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Archive for the ‘Psychodynamics’ Category

I likes it.

Via, an old wiki entry that’s been replaced by a more clinical definition, alas:

“The goal of psychodynamic therapy is the experience of truth. This truth must be encountered through the breakdown of psychological defenses. Simply stated:

[psychodynamic] psychotherapy teaches the client to be honest.

Individuals suffering from “psychological disorders” or deep-rooted “personality disorders,” often come from confusing, manipulative, dishonest, or even violent families in childhood. Being honest with ones feelings is a difficult, even terrifying process for these people.

But there is a silver lining. If the patient client is willing to face up to their hidden secrets they will discover the unconscious reason for many of their feelings, and therefore obtain self-understanding and relief. In essence

the more honest and direct one is with his/her life,

the more “symptoms” will

dissolve,

and the more one’s childhood and defenses are understood.”

Read a decent exploration of how all that comes together at Mental Health Net: The HBO TV show In Treatment: Understanding how patients ‘lie’ to themselves and others is at the heart of dynamic psychotherapy.

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I have been consumed with feline diabetes the last few days, as I should, it’s complex as it gets and the knowledge base as demanding as that of informed mental health patients. Angelbait will need me to test her glucose 4 times a day, before and after I give her the shots, that means pricking her ear and getting the reading on a monitor. She will need prescription food and I have to figure out how to do things like get the insulin from the vet to my house in 100 degree heat without a car, the insulin has to be kept refrigerated. This home-based disease management will cost about 150 a month, the only way that will work is if I quit smoking. And I have to figure out how to do all this when the legislature is in session, and bills are passed at 2 AM, when I’m at the Capitol 18 hours a day.

Sometimes the glass is half empty. I just found an Austin blogger who accuses my vet of killing 2 pets.

He killed my cat.

I don’t know if she’s right or wrong and based on her post, neither can you. All I know is Angelbait is in this same man’s hands, at that clinic still, right now, and I feel powerless. Am I? What would you do? I don’t know where to go from here. I talk to the vet, he says all the same stuff to me he said to this blogger, I went and saw X play last night and stopped crying for the first time since Sunday, thinking it’s going to be a long hard road, but if I keep my shit together Angel will make it. I can’t sleep from the hundreds of rules to learn and remember, and I stayed up to research the vet and found that post and this 2006 reprimand by the Licensing Board for violating the “PROFESSIONAL STANDARD OF HUMANE TREATMENT, by failing to begin treatment for Sarcoptic mites, even with an initial negative skin scrape when confronted with symptoms of crusty ears, generalized itching, non-responsive treatment protocols, and a human rash. Disciplinary Action: Informal Reprimand.”

Should I see red flags? Are reprimands common with vets who have been practicing long? All I know is he examined the older cat Kamikaze twice and agreed to let me administer the shots at home and he gives me a break on the price. I asked him 2 years ago if the cortisone would shorten Kami’s lifespan and he said “probably, yes, it’s likely. But it’s either that or letting her suffer like this.” His candor appealed to me, the Animal Trustees non-profit recommends him for low-income pet owners, he is a nice man, and with Angelbait he will allow me to do home-based glucose monitoring. That is a big plus in his favor, according to the progressive feline diabetes community.

I would be remiss to leave out the impact these readings are having on me. I read that post and disciplinary action and went into conversion disorder for the first time since I wrote about standing up and falling down on troublewaits. I would like people who don’t believe in mental illness to see what conversion disorder looks like, you fucks, and deal with the fact that it was a certified psychiatrist what taught me how to deal with it. (“Talk to people, express yourself; hysteria is caused by over-control and stoicism, which is contraindicated due to your trauma history”.)

Contraindicated: he was recommending I let myself fall apart, validating my craziness as the way things are supposed to be, bless you Dr. Oppressor. I’m calling him up inside my heart and going over the protocols for these times. He said you will probably have falling down spells for the rest of your life when overwhelmed by emotion and you will get through them because you have so far. I asked how I can *share* like a human being when my speech goes garbly and I drop for no apparent reason, how can I talk when I can’t form words. He put his thumb and forefinger together with a fraction of space between them and said “This is how much understanding you’ll find out there. But it’s either try or suffer in silence, and silence is why it’s happening.” He said at first the speech and falling down will be TEH SUCK, but “once you start talking everything smooths out.” I’m not telling you this to stick up for him, but to share my disdain with the antipsychiatry dickstains who feel welcomed here for some incomprehensible reason.

I have not followed my old shrink’s advice, am reclusive, have no one I am close to, the only person I talked to about Angelbait said I should prepare myself to put her down. Well-meaning betrayal stings less, but that friend is off my helplist. That’s how he escaped his certain fate, as luck would have it. I need help, some support or perspective.

UPDATE: I called the licensing board. My vet has 2 reprimands, one informal the other formal, only 2% of vets get reprimands of any kind. 98% do not get one. Angelbait is undergoing intensive regulation treatment, I asked the licensing board rep if moving her in the middle of the process would kill her. He couldn’t say. All my questions are unanswerable, I guess but they are warranted aren’t they. Should I call a philosopher?

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And you know what, I’m gonna leave off this for awhile, I can’t handle it, there’s a lot of positive stuff going on in the movement and I’m gonna spend the next couple days drinking it in. But first let me show you my pain, from an email I sent to TMA yesterday, and we’ll call it tabled for now, and let things simmer while I get back on track.

Hey. I am still talking to the folks on that thread at Icarus, it’s calming me down. I’ve spent the last couple days researching NAMI and am seriously triggered, sobbing, grief trauma stuffings pouring out. It’s all so symbolic. I know you will understand, but I can’t put it straight yet. NAMI is deception, the embodiment of what I lived with, not in concrete details, but psychologically, this is an organization about hugely dysfunctional families that gang up on the weak link as expendable, all a ruse to keep from dealing with interpersonal violence, and they’re happy to destroy this person they denote as a loved one for whom there’s no exit once inside the psych system, no healing for the family unit because they’re avoiding the source of the real problem, the real interpersonal dysfunction. I discovered that NAMI attacks family therapy, just as it attacks all psychosocial intervention and critics of biopsychiatry. They’ve put themselves completely out of reach of the typical programs geared toward the typical family recognized as embroiled in typical domestic violence, because they’ve convinced everyone of their interpersonal innocence, their kids are delusional, have genetic diseases the ‘rents can’t be blamed for, it’s all smoke and mirrors, and the media buys it. NAMI is leading the culture around, held up as the authority on mental illness, and the public doesn’t understand the true focus of these anti-stigma campaigns is on abolishing prejudice toward families, not the “delusional, mentally ill who don’t know they’re sick”, family support groups are steeped in ideology and entirely funded by AstraZeneca, forcing drugs and ECT on their children, who are right now living in the Matrix, without due process, everyday, you step into the abyss and find it only comes up to your knees.

