Category: Memory

Lesia-Szyca-470x260-2a0d4aa1392c9744becfe8cf31b5a48ce0ce5788

Death Penalty May Not Bring Peace to Victims’ Families

00Featured news, Forgiveness, Law and Crime, Memory, Punishment, Stress, Trauma October, 16
Source: Lesia Szyca – Trauma and Mental Health Report Artist

On May 15th 2015, a federal jury condemned Dzhokhar Tsarnaev to death for his role in killing four people and injuring hundreds in the Boston Marathon bombings in 2013. Before the verdict, Bill and Denise Richards—the parents of a nine-year old boy who was killed in the attack—asked that the government not seek the death penalty against Tsarnaev. In an open letter published in the Boston Globe, they explained:

“The continued pursuit of that punishment could bring years of appeals and prolong the most painful day of our lives.”

The death penalty is often touted as the only punishment that provides true justice and closure for a victim’s family and friends, also known as covictims. But this is rarely based on covictims’ actual sentiments.

Research by University of Minnesotta sociology-anthropology professor Scott Vollum and colleagues found ambivalence in covictims’ reactions to capital punishment. Their study showed that only 2.5% achieved true closure, and 20.1% said that the execution did not help them heal. Covictims in the study also expressed feelings of emptiness when the death penalty did not “bring back the victim.”

The long judicial process between conviction and execution, which can span many years in some cases, also prolongs grief and pain for covictims. Uncertainty prevails in the face of appeals, hearings, and trials, while increased publicity inherent in death-penalty cases exacerbates covictims’ suffering. Through media exposure, they repeatedly relive traumatic events.

Pain and anger, especially, are common in the wake of tragic loss and can be accompanied by an overwhelming desire for revenge. Some covictims in the Vollum study voiced that the death penalty was not harsh enough, while others communicated a wish to personally inflict harm on the condemned. In the majority of cases though, executions were not sufficient to satisfy these desires.

“More often than not, families of murder victims do not experience the relief they expected to feel at the execution,” states Lula Redmond, a Florida therapist who works with surviving family members. “Taking a life doesn’t fill that void, but it’s generally not until after the execution that families realize this.”

In a number of cases, covictims actually expressed sympathy for family members of the condemned, often empathizing with the experience of loss. “My heart really goes out to his family. I lost my daughter, and I know today is a terrible day for them as well,” statedone covictim.

A death sentence can polarize the two families, obstructing healing for both. Prison chaplain Caroll Pickett has witnessed how capital punishment inflicts trauma on loved ones of both the condemned and the victim, as well as prison employees and others in the judicial process, stating in his autobiography, “All the death penalty does is create another set of victims.”

Of course, findings like these beg the question, are other forms of punishment more conducive to healing? A 2012 Marquette University Law School study showed improved physical and psychological health for covictims, as well as greater satisfaction with the justice system, when life sentences were given, rather than capital punishment. The authors hypothesize that survivors “may prefer the finality of a life sentence and the obscurity into which the defendant will quickly fall, to the continued uncertainty and publicity of the death penalty.”

Would covictims move through the natural healing process more rapidly if they were not dependent on an execution to bring long-awaited peace? Perhaps the execution as an imagined endpoint for closure only leads to more grief in the meantime.

As one survivor expressed, “I get sick when death-penalty advocates self-righteously prescribe execution to treat the wounds we live with after homicide… Healing is a process, not an event.”

The realities of capital punishment may be poorly suited for healthy grieving and healing. The Richards family wrote, “We hope our two remaining children do not have to grow up with the lingering, painful reminder of what the defendant took from them, which years of appeals would undoubtedly bring.”

