I Aced the Test! Part 4: Know thy enemy

I promised we’d take a look at the consequences of long-term stress (and, by association, trauma) on the body, didn’t I? That’s today’s topic so buckle up, Class.

Before I jump in, I want to define a few terms so we’re all speaking the same language.

The amygdala is a little almond-shaped cluster that controls your emotions–namely, fear and the fight/flight/freeze response. Memory and decision-making are also controlled by the amygdala.

The autonomic nervous system controls all unconscious processes, like breathing, blood pressure, and heart rate. Think of it like a car with automatic transmission, or being on autopilot.

Adrenal glands produce adrenaline and cortisol when the body reacts to a stressor. The inner medulla is the part that produces the hormones epinephrine and norepinephrine, which help kick off the whole fight-or-flight response.

In a nutshell:

Stressors trigger the sympathetic nervous system and hormones come rushing in full-bore. The amygdala enters the chat, which sets off a chain reaction with the adrenal glands and other endocrine systems. Your blood pressure goes up, your heart rate increases, you sweat. Without you even noticing it, your body is preparing to take one of three paths: fight, flight, or freeze.

When in crisis, our bodies and minds work in tandem to respond to the situation. The good old autonomic nervous system kicks into gear, triggering an immune response (which is designed to protect the body and fight off “intruders,” so to speak)¹. This immune response releases histamines, which are also the cause of hay fever symptoms like itchy eyes and hives. It may sound counterintuitive, but all of these unpleasant symptoms are part of your body’s fight to keep you alive. The second the stress hit that tiny little amygdala, you were no longer in the driver’s seat. Ever since that moment, you’ve been on autopilot–think of your body as a kind of gundam suit designed to protect you by any means necessary. This response is as effortless and natural as breathing. 

When most people hear the word “adrenaline,” they often imagine a scene such as a mother lifting a car off her baby. Our entire autonomic nervous system is wired to keep us alive, and the body can do incredible things when under acute stress. 

However, you can’t sustain that level of intensity forever. Think of a rubber band. You can only stretch it so much before it begins to lose some of its elasticity, and the same principle applies to stress and the body. Our bodies are not built to sprint at 84,000 miles per hour 24 hours a day, 8 days a week, and that’s precisely what long-term stress demands of you. 

Miller, Chen, and Parker (2010) describe stress as something that “accumulates” in the body’s cells. What this means for you, dear Reader, is that your body is in a constant state of inflammation because those hormones are poppin’. Even if it’s more of a wallflower than the life of the party, that inflammation is still there. 

This leads us to our next point: vulnerability for chronic illness. When your body is constantly on high-alert, it reacts to stimuli that may not bother the average bear. Many trauma survivors have at least one, if not multiple, chronic health conditions. Autoimmune disorders such as lupus are more common in adult cis female trauma survivors². Additionally, the odds of an autoimmune disorder causing an individual’s first hospitalization were higher among adults who reported two or three different types of childhood adversity, such as physical, sexual, and/or verbal abuse; parental neglect; or having a parent or caregiver who struggles with substance abuse or mental illness³. 

There is a strong behavioral component to this complex issue as well. Early trauma leads to hypervigilance and mistrust, meaning there are cognitive and emotional factors layered on top of the biological aspect. (It’s like the world’s worst sandwich, basically.)

Let’s pause for a visual aid. I wonder how many of you are familiar with our good friend Ouroboros. 

Picture the biological factors as the head of the snake, and the cognitive/emotional factors as the tail. Or reverse it. Either way, they are simultaneously feeding and devouring each other. Much like our old pal Anxiety, stress feeds itself. 

So, that probably sounds terrifying, right? It doesn’t have to be. Here are some platitudes to explain why:

• Knowledge is power.
• Know thy enemy.
• If it bleeds, we can kill it.

If we know what our own vulnerability factors are, we can find ways to counter them. If you have a chronic illness, make sure you’re keeping in touch with your doctor and taking any medications you’re prescribed. Try to eat well, stay hydrated, get enough sleep. Take at least a minutes throughout the day to do something you enjoy and celebrate being alive. A client once very astutely described living (versus surviving) as “nurturing the being as well as the human.” We exist on many levels–physical, emotional, cognitive, spiritual. Please be kind to yourselves and send love into the darkness.