You know I am sympathetic to the violent mentally ill meme, my big brother, killed who knows how many people. I saw it, I saw us all decompensate over the course of our childhoods, I was there, he was in and out of psych wards and jail, sorrowful mom had him involuntary committed when he was 17 and who knows how much one thing has to do with the other, nothing helped, made him worse, didn’t it. And yes, he was a sadist, but he was beaten and molested as a child, we all have records of broken bones, he had sex with mom at four years old, this is a story, where does his story come in? I’m sorry, I’m just processing so much so fast, I know my thoughts aren’t organized. The thing is I knew all this, right, but it’s being in the same room with them, including the ex NAMI rep I feel attracted to, who is the worst really, and the chief of police, and even our protection and advocacy person kissing ass. We had to introduce ourselves, 20 people and no one identified as a consumer, at a Consumer Council meeting, it was all agency heads and law enforcement. When it was my turn I said I was a “community activist” and the police chief said, “that’s……………….okay,” I felt like such a joke. I’ve been on stage before, doing monologues and poetry readings and on the radio for ten years, I know I can push through the normal stage fright, this isn’t normal stage fright, it’s the assimilating that’s got me terrified. They represent something I don’t want to believe, and am on a mission to get to the bottom of it.

Also Teema, I learned at that meeting that our local MH Authority does not recognize PTSD as a legit mental illness, and do not treat people, including vets who present w/the PTSD dx. It’s like all my fears from 2002 are materializing, and you’d think I’d find that reassuring or something, but it’s crushing and stark, and I am not yet aware of the size of it.

So that’s all I got, but this is a link worth clicking, and y’all can draw your own conclusions.

Thank you for reading, in courage and valor.

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I’m still having a hard time recovering from mental illness awareness week, migraines, can’t sleep and nightmares when I can, plus waking up crying. I woke up and hollered “Molly!” a few hours ago, and I’ve been drinking a bit to take the edge off, which is nothing to me but a clue. Molly Ivins lived in this city, and this week I’m going to walk the streets she walked, the streets she urged us, in her final proclamation, to run into with glee, banging pots and pans, shouting “We are the deciders.”

No, we’re not. Over a hundred google alerts in my inbox last week promoting awareness of mental illness, and not one word about child abuse, because, do I have this right — because NAMI — a family organization — is in charge — do I have that right — in charge of mental illness awareness — NAMI, is that right? Wait, ok, so the ghosts are in my house, my people, my blood, thicker than water, kinship, my loyal perpetrators, no escape, she’s dead and I’m buried, mom without end. This is how it was, invisibility in the family, this is how it is, invisibility in the mental health system, it feels like I’m in the wrong time frame, I don’t even know where I am, it’s all seamless, positively fourth street. I read the pdf files and feel like I’m losing my mind, they use our language, capital “R” recovery — recovery is possible, expect recovery! Recovery from what? With what? Drugs and denial, symptom suppression, fuck you, my symptoms need expression, space, recognition, discharge, that takes skill, competence, — Expect Recovery — I expect Mark Eitzel is on the stereo saving me “Why do you say everything as if you were a thief? Like what you stole has no value, and what you preach is far from belief?”

That’s what they do, steal a thing of beauty and turn it into shit, “It only takes one person to change the world!” Yes and tomorrow we’ll change it back, because we write, another behavior you’ll never begin to understand.

I have to type more about me and the first thing to appreciate is that I don’t want to. This is one reason we remain invisible in mental health policy and even to our own ignorant CBT “solution focused” treatment providers, we avoid the material, and all the fixers in the system collude with us, by failing to educate themselves about traumatized personality development, because they don’t want to look at it either. It’s a human tendency to avoid the dark and depraved, it’s unsettling to sit with, and take it in day after day, it screws people up to listen. It’s about helplessness, people have a problem with being helpless, they can’t change or undo anything, they can only be witnesses, and that’s enough!

The only therapists who are of any use are not available to most of us anymore, the old school, expensive, time-intensive treatment associated with psychoanalysis is what we need, and that is not an option today.

Therapists can’t just ask outright “were you abused as a child?” Because we’ll say no, dummy, we were indoctrinated to conceal, minimize and forget what was happening. We have no language. I didn’t say a word my first year, I drew pictures, gave my therapist collages made from magazines, took her by the hand and walked her outside and pointed at a tree. It takes a year in therapy to prepare to do the work of trauma, to build trust and go at it at a very slow angle. You need an intentional therapist sitting across from you that whole year, who knows what they’re doing, consciously working to prepare you for doing the work you dread.

I have been scared for a long time, I have been thinking about it all last week, remembering troublewaits, when I didn’t even know what I was talking about, just wailing that some undefined they were taking trauma out of existence. Erasing the concept. Now I am seeing it happening. I think. Who is doing this? Is it NAMI? Am I invisible to my allies too? Do others working as activists in mh liberation who know I insist on inclusion of the trauma model know or care why I say that? Tell me, what are my Suicide Survivor Notes about? When I talk about “my hospital records” do you assume I mean psych ward, and not the general emergency room where I went to get my ribs taped up after my NAMI did what they always did? I won’t spell that out every time you know, that was my mother.

Fighting biopsychiatry is not just about getting to the truth, it’s about the specific needs and challenges facing traumatized persons in the realm of mental health, and about making general sense out of personalities that are a real foreign land, which is useful for everyone, but of paramount relevance for people in the provider system. There are maps, this has all been studied and paid for, research and books and movies and songs, and 1200 scars on my best friends arms, programmed to self-destruct, still here, heroically in the way. We are in the system, we don’t always know why we end up in a mental health facility, but I am one who does know what happened to me, and what it did to me, and that there is no cure, and that there doesn’t need to be.

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Someone asked me if I believe in the biopsychosocial model of illness and recovery.

This is the wrong direction to take regarding the previous post. It’s not important what I believe. I don’t need you to believe what I do. What’s important is what policy makers and mental health providers believe. I personally work to rid myself of beliefs, unfortunately people who exercise power over the lives of others do that out of a belief system. Knowing what they believe is pragmatic, information that helps me navigate the system. Consumers need this information to make a correct assessment of their treatment providers, in knowing who to look for, what to avoid, why treatment is or isn’t working, and what you want to see made available in the marketplace of mental help.

Finding these answers can be depressing, the way finding out how stupid educated people can be is always depressing, but it’s also empowering, which is why consumers are regularly discouraged from asking these questions and why doing so raises eyebrows by breaking form as mindless sheep. They literally don’t believe we have minds, in the philosophical sense, this is what the brain model of mental illness is all about, and why identifying underlying beliefs is imperative.