–Caitlin McNair, Contributing Writer, The Trauma and Mental Health Report

–Chief Editor: Robert T. MullerThe Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

Nasal Spray May Prevent PTSD, Study Finds

Nasal Spray May Prevent PTSD, Study Finds

00Ethics and Morality, Featured news, Law and Crime, Memory, Neuroscience, Post-Traumatic Stress Disorder, Therapy, Trauma January, 16

Source: Stan Dominguez on Flickr

The emotional connection between a memory and an event can be powerful. A child rescued from a house fire or a soldier returning from Afghanistan may be plagued by flashbacks that elicit guilt, fear, and anxiety. These associations may disrupt daily functioning, causing social isolation, difficulty sleeping, and paranoia—all symptoms of Post-Traumatic Stress Disorder (PTSD).

Traditionally, PTSD has been treated with counseling and cognitive behavioural therapy, as well as psychiatric medications. Now, new research by biochemistry professor Esther L. Sabban and colleagues at New York Medical College is exploring how to stop the negative emotional association from being formed in the first place. They developed a nasal spray that, when administered before, during, or after crises, may do just that.

The spray contains Neuropeptide Y (NPY) which, at low levels, is associated with reduced negative emotional processing of events. Increased NPY in the amygdala and hippocampus—structures of the brain involved in processing memory and emotional responses—is associated with decreased anxiety, fear, and depression resulting from stressful situations.

Sabban and colleagues found that, when inhaled, the peptide acts as a neurotransmitter that has an immediate effect on the brain and prevents the development of PTSD symptoms in rats. In their study, rats were first subjected to stress by being immobilized, forced to swim, and exposed to chemicals which made them lose consciousness. Thirty minutes before or after the stress, some rats were given NPY. After seven days, rats that received NPY had lower levels of anxiety, decreased avoidant behaviour, and fewer startle responses.

Similar results were obtained when the spray was administered a week after the stressful event.

If effective for people, the spray might benefit those with high-risk jobs or those who help others during emergencies. By reducing negative emotional processing of a traumatic event, victims and responders might have a weaker emotional reaction to the memory, limiting the subsequent development of PTSD symptoms.

But there are many questions as well as practical impediments.

Professor Evelyn Tenanbaum of Albany Law School outlines a number of legal and ethical issues that using this spray might have. She argues that blunting the emotional impact of such an event could hinder a victim’s ability to impact a judge or jury in criminal trials. Social change may also be more difficult as the emotional stories of trauma victims often act as catalysts.

Informed consent before administration must also be considered. Victims need to know they may no longer be a reliable witness to a crime and that their memory of the incident may become unclear. Informed decisions may be hard to make during crisis situations.

It is also important to remember that the spray has only been tested on animal populations. NPY purportedly severs ties between emotion and memory; it is unclear what this would mean for humans. Would individuals be left feeling neutral regarding the traumatic event?

A lack of emotion may leave some victims confused or depressed in an entirely different way. Philosophical counselor Elliot Cohen writes how some individuals may become depressed over not feeling guilt, even if they were not personally responsible for the event’s occurrence. And, some victims find their traumatic histories become vital parts of their identities. Personal experiences, memories, and feelings about painful events inform how we see ourselves. What does blunting memory do to a person’s sense of who they are?

NPY’s unpredictable effects on human emotion require much research. If effective, the spray might be a powerful tool for preventing PTSD in some.

Still for others, a painful memory may be preferable to none at all.

– Anjali Wisnarama, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

Grieving the Loss of a Child: The Five Stage Myth

Grieving the Loss of a Child: The Five Stage Myth

00Caregiving, Featured news, Grief, Identity, Memory, Parenting, Resilience, Trauma June, 15

Source: Bethan/Flickr

When we think of death, dying and grief, no one therapist has had the impact and staying power as that of Elisabeth Kübler-Ross. Her five stage model, presented in her classic, On Death and Dying, has been an influential voice on the topic for decades.

But in the last few years, work in the field has put the universality of that model in question. Some, such as Russell Friedman, therapist and director of the Grief Recovery Institute argue that with many kinds of loss people don’t grieve in five stages at all.

Originally intended to describe experiential stages of people facing their own impending death, mental health providers as well as school counsellors and educators seem to have generalized the Kübler-Ross model to a multitude of situations, some applicable, some not so much.

