “It’s better to have loved and lost, than never to have loved at all.” I can only hope that this tremendous sense of loss will become a little easier and less painful to bear as time goes by.

We couldn’t have possibly asked for a more perfect dog than Nikki. I am forever grateful to her for helping us raise our family. Some might say, “What? Dog? Raising a family?” But yes, she truly did, simply by her presence. She provided a tremendous source of comfort and joy at a time when I needed it most. My husband had just begun the most challenging phase of medical training, and I was struggling as a first-time mom with my son’s health complications in a totally new environment that I had no one to turn to for help.

Since her passing, I’ve been displaying a shrine with a large picture of her in our front hallway where she spent her last weeks (because she had no longer been able to climb up and down the stairs). Underneath her picture is an urn containing her ashes, along with flowers, candles, water, dog treats, her favorite snow goose and a statue of St. Francis. I keep candles burning to honor her spirit. Two months before she died, I’d hired a professional dog photographer to take pictures of her, and those pictures, too, have been displayed throughout our house as a remembrance of her gentle and loving spirit.

After all, through this experience I realized once again the importance of savoring and cherishing each and every moment by immersing myself into it—a timeless message of life Nikki showed me simply by her way of being. This was a gift from her. 

Godspeed, dearest Nikki. Thank you for all of the wonderful memories. I will always love you with all my heart.

Writing the Memoir

How I wrote the book; how long it took; why I wanted to tell the story; and what I'm hoping the book does for its audience

My writing background had been primarily academic, and I'd initially struggled with creating writing. But after participating in several weeklong "Freefall Writing" retreats in British Columbia led by Barbara Turner-Vesselago, I gradually learned to write from the higher self, free from the ego-censor. Through this method, I experienced powerful breakthroughs, and found its process very liberating and healing.

Some of the chapters in my book were adapted from pieces I'd written during those retreats that date back as early as 2007. But I didn't begin tackling my book project in earnest until 2015. In the meantime, I'd enrolled in a series of writing classes and residencies, as well as working with a writing coach.

I knew I had an important message to deliver, but this project seemed at times so enormous and overwhelming, and the process painstakingly slow and organic. It felt as if chiseling out a big marble stone little by little in order to uncover the shape of the story and zero in on its themes.

Through the process of writing this story, I came to learn that the symptoms I'd been experiencing all my life are in line with what is now called complex PTSD. This diagnosis has become more widely known in recent years, with neuroscience studies pointing out that prolonged adverse early childhood experience (emotional neglect in my case) can negatively affect the trajectory of an entire life by fundamentally altering the architecture of the developing brain (thus making the individual more susceptible to stress). With this realization, I felt validated for what I'd gone through as a child, and liberated to realize that my struggle wasn't my fault. This understanding helped to heal many of my childhood wounds and to find a way forward by practicing self-care and self-compassion.

I hope this book will help people with similar struggles feel less alone, and find hope and inspiration in their healing journeys.