Can I prove I have a mind? No, what I will do is acknowledge my beliefs for what they are, and since the biopsychosocial model works for me, as a consumer I’ll take my business to treaters consistent with my orientation. And if they’re going to disappear I see no reason to let them go quietly.

I’m pissy about seeing the biopsychosocial model abandoned in mental health discourse. It’s the latest model in a long line of theoretical frameworks sacrificed on the alter of biopsychiatry. I do feel hopeless. The BPS theory has been gaining ground for decades, and professionals felt obligated to at least pay lip service to it. Is it the one true model? That’s not the question, the point is it was a model of the mind, and like all belief in the mind it’s been scrapped for the hysterical pseudo-science of the broken brain model. But yes, I think it’s a better model than let’s-play-eugenics, and is still the gold standard in forensic psychiatry. Or was. I don’t know, it’s hard to keep up with the dogma. It’s still out there in forensic psych television, just last week if I remember correctly Mandy on Criminal Minds described biopsychosocial as biology being the gun, social the bullet, and psychology the trigger. Something for everyone! I prefer the layer cake metaphor, myself, but that’s just me being sweet.

But seriously, every psychiatrist I’ve seen who used BPS to explain my troubles was able to report a good outcome in my treatment, because his ideas weren’t insane, and that gave me grounds to trust and in general comply, including the neuropsychiatrist who put me on medication.

I can console myself somewhat by seeing the BPS model still in the Wikipedia, which links to an exellent essay at the British Medical Journal:

Human beings exist in a meaningful world. When we use terms such as “mind” and “mental” we are referring to some aspect of this world. But this is not something internal, locked away inside a physical body. Think of a painting by Picasso: the famous “Guernica,” perhaps. How do we understand and appreciate this? The type of pigment is important, as are the brushstrokes used. So too are the colours and the shapes of the figures. But to understand what the painting means and the genius of its creator we reach beyond the canvas itself to the context in which it was created. This entails historical, political, cultural, and personal dimensions. Without engaging with its context, we could never appreciate “Guernica” as a work of genius. Its meaning does not reside in the pigment or the canvas but in the relation between these and the world in which it was created and now exists.

Similarly, we will never be able to understand the various elements of our mental life such as thoughts, beliefs, feelings, and values if we think of them as located inside the brain. Trying to grasp the meaningful reality of sadness, alienation, obsession, fear, and madness by looking at scans or analysing biochemistry is like trying to understand a painting by looking at the canvas without reference to its wider world. The philosopher Wittgenstein and his modern followers argue that “mind” is not inside but “out there” in the middle of a social world. We agree.

Me too. Funny that it should even need to be said, unless you know that your days are numbered.

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I could imagine him falling asleep in front of a schizophrenic patient and I realized that he was probably the only psychiatrist in the world who would actually do such a thing. He would not be afraid of psychotics because their experience is not foreign to him. He has been to the farther reaches of the mind himself, has experienced their ecstasies as well as their terrors, and would be able to give an authentic response, based on his own experience, to virtually anything a patient could show him.*

Ronald Laing died 18 years ago today. He was a hero and a fuckup and many speak his name with reverence because not only did he get it, he insisted that getting it is no big deal, that all you have to do is try.

At face value Laing was a scholar educating other scholars about the experience of madness, but on a deeper, more altruistic level he was actually channeling psychosis, talking to and for the outcasts who experience it. That’s his legacy, which for some is more like a presence we turn to reflexively, not to flee but to ground the self in the unmistakable experience of Omygod-I’m-losing-the-plot, because terrifying as that is, reading Laing makes you less terrified, while maintaining awareness of what’s happening to your mind. And being “with yourself” in concern and compassion opens the door to doing the things that help to live through it. What a nightmare life would be without his books on the shelf.

…I think that it’s definitely true that some people, ah, you might say, blow it… they go over the hill, you know. Well, they go over the hill, they go into the wilderness, they lose their bearings, they lose their way, they become completely disorientated, they don’t know who they are or where…now. I’ve been in a certain amount of that territory myself, ah, without being labeled insane, and I can sometimes – sometimes – you know, when someone has gone over the hill and got lost, I can sometimes go out if I, if I want to take the trouble to do so, and go out and hunt for that person, and find them, where they’ve got to, and meet them there, and say, “… Do you want to come back?”

RDL, interview, Arts and Entertainment Network, May, 1987

So I’ve been surfing the web for a proper tribute by a representative of the so-called sane and am pleased to have found something both schooly and intimate, at a blog called Still Point. These off-the-cuff musings on The Divided Self are lovely and discursive and capture the main teachings of the one who did so much to articulate what had no words before him.

Excerpted from
Another Wounded Healer, RD Laing
Communicating with those diagnosed as Mad

In the course of his life, R.D. Laing moved from the forefront of humane, and humanist, psychiatry to a position of notoriety. Latterly, he was alcoholic, professionally unlicensed, and as disturbed, at times, as anyone he had ever treated. His work also descended into near-madness. Be that as it may, his work from his early and middle years is insightful and truly humanizing and ennobling of his severely ill patients. This last point alone is surely an important reason for never forgetting his contribution to healing the mentally ill. Thankfully, there is a Society for Laingian Studies with an official site at http://www.laingsociety.org/

Laing may be said to have contributed much to what today is called “critical psychiatry.” This latter movement challenges the medical tendency to overly or almost completely scientifically explain away and categorise supposed ‘mentally ill’ behaviour. However, unlike the “anti-psychiatric” movement, it demands recognition and understanding of those who are stigmatised by a psychiatric diagnosis because, for example, they hear voices, or engage in some other behaviour incomprehensible to medical specialists. In many ways, therefore, critical psychiatry continues the project to which Laing contributed so much.

… One term he favoured was “ontology” which in philosophical circles refers to the study of existence, and in the more esoteric realms of metaphysics would refer to the study of existence or being in itself apart from the nature of any existent object. Needless to say, this latter esoteric… study was not what Laing referred to.

Most of us, according to Laing, experience ourselves as “ontologically secure” and this is how he defines this term: Such a person “will encounter all the hazards of life, social, ethical, spiritual, biological, from a centrally firm sense of his own and other people’s reality and identity.” (ibid., p. 39). Hence, for Laing, the mentally ill experience themselves as “ontologically insecure”as there is no sense of their own or other people’s reality or identity.
Therefore, Laing talks about “the primary ontological security” of us so-called mentally healthy or sane individuals in contrast to the “primary ontological insecurity” of the mentally ill or insane. Laing was revolutionary in valuing the content of psychotic behavior and speech as a valid expression of distress… albeit wrapped in an enigmatic language of personal symbolism which is meaningful only from within their situation. According to Laing, if a therapist can better understand his or her patient, the therapist can begin to make sense of the symbolism of the patient’s madness, and therefore start addressing the concerns which are the root cause of the distress. Laing engaged, then, with the patient in their “primary ontological insecurity” insofar as this was humanly possible. The WIKI puts it thus: “For Laing, madness could be a trans-formative episode whereby the process of undergoing mental distress was compared to a shamanic journey. The traveler could return from the journey with important insights, and may even have become a wiser and more grounded person as a result.”