In a recent interview, The Trauma & Mental Health Report spoke with Katherine, who described her personal reactions throughout the first year after the loss of her son, Ben, who was killed in a car accident ten days shy of his twenty-first birthday. Like many coping with loss, her grief did not follow the patterns described by Kübler-Ross, it was much less predictable.

Katherine: I decided to see a social worker a few months after Ben died. We talked about grief after loss and the counsellor recited Elisabeth Kübler-Ross’s five stage grief model: denial, anger, bargaining, depression, and acceptance. This didn’t describe how I was feeling at all…

During the first few months after the accident, the only way I can describe how I was feeling is that there was no ‘feeling.’ It was as if my heart was ripped out and stomped on. There was nothing left, but a complete numbness.

According to clinical psychologists Jennifer Buckle and Stephen Fleming, co-authors of Parenting after the Death of a Child: A Practitioner’s Guide, this feeling of numbness described by Katherine, is often the first grieving experience reported by bereaved parents. Coupled with this sense of numbness, bereaved parents, especially mothers, feel vulnerable and unprotected in what is now considered to be an unfair world.

Eventually the numbness subsides and the unsettling and preoccupying images of the child’s death take over. Almost all bereaved parents make reference to traumatic memories. Even parents not present when their child died describe the trauma experienced as if they were physically there and directly involved.

Katherine: The nightmares just didn’t want to go away. I would have the same reoccurring dream. I would see a red traffic light and hear cars crashing, and then I would wake up in panic. It came to the point where I was anxious every night before bed; I knew what was coming, another nightmare or barely any sleep. I can’t recall having a peaceful sleep the first few months.

Katherine’s nightmares became less frequent over time, but still crept up on occasion. In Buckle and Fleming’s view, the impact of trauma can lessen for some over time; but for others, the images and violent memories may vividly persist.

Grieving parents also fight with recurring flashes of past memories they shared with their deceased child. After a child’s death, most parents feel as if a part of their life has been erased, this is a very frightening. To cope, some parents will resort to avoiding places they associate with the deceased child.

Katherine: It took me over a year to set foot in another hockey arena. Ben was coming home from hockey the night of the accident… just the idea of going into an arena was painful. All the memories… watching him learn how to skate, going to hockey practices, and going with the family to hockey tournaments. I was trying to avoid that pain.

Bereaved parents put a lot of energy into avoiding feelings, memories and places that remind them of the child. At times they also ruminate, thinking about what could or should have been.

Katherine: Sometimes I can’t help it, something will remind me of Ben, and I immediately think about what things would be like now if he was still around. It gets really hard at family get-togethers and around birthdays and holidays. Not having him there… a parent can never get used to that.

Psychology professor Susan Nolen-Hoecksema, on faculty at Yale University, reports that women tend to ruminate more if they were battling depression before their child’s death, in comparison to women who were not. Elderly bereaved parents also tend to ruminate more than younger bereaved parents. With more free time on their hands, there is occasion to think about what might have been.

So why do some parents have an easier time adjusting after the loss of a child, compared to others?

To move forward, grief counsellors tend to agree that parents need to experience their own pain, keep the deceased child’s memory alive, and accept the loss, a notion that aligns well with the Kübler-Ross “acceptance” stage. Parents who continue to avoid don’t adjust so well.

The ability to learn from bereavement helps parents take responsibility for creating a new purposeful life. Irvin Yalom, author of Existential Psychotherapy posits that when parents find it too painful to learn from their bereavement experience, they are unwilling to “feel true feelings guiltlessly.” For parents to adjust well, realising that it’s okay to be happy again is crucial.

The loss of a child is likely the most difficult thing a parent can endure. Perhaps it is fitting that a life experience so profound would turn out to be complex and hard to fit into predictable stages.

– Tessie Mastorakos, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

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Forgetting PTSD: How Genes Affect Memory

00Fear, Featured news, Genetics, Memory, Neuroscience, Post-Traumatic Stress Disorder, Therapy, Trauma April, 15

Source: Jared Rodriguez // Flickr

Memory can be a double edged sword. It holds our identities, our relationships, our histories. But when memory holds our most unspeakable stories, it can become a painful burden.