One final note:

Take care of yourselves, Readers. Go take a safe, socially distant rainbow walk. Get some vitamin D–it’s good for you! Read a book. Plant a tree. Take a hot shower with a frozen orange. Meditate. And for the love of god, wear a mask and stop touching your face.

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1 Quas, J. A., Bauer, A., & Boyce, W. T. (2004). Physiological reactivity, social support, and memory in early childhood. Child Development, 75(3), 797-814.

2. Roberts AL, Malspeis S, Kubzansky LD, et al. Association of trauma and post-traumatic stress disorder with incident systemic lupus erythematosus in a longitudinal cohort of women. Arthritis Rheumatol. 2017 Nov;69(11):2162–2169.

3. Miller, G. E., Chen, E, & Parker, K.J. (2011). Physiological stress in childhood and susceptibility to the chronic diseases of aging: Moving toward a mdoel of behavioral and biological mechanisms. Psychological Bulletin,137(6), 959-997.

I Aced the Test! Part 3: The COWs are out to pasture

Disclaimer: Growing up in the Midwest, I never encountered any actual stories/incidents of cow-tipping. But my god, I wish I had.

In 1959, Carl Rogers coined the acronym “COWs,” or Conditions of Worth. According to the man himself:

“The self-structure is characterized by a condition of worth when a self-experience or set of related self-experiences is either avoided or sought solely because the individual discriminates it as being less or more worthy of self-regard. … A condition of worth arises when the positive regard of a significant other is conditional, when the individual feels that in some respects he is prized and in others not. Gradually this same attitude is assimilated into his own self-regard complex, and he values an experience positively or negatively solely because of these conditions of worth which he has taken over from others, not because the experience enhances or fails to enhance his organism.” *

TL;DR: We crave unconditional positive regard from our caregivers pretty much from the get-go (example: “I will love you no matter what”). Unfortunately, a lot of times, you end up with a child receiving the message (whether overtly or through subtext) “I love you if/when you ___” and/or “You’re bad/undeserving of love/etc. if you [insert thing that caregiver/person of influence has determined is bad].”

That’s radically different than the message of “I love you, you’re safe, I’ll take care of you” that we instinctively need. Again, the pleasure principle applies: We’re hardwired to gravitate toward what feels good and avoid what feels bad. 

Ironically, it’s the uncomfortable things that stick in our minds. Think about a time you received a critique at work or got into a fight with a loved one. When you think about that day, what do you remember most–the critique/fight or everything else you did within that 24-hour span?

That negative little voice in your head–whose is it? A parent? A friend? A romantic partner? …

Yourself?

This is where core beliefs come into play, but that is an entirely different discussion for another day. In the meantime, take a look at this worksheet for more info on core beliefs and how to identify yours.

This is one of the reasons why those pesky ACEs are so persistent, even years later. We may be designed to move toward the comfortable, toward stasis, and yet we’re awesome at making ourselves miserable.

The next post in this series will focus on the biology of chronic stress and how ACEs can be a risk factor for certain illnesses. In the meantime, readers, take a moment to reflect on the following questions about your own inner monologue/critic. 

 

* Rogers C (1959) ‘A Theory of Therapy, Personality, and Interpersonal Relationships, As Developed in the Client-Centered Framework’, in Koch S (ed) (1959)

I aced the quiz! Part Two: That face.

Okay, so now that we know what ACEs are, let’s get a little more personal.

To begin, I’d like to share with you two pictures from my childhood.

1993, age four

1994, age five – kindergarten photo

Are these the same child?

Yes.

In the photo on the left, I am dolled up and mugging for the camera. I’m not sure who took me to get my photo taken that day (probably at Sears). If it was my biological mother, she was having an exceptionally good day. The reality is that one of my aunts probably arranged the whole thing. But I look happy, round-cheeked, grinning at the camera with a twinkle in my eyes.

In the photo on the right, taken roughly a year and change after the first, I am posing for my kindergarten photo. I was grumpy partly because of that damn cowlick, but also because my home life had basically gone to hell in a handbasket in the space of a year. My mother was drinking again, heavily. She would often leave me alone in the house at night to go out to bars. One of my earliest memories is waking up alone and wandering through the darkened house. I walked outside and paced the sidewalks for what felt like hours, watching as the lights in the houses lining the street flickered off, one by one by one.