In his chapter on “ontological insecurity” Laing refers to literature and the experience of suffering – to Shakespeare, to Keats, to Kafka and to Beckett. While all four spoke about and undoubtedly experienced the evil of suffering in their lives, one can only agree with Laing that both Kafka and Beckett experienced it at a different, perhaps deeper, definitely more alienating a level than the first two. Why? Well for starters both Keats and Shakespeare evil along with a strong sense of personal identity whereas the latter two experienced it without such a sense of personal identity – in fact that sense of personal identity had been stripped away. Hence in these existential works there is despair, there is terror, and there is a gnawing experience of boredom – this last is called anhedonia in psychological circles. Laing even turns to the artistic oeuvre of the modern Irish artist Francis Bacon to depict a similar sense of meaningless to existence.

Laing argues, it would seem, that Shakespeare and Keats experienced some sense of “primary ontological security” whereas our latter two authors might have experienced some sense of “primary ontological insecurity” – namely that they too had some inkling of what it means to be mad or to go mad.

Here is what Laing says about the growing young person: “To anticipate we can say that the individual whose own being is secure in this primary experiential sense, relatedness with others is potentially gratifying; whereas the ontologically insecure person is preoccupied with preserving rather than gratifying himself: the ordinary circumstances of living threaten his low threshold of security.” (ibid., p. 42)

Laing goes on then to discuss three categories of anxiety encountered by the ontologically insecure person. These titles alone are enough to scare us indeed.

1) Engulfment: Laing quotes a patient from an analytic group in hospital: “At best you win an argument. At worst you lose an argument. I am arguing in order to preserve my existence.” The import of this statement cuts me to the quick to say the least, because, thankfully I have never been that low, or so low as to question or even to doubt my “ontological security.” Here the person … fears that they will lose any sense of self at all – every possible relationship threatens the individual with loss of identity. Reflecting on my own relationships or attempted relationships with the “ontologically insecure” I now know exactly what Laing is getting at and it helps me in retrospect to understand why these individuals withdrew into their own worlds. So engulfment is a high risk for these individuals – a risk in being understood, comprehended, grasped, loved even, because once such happens they are literally identity-less, lost, drowned, engulfed.

2) Implosion: This again is an extremely strong word and Laing acknowledges this. Here the person fears that his/her whole world is about to crash in on them or implode. It is an experience of terror. Laing goes on to point out that his word is again most suitable because the patient feels empty, quite like a vacuum. For the patient his experience is emptiness, is nothingness and the world of the other can and possibly will come crashing in.

3) Petrification and Depersonalization: the first of these words means literally being “turned to stone.” I have an experience of seeing someone thus. This, Laing, points out is the fear of being turned into an “it” rather than a subject or an “I.” I am reminded here of the famous Jewish philosopher Martin Buber who wrote a very interesting and beautiful book called “I-Thou” which I read years ago for philosophy and which I must re-read and review for these pages. Anyway, the truly human and mentally healthy person will have an I-Thou relationship with most significant others. An I-it relationship, needless to say, is a depersonalized relationship, to use Laing’s term. The patient as person feels that he or she will lose their autonomy and all inner life and is totally depersonalized.

One cannot help but notice that the Nazis were adept at making their captives and inmates in their hellish and murderous concentration camps “petrified” and “depersonalized” by the systematic stripping away of every vestige of personality and identity. No wonder, even the strongest physically, intellectually and even morally died. As Frankl so well pointed out only the spiritually or psychically strong survived, that is those who had the strength of spirit (not even character) to find some little (or is it even great?) meaning in sheer absurdity and in the most brutal of hells.