Sufferers of PTSD live with this reality. Many cannot forget. Recent studies have found that a gene, called tet1, plays a central role in forgetting such traumatic experiences.

Massachusetts Institute of Technology researcher, Andrii Rudenko, found that when people with normal levels of this gene experience a traumatic event, the triggers to traumatic responses become extinct over time. For example, if you were bitten by a dog after walking past a neighbour’s house, you may be reluctant to walk by that same house again. And if you continued to walk past the house and nothing happened, eventually the association with being bitten and walking past that house would become extinct –you would no longer fear walking past the house. However, people with PTSD do not form these new associations, and would continue to fear walking past the neighbour’s house.

Currently, one of the most effective treatments for PTSD is exposure therapy, where patients learn new associations by being exposed to the triggers of PTSD in safe environments. This can include practicing driving on a driving simulator for someone who is afraid to drive due to a motor vehicle accident. Over time, patients begin to learn that driving is not as dangerous as they came to believe.

The tet1 gene aids in the expression of genes in the brain that help people form new memories and cover up old ones. However, when a person has low levels of this gene, old and traumatic memories are not masked.

In Rudenko’s study, mice were conditioned to fear a particular cage using electric shocks. When the electric shock was taken away and the mice were placed in the cage, the mice with normal levels of the tet1 gene lost their fear of the cage, while the mice with low levels of the tet1 gene continued to fear as before.

A process called DNA methylation blocks the expression of the promoter genes that are responsible for forming new memories. The methylation process is lowered by tet1 and other tet proteins in areas of the brain that are important for forming memories, including the hippocampus and the cortex.

Simply put, the more tet proteins, the more expression of promoter genes and memories formed. Conversely, even though low levels of the tet1 gene make learning new things difficult, it has been hypothesized that fear responses are so strong that tet2 and tet3 proteins can compensate for the demethylation processes of tet1 proteins. Therefore, memories are formed during strong responses to fear or traumatic events, but with a lack of tet1 proteins, new memories are not formed to replace the old memories, and chronic PTSD is the result.

Li-Huei Tsai, director of MIT’s Picower Institute for Learning and Memory, told MIT news that “if there is a way to significantly boost the expression of these genes, then extinction learning is going to be much more active.” That is, if we can find a way to boost the expression of the tet1 gene, then people’s traumatic memories will be covered up by new memories quicker.

Memory extinction, prefrontal lobotomies, and other psychosurgeries have been a topic of popular film and literature. It’s not surprising that questions on how these findings may be applied to PTSD treatment have raised eyebrows.

According to Tsai, “What happens during memory extinction is not erasure of the original memory.” Instead, new memories and associations can be formed and old ones forgotten. In the case of the mice, the mice with the higher levels of the tet1 gene begin to learn that the cage is safe, and forget that it was once dangerous. In Rudneko’s view, “association with safety is rebuilt.”

Manipulating tet1 proteins in the brain and combining exposure therapy may bring new PTSD treatment possibilities. This method might even be used to assess a person’s genetic predisposition to PTSD. One imagines a possible screening tool for applicants to jobs with exposure to highly stressful events, like police officers.

This research is still in its infancy. Yet it shows promise for those who, despite their best efforts, can’t find a way to forget.

– Contributing Writer: Andrew McColl, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

Photo Credit:Jared Rodriguez // Flickr

This article was originally published on Psychology Today

love is war, feature2

Love Is War: Post Infidelity Stress Disorder

00Anger, Attention, Cognition, Dreaming, Empathy, Featured news, Health, Hormones, Infidelity, Memory, Post-Traumatic Stress Disorder, Relationships, Self-Esteem, Sex, Sleep, Stress, Trauma March, 15

Source: Daquella manera/Flickr

Blind-sided by the one you love, the one you married.