Readers, that is the loneliest I have ever felt in my life.

If we ignore the backstory and focus only on the images (lighting and photo quality aside), what remains is this: The girl on the right has lost all the baby fat from her cheeks. Her eyes are huge, dark, and sunken. She is trying to smile but her teeth are gritted. She does not look at the camera, but rather past it, as if trying to see something in the distance. You know, that old chestnut–the Thousand Yard Stare.  Still a cute kid, but not the type of child you’d look at and go, “Oh, yeah, she’s doing well.”

Chronic stress changes the body in a myriad of different ways. I’ll touch on the biology of chronic stress (behavioral medicine is a fascination of mine) in the next post, but for now, let’s focus on face.

They say the eyes are the windows to the soul. If we peeked through your windows, what might we find? I’m looking forward to hearing from you, readers!

I aced the quiz! Part One: Know thy enemy.

Disclaimer: The information contained in this post is not intended to diagnose or treat any condition. I am a licensed therapist, but I am not your therapist. 

I ACEd the quiz! Tongue firmly in cheek, of course. There is no quiz, but today I would like to touch on trauma and its physical effects–hence the reference to ACES, or the Adverse Childhood Experiences Scale.

As any even casual reader of the blog knows, trauma is kind of My Jam. I love working with clients who are struggling with the same core issues I struggled with the first 20+ years of my life. I knew that was going to be bailiwick from the time I started therapy myself, at 18, but I didn’t really do much with it until I entered grad school and suddenly had to write a thousand different papers (that were not centered around arguing whether the box of money in Faulkner’s The Sound and the Fury is actually a box of shit. Look it up. It’ll change your life).

When I got my very first assignment, my brain went “PING!” and told me trauma was the area to hit. It’s a touchy area, for sure. Go too fast, and you risk re-traumatizing your client and damaging rapport. Go too slowly, and your client will stagnate. It’s like a dance.

The ACES study began in an obesity clinic in 1985, believe it or not. Physicians were interested in figuring out why people kept dropping out of their weight loss program; long story short, they developed the Adverse Childhood Experiences Scale and administered it to their patients. The results were unprecedented: they uncovered a link between childhood trauma and struggles with controlling their weight later in life. 

I’d love to wax poetic about the biology of chronic stress and implications for adulthood, but that needs its own post.

On to the significance of ACEs. The instrument itself is simple–ten self-report items, scored either “0” or “1.” I’ve re-typed it here for the sake of your eyes, but you can see the original and lots of great info on acestoohigh.com.

To avoid inadvertently triggering readers, I’m going to put the actual scale underneath this spoiler tag, as the questions do involve all forms of child abuse.

On Vulnerability

There are so many words in the English language relating to innocence and vulnerability, and most of them can bring me way down if I’m not careful. They provoke some ancient anxiety that I’ve come to realize, with the help of my excellent therapist, are linked to what she calls my “wounded younger self.” (I was incredibly skeptical of inner child work at first, but it is incredibly effective and incredibly healing.)

“Little” is an adjective that, when paired with certain words that also remind me of innocence, usually messes me up emotionally. That’s the word that got under my skin tonight.

I’ve been feeling kind of “off” the last few days. I recently blocked my mother completely on my phone–including the second number I thought she’d deleted until she used it to contact me after I blocked the first number–and was treated to some really unsettling dreams on Monday and Tuesday night.

Monday’s main feature involved me skipping my grandmother’s birthday party because my mother was going to be there and I knew she’d be drunk. Tuesday’s late-night horror show involved a healthy helping of guilt because I was hiding from her (in a Target, of all places) while she wailed and lamented that she “couldn’t believe [I] didn’t want to talk to her.”

Naturally, this put me in a pretty weird headspace today. Wednesdays are my big clinical days and I do group as well as individual client work. As such, I generally store my feelings away to deal with later and do a pretty good job of not thinking about them at all during the day because I’m 100% focused on my clients. (Side note: I adore them, and I’m bummed that I’m leaving my practicum site in a few weeks!)

On the drive home from class this evening, though, those neglected feelings reared their ugly collective heads and roared.

The anxiety and guilt were so powerful that I considered just going to bed early and sleeping it off.