I am left again with the feeling after reading this deep if brutally honest and disturbing chapter that R.D. Laing is much to be thanked for his understanding of the suffering of others.

~~~
Very nice. All you have to do is try.

*Fritjof Capra in Uncommon Wisdom, p. 155

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Dear Survivor:

This booklet is about the experience of being hurt on purpose by other people, and the changes in your life that it leaves behind.

You may wonder if what happened to you was bad enough to be called abuse. If you have to ask that question, it probably was. If you cannot remember large parts of your life, it almost certainly was.

I am sorry you have to read this on the internet. These things are better dealt with face-to-face. The effects of violence are best helped by different and more positive experiences with people. This is hard to do when you are looking for help on your own.

Take your time reading this. Use whatever parts seem helpful in your situation. Be patient with yourself. It will take time and work, but you can feel better.

Take care,
Joe Parker, RN
Prostitutionrecovery.org

WHAT DOES POST TRAUMATIC STRESS DISORDER MEAN?

Post is the Latin word for “after”.

Trauma is the German word for “nightmare”, but in English, it is used for any kind of injury, physical or psychological.

Stress is a force that changes the shape of things (including people).

Disorder refers to things that are a problem in a person’s life now.

To understand PTSD, it is necessary to tell two stories.

Once upon a time, several blind men wanted to understand about elephants.

An elephant was brought to them, and they all approached it from different directions.

One felt the tail, and said “an elephant is like a rope”!

Another found a leg, and said, “no, an elephant is like a tree trunk”.

A third walked into the side of the elephant, and said, “really, an elephant is like a wall .

Others found the ear, the trunk, a tusk, and each felt his part of the elephant was the real elephant.

Each blind man was right about his part of the elephant, but none of them really understood about elephants.

The story of Post Traumatic Stress Disorder is similar.

PTSD was first recognized after the American Civil War. Doctors noticed that some soldiers who had been in heavy combat complained of having attacks of fast heartbeat, chest pain, difficulty breathing, and fear that they were dying or going crazy.

The symptoms were similar to heart attacks. Not having the scientific equipment to investigate further, they assumed the attacks were a form of heart disease. They called it “soldiers’ heart”.

We now know the attacks are not heart disease. They result from rushes of adrenalin, triggered by bad memories or nightmares.

A few years after the war, most people forgot about the problem, but the part of the elephant they had found was real.

World War I was the first time very large numbers of explosive shells were used in battle.

It was noticed that some combat veterans, afterward, had trouble with feeling somewhat dazed or confused, and with poor concentration and memory.

This seemed similar to what happened in many brain injuries. It was thought that the concussions of the shells caused tiny spots of bleeding in the brain. They called it “shell shock”.

Eventually, a lot of autopsies were done on soldiers who had died of other causes, and no such bleeding was found. It was recognized that the symptoms resulted from extreme stress, not brain damage.

It should be remembered that many people with PTSD, especially from child abuse and domestic violence, have had damage from blows to the head. Both symptoms of brain injury and effects of overwhelming stress may be present in the same person.

A few years after the war, the matter was again dropped, but they had found another part of the elephant.

When World War II came, it took until June of 1944 to redevelop the treatment methods used in 1918.

In that war, they learned two important things. The severity of a person’s symptoms was directly related to how much stress he or she had undergone, over how much time.

It was calculated that of 100 men in continuous combat, every single one would break down within 189 days. They called it “combat fatigue”, or “combat exhaustion”.

It also became clear that there is no such thing as a stress-proof person. Certainly some people break before others, but with enough stress and enough time, everybody breaks. They had another part of the elephant.

After World War II, it was assumed (never investigated, just assumed) that symptoms of traumatic stress went away in 6 months or a year, after the war was over. They were greatly mystified at the large number of alcoholics who came out of that war.

Only after the Vietnam War did it become clear that PTSD symptoms could appear at any time, during or after the war. The symptoms could go on, better or worse from time-to-time, all of a person’s life.

The severity of the symptoms is influenced by how much emotional support a person has available during and after trauma.

Veterans of an unpopular war, such as Vietnam, were clearly affected by the fact that nobody wanted to talk about it later.

Survivors of child abuse and domestic violence are more severely affected because family or friends, who normally would provide support, are the perpetrators of the violence.

In the late 1970’s feminist writers began publicizing the fact that far more child abuse, sexual abuse, and domestic violence were occurring than previously admitted.

Studies began to reveal that domestic violence is a problem in about 25% of all families, regardless of race, religion, income or education. About 16% of all girls and 8% of all boys are sexually abused before the age of 18 years. Rapes reported to the authorities may represent less than 10% of those that actually occur. About 10% of the adult population is alcoholic. Inclusion of other abusable substances may raise the figure to double that.

Very few people are directly involved in wars, but most people have a family.

Unlike in times past, the feminists and Vietnam veterans have not shut up and gone away. Post Traumatic Stress Disorder is now an official diagnosis in the diagnostic and statistical manual.

Consciously or unconsciously, the brain remembers everything. Trauma really happens, and it changes who you are. You cannot seriously hurt human beings and expect them to forget it and be all right afterwards.

People who have Post-Traumatic Stress Disorder often worry about whether they are “crazy”.

The word “psychotic” (or crazy) usually means experiencing or believing things that are not real: being “out of touch with reality”.

People with PTSD’s have essentially the opposite problem. They are in too much contact with reality, and in contact with realities that most people have the privilege of not knowing about.

It is just as possible to be sick from too much contact with reality, as from not enough.

That is the whole elephant.

The official definition of Post Traumatic Stress Disorder includes a combination of the following:

1. An extreme, painful experience, which would be severely stressful for almost anyone.

2. Continuing psychological “re-runs” of the events, including:

1. frequent thoughts and memories about what happened, even when trying to avoid them.

2. repeating nightmares about the trauma.

3. suddenly feeling or acting as if the events were happening again (flashbacks).

4. strong, painful feelings set off by things which are in some way related to what happened.

3. Ongoing attempts to avoid memories and feelings by:

1. becoming generally numb to everything, by cutting off most feelings, both good and bad.

2. avoiding activities or situations which may bring back memories and feelings.

3. loss of large areas of memory about past life.

4. loss of interest in things most other people care about, feeling different and cut off from other people.

5. lack of any sense of having a future.

4. Continuous extreme physical alertness, including:

1. constantly watching for signs of danger, with “startle responses”, and trouble sleeping.

2. trouble concentrating on business in the present world.

3. irritability, outbursts of anger.

4. physical reactions similar to what happened during past trauma (tremors, sweating, nausea etc.)

5. These symptoms continue for more than a month and can begin anytime from immediately to years after the trauma.

PSYCHOLOGICAL ABUSE

Children come into the world knowing nothing about themselves: whether they are smart or stupid, good or bad, lovable or unlovable. They can only learn these things from family, from people around them. If they are given “poison information”, they have little choice but to believe it.

For the abuser psychological abuse has several advantages:

1. It leaves no physical marks. Unless the child becomes extremely depressed or psychotic there is no evidence to show in court.

2. It is safe. There is no risk of accidentally killing the child and being sent to prison. There is no problem with the child getting big enough to physically fight back or use a weapon.

3. It is easy. Psychological abuse can be kept up for years, wearing away at a child like rust. There is no great amount of energy or time involved.

Psychological abuse takes several forms. They are usually used together – it is rare for an abuser to use only one type.

1. Rejecting

“I hate you, you ruined my life”. “You are not my child” Nothing the child is or does is ever good enough.

2. Isolating

Keeping the child away from any people other than abusers. This prevents the child from learning anything about him or herself except the “poison information” provided by the abusers.