Learning about your spouse’s infidelity can be emotionally and physically devastating. The emotional damage is reflected in what some mental health professionals call Post-Infidelity Stress Disorder (PISD), for the stress and emotional turmoil experienced afterward.

Psychologist Dennis Ortman, author of Transcending Post-Infidelity Stress Disorder, describes the term as “not to suggest a new diagnostic category but to suggest a parallel with post-traumatic stress disorder, which has been well documented and researched.”

In Post-Traumatic Stress Disorder (PTSD), re-experiencing the trauma repeatedly is the first of three categories of symptoms described. The disorder is marked by flashbacks of war for veterans, nightmares of the accident for car wreck survivors, and painful memories of abuse for survivors of intra-familial trauma.

So too, in PISD husbands and wives will replay the painful realization of betrayal.  Even after the initial fall-out, people will have recurring thoughts of their partner with another.

Psychologist and certified sex therapist, Barry Bass, adds, “Like trauma victims, it is not unusual for betrayed spouses to replay in their minds previously assumed benign events,” those times when their spouse became defensive when asked a simple question, or the late nights at work, or the text messages from unnamed friends, all of these become viewed as possible deceitful acts.

The second category of symptoms for PTSD, avoidance and emotional numbing, is seen in PISD as well.  Rage or despair that comes after the initial shock of discovering the infidelity can be followed by a state of emotional hollowness.  Formerly pleasurable activities lose their appeal.  Those who were cheated on sometimes withdraw from friends and family and describe feelings of emptiness.

The last category of PTSD symptoms, hyper-vigilance and insomnia, can also arise for those dealing with infidelity.  Sleep patterns become erratic; and concentration becomes a challenge, affecting work performance and family life.

PISD can have physical consequences as well as emotional ones.  The stress of discovering infidelity can lead to what has been dubbed broken heart syndrome, also termed stress cardiomyopathy.  The American Heart Association describes symptoms such as sudden chest pain, leading to the sense that one is having a heart attack.  Physical or emotional stressors, such as a loved one passing or major surgery trigger a surge of stress hormones that temporarily affect the heart.  The condition typically reverses within a week.

Despite the stress, there is life after an affair.  Due to the symptomatic similarities, therapists are now beginning to use PTSD counseling techniques to help couples either stay together or move on.

Exposure and cognitive restructuring are techniques used when dealing with traumatic memories.  In exposure, spouses are asked to gradually imagine those heart-wrenching moments and to cope with them gradually, whereas cognitive restructuring substitutes irrational thoughts, feelings, and behaviours induced by the trauma, with adaptive ones.

Counselors use these “trauma focused” explorations with clients, sifting through the distressing memories and aversive feelings, to help build the client’s self-esteem and confidence in dealing with the betrayal or loss of the relationship.

Therapists are also working with their clients to help them understand the unique reasons that led to the infidelity.  Understanding why the affair occurred can help both people.

Along with help from family and friends, wounds can be bandaged and trust restored.  Infidelity trauma and the time and strength involved in recovery remind us that love, like war, can have its casualties.

– Contributing Writer: Justin Garzon, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

Photo Credit: Daquella Manera/Flickr

This article was originally published on Psychology Today

Brain Trauma, feature2

Coping With Traumatic Brain Injury

10Anxiety, Child Development, Cognition, Depression, Empathy, Environment, Featured news, Health, Memory, Neuroscience, Productivity, Sleep, Sport and Competition, Trauma February, 15

Source: Shine In Your Crazy Diamond//Flicker

Traumatic brain injuries (TBI) contribute to many deaths each year, and can lead to the development of secondary mental health problems.  The Centre for Disease Control has reported that approximately 1.7 million TBIs occur every year, and individuals with a TBI commonly suffer cognitive impairments and developmental delays.

The Trauma & Mental Health Report recently spoke with Tricia Williams, a clinical neuropsychologist at Holland Bloorview Kids Rehabilitation Hospital, who works with children who have different forms of TBI.  Williams explained how to improve child development and mental health for individuals coping with a TBI.