Instead, I took a shower.

I focused hard on those thoughts and attempted to get a good, cathartic cry in. Nothing happened.

I turned the focus to that wounded younger self I mentioned and took the opportunity to literally hug myself while I waited for the conditioner to work its magic on my decidedly unruly hair. I decided to speak aloud because I’m home alone most days during the week and hey, I knew the cat wouldn’t judge me. (Audibly, anyway.)

I told my younger self that it’s okay. I told her I love her and that I’m sorry she felt like no one could keep her safe. I told her that I’m going to do it. This changed into me speaking to whatever hypothetical future child I’ll end up having. I promised that child to take the best care of it I can and to make sure it never feels afraid or lonely.

And I cried. Instead of stifling it or trying to be tough, I gave myself over to it completely–ugly, wracking sobs. After a while, those sobs turned into relieved laughter that I’m sure sounded like I’d finally gone completely ’round the bend.

I think there’s something to be said for having a good cry.

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On Monday, I spoke to my clients in group about the concept of “ghosts”–they had all shared some intense and profound stories about their deepest wounds, their secret shames, their most painful memories. I told them that while they can haunt you, they can’t physically hurt you. You can start to let go of them.

I led them in one of my new favorite exercises, which is “HA!” breathing. Basically, you take a deep breath and push that breath out while making a “HA!” sound. I opened the group with the exercise and invited them to imagine themselves yelling at someone or letting frustration out. I demonstrated (because I am not afraid to look silly anymore), and they loved it. After the big, intense sharing session, I led them in the exercise again, this time instructing them to imagine the “HA!” on the exhale as them blowing out part of their ghosts.

I’m glad it was a hit, and I encourage you all to try it, readers. Howling into the void or, as I called it, “therapeutic yelling,” is incredibly cathartic.

 

An Audio Post!? 4-7-8 Breathing Exercise

Hey readers! I haven’t posted any sort of “There’s a real person in here!” content in a really long time, so here’s a quick clip of me walking you through an even quicker breathing exercise. Click below for the transcript and let me know what you think!

(Side note: I love transcribing stuff because it makes me uncomfortably aware of my verbal tics. Sorry ’bout that.)

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Dichotomy

Is it possible to simultaneously be the most troubled and the most well-adjusted person you know? The deeper I go into my counseling program, the more this question pops into my mind. On the one hand, my demons are legion. On the other, I keep them very well-controlled and they all have little color-coordinated leashes.

Am I well-adjusted because I have to be? Does being well-adjusted look the same, or mean the same thing, for people who have backbreaking loads of trauma and those who don’t?

I used to worry a lot about whether my personal mental health history meant that I can’t be a therapist. I still worry about that, though thankfully not as much. Tonight in class, we were discussing self-disclosure and one of my classmates brought up that exact question–how are our clients supposed to trust us if they know we have our own set of problems?

I guess it’s one of those situations where what you have doesn’t matter as much as how you handle it. I get up every day and even though I do a fair amount of yelling at the intrusive negative thoughts, I still manage to accomplish everything on my to-do list. (Well…most things, anyway. I’m human.)

This has been on my mind for most of the day today, probably because I had intake with my new therapist yesterday and was thinking about the wall between my thoughts and feelings. I depend so heavily on that wall to keep it together, and I’m a bit worried–or, okay, a lot worried–that once I start really delving into the trauma and trying to merge my thoughts and feelings that there will be this monumental change and I’ll basically fall apart. I can’t remember the last time I was able to feel an emotion on an actual deep, meaningful, emotional level for more than a flash before cognition takes over and the brain reasserts control over the “heart.”

I know that’s unrealistic and that no one can do a total 180 in terms of functioning, but the unknowns are scary. As horrible as it is to know certain emotional things but not be able to feel them…better the devil you know than the devil you don’t, right?

I haven’t had self-doubt like this in quite a while, but getting the thoughts down on this little blog has helped a bit. It’s funny how writing about your troubles takes away some of their power, isn’t it? I’m also going to hit the self-care pretty hard tonight because tomorrow I have a phone interview with another prospective internship site–yay! That search is pretty terrifying, but I have a good feeling about the last couple of sites I’ve contacted, so fingers crossed.

Until next time, readers, remember to take good care of yourselves. I will, too.