3. Ignoring

Not responding to anything the child is, says, or does. Psychologically/emotionally “not there” for the child.

4. Corrupting

Involving the child in crimes, early alcohol/drug use, sexual activities, etc. that leaves the child unable to be part of normal society.

5. Terrorizing

Keeping the child constantly in fear of being hurt, making the child watch others being hurt, keeping the child emotionally out of control most of the time.

PHYSICAL ABUSE

A large part of the “normal population” consider it legitimate to use physical force to discipline children. “Spanking” with an open hand is commonplace in our society. Abuse, fueled by uncontrolled anger or intoxication, goes far beyond ordinary discipline. Abusers almost always blame their violence on the child or spouse who is the victim. This is confusing to survivors, who need to know what level of violence qualifies as “abuse”.

Abuse includes some combination of the following features:

1. Severity of injury. Cuts, bruises, broken bones, being strangled or knocked unconscious…..and sometimes death.

2. Weapons. Clubs, knives, guns and other instruments capable of causing severe injury or death. Life or death for the child depends totally on how well the abuser controls the weapon.

3. Use of pretexts. A child is punished for anything or nothing. The “rules” are made up as the abuser goes along, and change without warning. The child is never safe.

4. The abuser is out of control. Through alcohol/drugs, mental illness or personal choice, the abuser does not control amounts of force used. The child may be crippled or killed at any time.

It is sometimes useful, to understand the severity of a survivors current symptoms, to put together a lifetime total assault history. Multiply the total number of each type of assault per day/week/month by the total amount of time exposed to the various abusers. Be sure to count both assaults in childhood and in adult life. The total number sometimes explains a lot about why you are having so many symptoms.

Finally, estimate the number of days on which the survivor could be sure of not being hurt. Sometimes this number is painfully small.

Adults who recognize their actions toward children as abusive often fear to tell anyone, out of fear they will go to jail or lose custody of their children. In reality, many social services agencies work with parents who have abused, or fear they may abuse their children, to learn to stop the violence and keep their children. Parents Anonymous is free and a good place to start.

SEXUAL ABUSE

Normal sexuality is the exchange of pleasure between two freely consenting people. Abuse is the wrongful use of a human being, as a thing, for the pleasure of another. Sexual abuse commonly involves:

1. Use of force or threat to control a person who is not consenting. The threats may be against the victim (“Do what I want or I’ll kill you….”), against others (“If I don’t get what I want from you, I will just go after your little sister…”) or against the abuser himself (“If you tell anyone, I will have to kill myself, and it will be all your fault…”).

2. Use of lies to overcome resistance (“I’m doing this to teach you, for your own good”, “Everybody does this”, “You want it, I know you do”.). Lies can take the place of open violence.

3. Secrecy. Normal sexual relationships may go on in private, but they are not themselves secret. The demand for secrecy almost always indicates wrongdoing, and usually includes some kind of threat. (“You won’t be my special girl anymore”, “It would break your mother’s heart”, “You will be put in an institution”.).

4. Betrayal of responsibility. Children have to depend on older people for protection, for food, clothing, shelter, and for truthful information about how to get along in the world. An adult who uses a child’s natural needs in order to use the child’s body, is committing a crime. Sometimes the betrayal hurts more than the fear, the isolation or the injuries.

The most basic drives of human beings, and of all animals, are to survive and to reproduce. The use of power to control a child is ultimately based on the threat to hurt, abandon, or kill. The child does whatever is necessary to survive. Energy that should go into growing up, is spent on trying to just get by, day by day.

Use of sex as a weapon strikes a child’s basic ability to relate to, and trust, other human beings. It attacks a person’s sense of being connected to other people, both in the present world, and to past and future generations.

Sexual abuse is like any other serious injury: some people survive and do well, some people only get by, and some end up not surviving at all. Good help and the right choices can make your life more nearly normal, and much happier than it might otherwise have been.

To be hurt, especially on purpose by other people, makes everyone sad and ashamed. In thinking about their lives and symptoms, most people tend to underestimate the severity of their experiences, and overestimate the amount of control they had over what happened.

HISTORY

The brain has mechanisms like “circuit breakers” which block out memories too bad to handle at a given time. The memory loss is usually “spotty”, not complete, and gets better or worse depending on a person’s stress level and how much help is available.

Trying to force the memory, by emotional pressure, drugs or hypnosis, often hurts rather than helps. If the brain needs to block out a memory, it usually has good reason. People tend to “face reality” as fast as they can. Pushing becomes just another form of violence.

It is common to have to work on plans for recovery with incomplete information. Often, some of the most important facts come out only quite late in the process.

Because the traumatic experience really happened, and really hurt, PTSD symptoms tend to continue, better at some times, worse at others, most of a person’s life. Careful planning and use of recovery skills can greatly increase the amount of “good time” and make the bad times less frequent and less severe.

Putting together a written history of your life, and understanding the effect the traumatic parts had, usually helps make sense of many things that have happened in your life, during the abuse and after. It is very important in making plans for your recovery. Making the most complete possible history is a long term project. Memories come back in bits and pieces. Information from other people and from records also will come in bits and pieces. Some things may never be known.

This will be a stressful process, both in the effort spent in trying to remember, and in the energy needed to cope with what is remembered. Sadly, insight into what happened usually improves symptoms, but seldom completely removes them.

It helps to keep written notes, to avoid losing hard won information to the ups and downs of memory. Putting it in writing also seems to help keep things real, when so often they seem unreal, or even impossible.

1. Lay out a “life line”, beginning with your birth. Put in any markers that will keep track of time: places you lived, where you went to school, births, marriages, deaths, institutions you were in, etc.

2. Talk to family, friends, teachers, ministers, neighbors and anyone else who may have information about your life. Keep in mind that some of these people truly did not know, some did not want to know, some knew but did nothing, and some may have profited in some way from what happened. (For example, as long as the violence was directed at you, it was not aimed at them.)

3. If you decide to talk with the perpetrator, be very careful of your safety. Many are still dangerous. Be clear about what you are trying to do. If you want the perpetrator to confirm memories you can barely believe yourself, be prepared to be called a liar, crazy, or to be told you wanted or deserved what happened. Try not to hope for too much: most perpetrators do not admit responsibility or say they are sorry.

If your purpose is to confront the perpetrator with your anger and your knowledge that what was done was wrong, then, other than being careful for your safety, how the person reacts is not very important.

If the perpetrator is confronted in the process of warning other family and friends about the danger he or she presents, be aware that some other people may react in much the same way as the perpetrator might.

You cannot afford to attach your sense of self worth to the reactions of other people, because their responses have to do with who they are, not who you are.

4. Pay special attention to periods of time you cannot remember, or that others will not discuss with you. The more hurtful the experience, the more likely it will have been blocked out.

Sometimes it is possible to work backward from things that are known: who was living with us at the time, who was drinking at that time etc.

5. Send for copies of any hospital or institution records that may be available. Although you have a right to see and copy most records pertaining to you, sometimes the help of an attorney or health care provider may be needed. Be aware that many professional people are careful not to ask questions they do not want to hear answers to. Some of the records may be in a sort of code, that is: “chaotic family life” may mean drunken violence on a daily basis, and “sexually molested” may cover rape, sodomy and torture.

Put your notes in a safe place. You may wish to add to them from time to time, as you find new information. Sometimes reviewing them will help you understand some new problem in your life.

LIFE CHANGES