Q:  What are the most common injuries that lead to the development of a TBI?

A:  A TBI is caused when an external mechanical force, such as a blow to the head or a concussive force causes harm to the head or body.  Motor vehicle accidents are the leading cause of TBIs.

Other common injuries include falls (which are common in young children and infants), sport injuries, concussions, horseback riding, interpersonal violence (fighting, gun shots, physical hits to the head by person/object,) and war related injuries.

Q:  How is a TBI diagnosed?

A:  Professionals in emergency services diagnose a TBI in the acute state at the time of injury.  They assess the severity of the injury by checking eye responses, verbal responses, motor responses, and mobile ability.  CT scans are initially performed to rule out bleeding and swelling, and then an MRI may be performed as follow up.  Amnesia is another way to diagnose a TBI. The degree of memory loss prior to the event, and difficulty forming new memory can provide more information about the injury. The duration of loss of consciousness can also affect the severity of the injury, which may be ranked as either mild, moderate, or severe.

Q:  What is involved in rehabilitation following a TBI?

A:  In the acute state, the TBI is managed medically, including neurosurgical intervention.  Once stabilized at the hospital, children move on to rehabilitation.  An assessment of physical, functional, and speech abilities are conducted, and occupational therapists and speech and language pathologists then work with the children. Neuropsychological assessments are conducted after the acute state to help children transition back to school.  The children continue with follow-up visits to monitor the impact of the injury on developing cognitive skills.

Q:  As a clinical neuropsychologist, what is your role with patients who have a TBI?

A:  Children are seen as inpatients at the hospital after the injury, and are also seen as outpatients after they have transitioned home.  They can be followed for many years after the injury.  Typically, they are seen during transitional periods such as the transition from primary school to high school.  A thorough assessment of the child’s skills (IQ, memory and learning, language, processing speed, executive functioning, academic skills, visual and motor skills, socio-emotional status) are conducted and compared to previous testing to assess the child’s progress and developing difficulties.

Q:  What daily activities can become difficult for an individual with a TBI?

A:  Activities that can be difficult depend on the nature and severity of the injury, the stage of recovery, and how well they have been supported.  Common complaints across all injuries include:  keeping up with class, forgetfulness, difficulty paying attention, and becoming easily fatigued, overwhelmed, and frustrated.  Because these activities can be challenging, continued support from their physicians and neuropsychologists as well as family support is very important during the recovery process.

Q:  How can secondary mental health symptoms develop from a TBI?

A:  Depression is a common outcome, and can develop as a reaction to the injury or to neurochemical changes in the brain.  Anxiety is also a common reaction to the injury, because if the child is old enough to understand what has happened, they might expect it to happen again.  This is common for children who developed a TBI as a result of a sports injury.  Children can also be anxious about their academic achievement and about performing well in school.  It is important to make patients aware of potential secondary mental health symptoms. But, individuals with a TBI can also have a greater appreciation of life, as they see themselves as survivors.

Q:  What advice can you offer someone with TBI?

A:  Be patient with yourself and try to normalize your emotional variability.  It’s important to ask for and accept help, and to find the balance between accepting what has happened and moving on.  Individuals should keep in mind that while there are variable outcomes, full recovery is possible.  Finding a “new normal” for oneself without becoming centered on the injury is extremely important.

Q:  Do you have any further suggestions for coping with a TBI?

A:  Here is a list of helpful tips:

  • Take additional time on activities as needed
  • Manage fatigue (with exercise/relaxation, sleep)
  • Ask for repetition of key information and written outlines of key terminology
  • Repeat back what people tell you to ensure you are understanding
  • Use your phone or equivalent to make dictated notes and reminders with regularly scheduled playback times
  • Break down (or ask someone to help you break down) larger tasks into smaller manageable parts
  • Choose the time of day when you are most able to accomplish tasks that require more obvious mental effort and sustained attention
  • Recognize the signs that you are losing attention/productivity or becoming overwhelmed and take a break
  • Exercise can help relieve tension, improve sleep and attention
  • Seek out a quiet room to complete work or practice techniques as needed
  • Social support is extremely helpful

Traumatic brain injuries (TBI) contribute to many deaths each year, and can lead to the development of secondary mental health problems.  The Centre for Disease Controlhas reported that approximately 1.7 million TBIs occur every year, and individuals with a TBI commonly suffer cognitive impairments and developmental delays.