 

News Day Tuesday: Acronyms! (Or: MDMA for PTSD)

Good morning, readers!

School started last week and there’s been a lot going on in my life on the personal side–my 93-year-old grandma, who essentially raised me as her own for most of my childhood, has been ill and I’ve once again been dealing with anticipatory grief.

Anyway, on a happier note, here’s some news for you about PTSD. (And it’s literally happy–it’s about Ecstasy!)

In a nutshell: those lovable FDA officials just granted MDMA “breakthrough therapy” status as a potential treatment for PTSD. Clinical trials will (hopefully) be easier to come by now, and I am very much looking forward to seeing how this develops.

Important distinction: MDMA isn’t FDA-approved, but this is a huge step in a very promising direction.

Right now, PTSD treatment options are super-limited. My brand is pretty wicked, but my only option for dealing with the symptoms is lorazepam/Ativan. I count myself lucky that I only have depersonalization/derealization, anxiety around crowds, and the occasional nightmare. It could be a lot worse. I’ve written extensively in the past about my experiences with dissociation (hence the name of the blog), but like most things, you get used to it.

But it’s not something anyone should have to “get used to.” None of us should have to accept the symptoms as our “new normal,” and for many, the symptoms are debilitating. That pretty much goes without saying (though of course, I decided to say it anyway).

I recently completed a research proposal for one of my summer classes, and while it was a painful process for someone who’s not a big research fan, it was definitely eye-opening. There has been shockingly little research done on depersonalization/derealization; most of what I encountered deals with “dissociation” in broader terms and the individual disorders are either not specified or are all lumped together in a mass that ultimately provides no insight about the actual conditions.

Anyway, that’s a post for another day. What I’m getting at is that PTSD is an incredibly complicated beast. While some symptoms are consistent, it never looks the same in two different people. Anecdotally, the symptoms can look different at various stages in a person’s life.

Seven years ago, I was having flashbacks (not the dramatic Hollywood kind where you’re literally in the memory–the kind where you sort of space out and the memory plays out in your mind’s eye while you’re pretty much unresponsive to the real world). Then, in 2012, the flashbacks stopped and the depersonalization/derealization got its hooks into me and has been hanging on for dear life ever since.

Like I said, you get used to it. The pain fades. You adjust to never really feeling “real,” to being in this perpetual dreamlike state. When it spikes, I try to welcome it as a new adventure and pay attention to what feels different without getting anxious or judging it as “bad.”

Still, it would be nice if there was something out there that could help just a little. I’ll be keeping my eye on the MDMA  breakthrough and keep you posted on further developments.

In the meantime, readers, what helps with your symptoms? Grounding exercises are one of my favorite things to do if I start to feel anxious. It’s less tedious than counting things.

News Day Tuesday: BLOOM by Anna Schuleit

Hey readers! This week, we’re doing something a little different for News Day Tuesday.

I stumbled across Anna Schuleit’s beautiful BLOOM project from 2003 (yes, I know I’m super late to the party). Today, I want to celebrate that project.

In 2003, artist Anna Schuleit installed 28,000 (28,000! Yow!) potted flowers throughout the psychiatric ward of the Massachusetts Mental Health Center (MMHC).

Anna Schuleit’s installation project was created within the entire building of MMHC, on all floors, inviting former patients and employees, staff, students, and the general public, to re-visit the historic site once more before its closing. There was also a symposium at a nearby venue, and an open forum on the front steps of MMHC, during which the patients were invited to tell their stories. The events were dedicated to the memory of the thousands of patients of MMHC, and included as many of them as we were able to contact, as well as the doctors, nurses, support staff, researchers, students, and the general public. The project was a non-profit effort run entirely by volunteers and all of the events were free and open to all.

Source

As people living with mental illness, some of us with more than one, we know the therapeutic power of telling our stories, of having a voice when we’re so often voiceless. Mindy Schwartz Brown wrote some beautiful poetry about her experiences at MMHC, which you can read here. One poem in particular, “Asylum,” touched me deeply.

ASYLUM
(for Anna)

How did this edifice become “home” to its inhabitants-
the renowned multiply degreed,
the haplessly homeless dually diagnosed,
the walking wounded,
the worried well,
the happy go lucky who cleaned floors,
cooked lunches,
took blood pressures.