Extremely hurtful experiences, ones that produce more fear, pain and anger then anyone can handle, leave behind five ongoing sets of behaviors. These are not so much “scars” as attempts to cope with trauma. Like any kind of treatment, if carried too far, they can become part of the problem, not part of the solution.

1. You begin intense, continuous study of the experience, trying to understand why those things happened, and how to keep them from happening again.

This involves constant thinking about the events, to the point it may interfere with other activities. You may have repetitive dreams about the events which may be so intense as to interfere with sleep and set off adrenalin reactions. The feelings can be so powerful that it can seem as if you are living in two different “movies” at the same time: the “bad old days” and “now”.

Once you understand how the process works, you feel less disoriented, less out of control, and more able to cope. Learning more information about trauma does help. You can take classes, read about it, and talk with others who have been through similar things.

2. You learn to constantly scan the environment for signs of danger. The scanning is compulsive – you cannot turn it off so you have to plan for it.

Recognizing signs of threat may trigger strong reactions, sometimes as strong as the original events did. These reactions may be completely out of line with what is going on in the real world at the time.

Sometimes, you may well be aware of the connections between the present “trigger” and past experiences, even if you cannot control your reaction. At other times, the connection may be unconscious. You first become aware of your reaction, and may or may not later be able to connect it with the past.

The responses may be so intense as to feel like the trauma is actually happening again, that you are back in the bad old days. This is called a flashback. It can feel very crazy to find yourself feeling, saying, or doing things that do not relate to the present world.

To begin to control various kinds of flashbacks, it is important to map out your usual triggers, where they are likely to be encountered, and what your usual reactions are. Some triggers can be avoided almost completely, and should be. Others may be harder to avoid, or you may have good reason to take the chances involved in running into them.

Survival planning may include ways of minimizing exposure, arranging for support ahead of time, developing a “cool down” procedure, and concrete emergency plans in case of losing control.

3. Your body goes on chronic “red-alert”, always ready to fight or run. Physical symptoms include extreme muscle tension (“the shakes”), headaches, high blood pressure, involuntary startle reactions and trouble sleeping. You feel afraid all the time, even when you have no present reason to.

It is in attempting to control these symptoms that so many people with PTSD get involved with alcohol and illegal drugs. Expert use of legitimate medications can control most physical symptoms of PTSD. They do not produce a high, are not addicting, are legal, and are much safer than street drugs.

{snipped med recommendations}

Antipsychotic agents such as haloperidol (Haldol) often have been given to PTSD patients in the belief that their experiences were not real. Since the experiences were real, these drugs usually produce only a little sedation and a lot of side effects

Occasionally chlorpromazine (thorazine) is used as an emergency med for people who have rage attacks extreme enough that they fear killing someone. It is taken only to control an attack, and is much safer than the usual alternative, alcohol. These medications are given as examples. There are numerous others which may be useful.

As survivors move forward in recovery, some may no longer need medication, others will need it only during bad times, and some may need it always.

Serious trauma can change the way a person’s nervous system works, sometimes permanently. Even after allowing for the effects of brain damage and other injuries from violence, PTSD is a physical illness.

4. You are continually prepared to be hurt again, to lose again. The difference between the way life was supposed to be, and the way it turned out for you is a chronic stress.

You learn to avoid getting involved with other people for fear they will turn on you. You try not to care about people, animals or possessions, because sooner or later you expect them to be taken from you. You go so numb that you cannot feel anything, including good things. Being that numb hurts. Being cut off from good things, including people, makes you sad.

Emotions may swing like a pendulum, from overstimulated, hyperalert, fearful and angry, to depressed, numb and out of contact with the world around you. The extreme feelings often come and go in waves, and at times you actually may be out of control. Stabilizing this swing is a central goal of a recovery plan. Such a plan may include:

1. Mapping triggers and arranging your life to avoid recurring flashbacks.

2. Learning to recognize and avoid hurtful people.

3. Avoiding the use of drugs which temporarily improve symptoms, but make them worse on the “rebound”. If needed, symptoms can be controlled with legitimate medications.

4. Reducing your exposure to new injury. (For instance, stay out of places that serve alcohol…)

5. Stopping current patterns of behavior which may be replays or reenactments of your own previous trauma, such as prostitution, fighting, child abuse.

6. Actions to make the real world safer are much more helpful than just trying to cope with your feelings about what might happen. Good locks and a dog are more helpful than lying in bed trying not to be afraid.

5. When you could not physically escape harm, you may have learned to escape inside your head, by “disassociating” from what was going on. You learned to disconnect from feelings such as pain, fear and anger, and even to block out memory of whole events, all while looking quite normal to other people.

This skill produces effects ranging from brief “spacing out” under stress, to things as complex g as multiple personality disorder. It becomes a problem when:

1. Your life experience is cut up in pieces, with a lot of missing time and whole experiences “walled off” from memory,

2. It becomes such an automatic habit that you dissociate frequently in non-threatening situations, or

3. It so effectively blocks out your reaction to ongoing abuse that you fail to take action to protect yourself.

Since most dissociation occurs unconsciously, you cannot just turn it off when it gets in the way. Dissociation is reduced by making your real-world life as safe as possible, and by working with a counselor, carefully, over a long time, to deal with the things that have been walled off.

There is no way to stop or cure dissociation as if it were a disease. You can only improve your life until that defense is rarely needed.

DEALING WITH OTHER PEOPLE

Extreme traumatic experiences, especially if they happened at a young age, can make you different from most other people. Of special interest are two groups of people who may seem very strange to you: predators and normal people.

A person’s usual everyday approach to life and to other people is called a personality. A personality is made up of a person’s biological inheritance (genes), the total set of things that have happened in the person’s life, and the history of choices the person has made.

Every life is like a hand of cards. Some people play whatever they get well, others badly. Only a small number of people choose to hurt others. Even among people abused as children, 70% do not choose to hurt others.

Predators come in three forms:

1. Non-controllers:

All people have angry feelings, and all people have the impulse to hurt someone at times. Some choose not to control those impulses. Many choose to use alcohol and drugs, and let the chemicals block their impulse control. Others do whatever they feel like, sober or otherwise. Their attitude is: “I feel like shit, so somebody’s going to pay…”

People who are loaded occasionally have the bad judgement to pick on somebody tougher than they are, but most, sober or not, are quite careful to act out their impulses on people who cannot effectively fight back.

2. Users:

Some people act as if they were the only real human being in the world, and other people are more like plants. If they want something, they simply take it, as if they were harvesting vegetables. Users have no sense of other people’s rights and feelings, and do not consider that a problem.

It is not that they have something that other people do not. Rather, users are missing something most people have: a conscience, and, internal personal limits on what they do. Any control of their behavior must be provided by others, and often by force.

3. Sadists:

People who enjoy humiliating and hurting others, and who do so while in full control of themselves, may make up as much as 10% of the population. They are found in all parts of society, with all levels of education and income. For some, other people’s pain is sexually stimulating. Others like the feeling of power that comes with hurting people who cannot stop them.

The definition of sadism includes ongoing pattern of:

1. Using physical violence, threats or lies to control another person and inflict pain.

2. Humiliating and degrading a person in front of others.

3. Using a position of authority such as that of a parent to inflict unusually severe “discipline”.

4. Being fascinated by violence, weapons, torture etc.

5. Finding the suffering of other people and animals funny, pleasurable or sexually stimulating.

Some sadistic people are very obvious. Others are so subtle that all you notice is that you feel bad when around them. Abuse survivors have had to learn to ignore their own feelings just to survive. Learning to recognize, and trust, your feelings and to take rapid action to protect yourself, sometimes takes a lot of work.

Cruel people often are quick to notice people who expect to lose, and will move in fast. They avoid people who look like they know they have rights, and have people who love them, because they are likely to fight back.

It is necessary to learn to act like a person with value and rights, long before you can really feel it. In time, it will become real, not an act.

Many survivors spend years trying to understand why the abuser did what he or she did, and never reach that understanding. The reason seems to be that sadists are simply “wired wrong”. If you are one, their behavior makes perfect sense. If you are not one, you will never understand, even if you spend the rest of your life trying.

Normal people:

To deal with normal people, you must understand that the world they live in is very different from yours. They are not afraid all the time. They can feel many more things than pain, fear, and anger.

1. They have rarely felt so much pain that they have lost control of themselves, and certainly have not had that kind of pain caused intentionally by another person.

2. They do not assume they are at fault any time anything goes wrong.

3. They expect to be treated fairly, to be respected, and to love and be loved.

4. They can feel pleasure without drugs, they are depressed only occasionally, and do not know what being numb is about.

5. They expect to have a fair amount of control over their lives, and expect to live to be old.

With time and effort, you can learn to deal with people whose lives have been luckier than yours. One barrier will probably always remain: most normal people do not want to live in the world you know. Many will block you out so they can stay comfortable, not because you are doing something wrong. It is important not to reject all normal people, because there are always some who will work quite hard to understand how your life has been, even if they have had no similar experience themselves.

FINDING PEOPLE YOU CAN TALK TO

Think of how long it took you to put together the pieces of your history, make an accounting of how the abuse changed your life, and deal with your emotional reactions to that. You never had a choice about facing that because you had to live it.

Finding someone to talk to about it is not quick or simple. Some people will listen because they have had to live with abuse too. They may or may not be able to tolerate terrible stories at a given time. Listening to your story may bring up feelings they find too painful to deal with.

Others will listen because they are unusually committed to helping other people, or care a lot about you personally. Finding people who can listen is a key part of surviving. It involves several specific steps:

1. Talk with them about some part of your life that is fairly ordinary, and see if they really listen. If they listen poorly to the very ordinary, they certainly will not hear the really ugly. If they listen, then:

2. Choose a “medium bad” part of your story, one not too hard to handle if things go badly, and tell that. If they change the subject, turn mean, or drop a relationship, they probably are not worth any more effort.

If they get panicky or go numb, you may have found another person with an abuse history. Keep in mind that they may or may not consciously recall the experience. Given plenty of time and personal space, these people may talk with you. Just as it was with you., pushing hurts rather than helps.

3. Once you know a person really well, you may choose to tell him or her the very worst things that happened, the ones that would really hurt if not handled with gentleness and respect. After you tell another person the very worst, and are met with kindness and respect, the memories never have quite the same power over you again.

4. Sometimes you will know people you care about, and very much would like to talk to, but you really feel they could not tolerate the ugly details. You may choose to tell them only some of the story, or even none.

It is not fair that you should have to spend your energy to protect them from hearing about what you had to live, but occasionally it is necessary.

TRIGGERS

Human beings are creatures that learn, and keep on learning all of their lives, whether they want to or not.

They learn to recognize danger by noticing signs that were associated with past hurtful experiences. If the past experiences were severe, there may be a strong physical or emotional response, even if the conscious mind does not know what set it off.

These signs are called “triggers”. People who have a good understanding of what situations set them off, can plan to avoid them, or to deal with the reactions. They come to feel much more in control of themselves.

Triggers can be internal, that is, can be a thought or a memory, as well as an outside event. Triggers take several forms:

1. Single Triggers: One sign alone is enough to set off a reaction. Examples: beer breath, body odor, being yelled at, seeing someone else hurt, violence or happy family situations shown on TV.

2. Compound Triggers: Several things, coming together, will set off a reaction, when each would not have been enough if each appeared alone. Examples: being touched by someone who is angry, and has beer on his breath; or blood on bed sheets in the morning.

3. State-dependent triggers: One or several things which set off a reaction only when a person is tired, alone, in pain, intoxicated, etc. Without the changed mental and/or physical state the particular signs are not enough to set off a reaction.

It is helpful to keep a log of what is happening around you, and what you were thinking about, just before your body and emotions “went off”. Because of memory loss caused by stress, finding the trigger that set off a reaction can take time. Tracking down a trigger may also bring back lost memories. At other times, putting together more personal history will help identify triggers you had not recognized before.

BRAIN INJURY

Alcohol exposure before birth, blows to the head in childhood and as an adult, and heavy drug/alcohol use are all likely to leave some degree of brain damage. In some people it is so minimal as to go unnoticed. In others, it may make building a new life much harder. You may notice:

1. Trouble with your memory, especially remembering things over 5-10 minutes,

2. Less control of your emotions than before injury. Your reactions are more extreme and go on longer,

3. Trouble putting your thoughts into words, or trouble understanding what you read or what others say to you,

4. Thinking more slowly than before.

These “deficits” vary from time to time, and are worse when upset or tired. It is hard to build a picture in your own mind of gaps in your mental functioning. Often it feels like “climbing a staircase, and suddenly stepping off into nothing”.

A rough rule of thumb is that 85% of improvement after a brain injury occurs in the first 6 months, with the rest occurring in the next 2-3 years.

Because brain injuries accumulate, it is vital that your new life be arranged to avoid further injury (e.g., alcohol, violent people etc.}

FORGIVENESS

Abuse survivors often are pressed to “forgive” the perpetrator. The pressure may come from others, especially family members, or from the survivor’s own beliefs about what should be done.

Forgiveness is a word for something that does not exist in the real world. There is no way to go back and act as if nothing ever happened, which is what most people want and most people think forgiveness means. People other then the survivor made bad choices, with terrible outcomes, and became worse human beings as a result.

The survivor may choose not to seek revenge, may choose to continue some contact with the abuser, and may try to support any positive change that the perpetrator may attempt, but there is no way the survivor can control what the abuser chose to do. If the survivor had been able to control other people’s decisions, there would have been no abuse.

Children want very badly for their family to be good people, even in the face of strong evidence that they are not. They will blame themselves for things other people did. They will claim that they were somehow in control, rather than face the fact that they were helpless and that the bad choices were made by others. Survivors have nothing to be given forgiven for, because they did not make the choices.

The abuser can choose to give up violence, take responsibility for the damage, and work toward rebuilding a family. Failing that, the survivor may have to piece together a family out of whatever is left, without the abuser.

A LAST WORD

A new family can be built out of the people who choose to be part of your life, whether or not they were born Into it. A real family is something people do together, not something they are.

Building a new life may take terrible faith and courage. Some days it will seem easy, on other days, impossible. You go on living, with the unwanted knowledge of what evil people have done and can do, including what you yourself may have done and can do. Sometimes it takes all the courage you have just to get up and get dressed in the morning, knowing what can happen.

I wish you luck and courage on your journey. You will always have my respect.

Copyright 1993, Joe Parker
Clinical Director, Lola Greene Baldwin Foundation

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