How could it contain all of the
the egos,
the disintegrated, the inflated,
occupying one space in parallel play?
MD, SPMI
Ph.D, BPD
MSW, DBT
Tell me in this soup, where does one find one’s ME?

DSM IV, Anybody going for V?
What’s the code for those who close hospitals
then open prisons for the sick?

We all feel so much better now,
knowing our brains are
faulty and we are not.
Structural errors ,
neurotransmittor deficits,
viral origins,
genomic misconfigurations.

So now can we all be friends?
Can we do lunch?
Just as we would with a diabetic?

October 3, 2003

Mindy Schwartz-Brown © 2003

The pain of not being recognized is one we know all too well. The lines “We all feel so much better now, / knowing our brains are / faulty and we are not” struck a chord with me that resonated all the way through my body and down into what some people call the soul.

We are the ones who are forgotten. We are the ones who are hiding in plain sight, not out of our own desire to be invisible, but of the desire of others to make us invisible. We make others uncomfortable, particularly when we don’t outwardly fit the mold of the “mentally ill person.” Whenever I reveal that I have bipolar I and CPTSD to someone, I am typical met with one of two reactions. The person either recoils–the discomfort in their eyes is stark and harrowing–or they tell me how “brave” I am.

I am not brave. I simply live. What choice do I have? I do not want to die, though there are plenty of people who view living with a mental illness as a fate worse than death–and I find that more disturbing than anything going on in my attic. There have been countless times when the hauntings have gotten so noisy that I feel as though my mind may literally split in two. Still, I live. Our lives have worth. We have worth.

I’d like to end by including a few photos of Schuleit’s installation. I spent a great deal of time yesterday perusing the photos and reflecting–not on my own experiences, as I have never been inpatient, but on what others’ experiences might have been like as they lived out their day-to-day at MMHC.

All images above copyright Anna Schuleit.

Tell me your stories, readers. It’s important.

News Day Tuesday: New treatment for PTSD?

Good morning, readers!

This week, I rustled up an article about some exciting developments in PTSD research.

Basically, scientists are looking at glutamate (one type of those fun little things in your brain that sends signals) and how alterations in glutamate levels affect PTSD. What this means for us is that PTSD is now being studied on a molecular level, which means that new treatments could be on the horizon!

My PTSD is generally well-controlled, as far as “controlling” it goes. I’m still mad-jumpy and don’t have a good time in crowds (the dissociation spikes, and sounds that hit my left ear first seem to make it worse, though my previous psychiatrist had no idea why). I still feel depersonalized/derealized every single day, though the level of detachment varies widely. I haven’t been able to pinpoint exactly what it is that makes it better or worse, but admittedly, I’ve been super lazy about charting it.

However, I’m sleeping soundly for the first time I can remember. I think a lot of us can relate to the hypervigilance and, by extension, light sleeping. Loud noises still startle me awake and my fiance sometime scares the bejeezus out of me by touching me–gently–to wake me up. But! and this is good news–the sounds of the cats wheezing or vomiting or fighting don’t wake me in a panic. It’s more of a “God, this again?” reaction, which, while not fun, is better than waking up with a racing pulse and momentary confusion about where I am.

As far as journaling about symptoms goes, I’m still trying to figure out a system. How many times in a day should I note what’s going on upstairs? I don’t want to become obsessive about it, as I did with my mood journal when I was first beginning treatment for bipolar disorder. At the same time, I want to make sure I have an accurate log of my symptoms and the events that may have caused an increase/decrease in the weird floaty feelings of unreality.

That being said, it’s sometimes hard to notice the changes because they’re subtle. Because this has been chronic for six years now, it often takes an absolutely massive spike before I notice anything is off. On a related note, I often don’t notice the symptoms decreasing because hey, it’s my “normal” now.

Any ideas or tips, readers? Should I follow the standard day/time/preceding events/level (on a scale of 1-10) format I’ve used in the past for mood tracking? What system(s) do you use?

I look forward to hearing from you! I’ll see you next week and as always, stay safe and remember to say one nice thing to yourself every day. Today I have two: “My new DIY manicure is bangin'” and “I am surviving my fiance’s work trip with zero negative emotions!”

It’s important to focus on the positive, especially when our emotional weather is often stormy.