The Trauma & Mental Health Report recently spoke with Tricia Williams, a clinical neuropsychologist at Holland Bloorview Kids Rehabilitation Hospital, who works with children who have different forms of TBI.  Williams explained how to improve child development and mental health for individuals coping with a TBI.

Q:  What are the most common injuries that lead to the development of a TBI?

A:  A TBI is caused when an external mechanical force, such as a blow to the head or a concussive force causes harm to the head or body.  Motor vehicle accidents are the leading cause of TBIs.

Other common injuries include falls (which are common in young children and infants), sport injuries, concussions, horseback riding, interpersonal violence (fighting, gun shots, physical hits to the head by person/object), and war related injuries.

Q:  How is a TBI diagnosed?

A:  Professionals in emergency services diagnose a TBI in the acute state at the time of injury.  They assess the severity of the injury by checking eye responses, verbal responses, motor responses, and mobile ability.  CT scans are initially performed to rule out bleeding and swelling, and then an MRI may be performed as follow up.  Amnesia is another way to diagnose a TBI. The degree of memory loss prior to the event, and difficulty forming new memory can provide more information about the injury. The duration of loss of consciousness can also affect the severity of the injury, which may be ranked as either mild, moderate, or severe.

Q:  What is involved in rehabilitation following a TBI?

A:  In the acute state, the TBI is managed medically, including neurosurgical intervention.  Once stabilized at the hospital, children move on to rehabilitation.  An assessment of physical, functional, and speech abilities are conducted, and occupational therapists and speech and language pathologists then work with the children. Neuropsychological assessments are conducted after the acute state to help children transition back to school.  The children continue with follow-up visits to monitor the impact of the injury on developing cognitive skills.

Q:  As a clinical neuropsychologist, what is your role with patients who have a TBI?

A:  Children are seen as inpatients at the hospital after the injury, and are also seen as outpatients after they have transitioned home.  They can be followed for many years after the injury.  Typically, they are seen during transitional periods such as the transition from primary school to high school.  A thorough assessment of the child’s skills (IQ, memory and learning, language, processing speed, executive functioning, academic skills, visual and motor skills, socio-emotional status) are conducted and compared to previous testing to assess the child’s progress and developing difficulties.

Q:  What daily activities can become difficult for an individual with a TBI?

A:  Activities that can be difficult depend on the nature and severity of the injury, the stage of recovery, and how well they have been supported.  Common complaints across all injuries include:  keeping up with class, forgetfulness, difficulty paying attention, and becoming easily fatigued, overwhelmed, and frustrated.  Because these activities can be challenging, continued support from their physicians and neuropsychologists as well as family support is very important during the recovery process.

Q:  How can secondary mental health symptoms develop from a TBI?

A:  Depression is a common outcome, and can develop as a reaction to the injury or to neurochemical changes in the brain.  Anxiety is also a common reaction to the injury, because if the child is old enough to understand what has happened, they might expect it to happen again.  This is common for children who developed a TBI as a result of a sports injury.  Children can also be anxious about their academic achievement and about performing well in school.  It is important to make patients aware of potential secondary mental health symptoms. But, individuals with a TBI can also have a greater appreciation of life, as they see themselves as survivors.

Q:  What advice can you offer someone with TBI?

A:  Be patient with yourself and try to normalize your emotional variability.  It’s important to ask for and accept help, and to find the balance between accepting what has happened and moving on.  Individuals should keep in mind that while there are variable outcomes, full recovery is possible.  Finding a “new normal” for oneself without becoming centered on the injury is extremely important.

Q:  Do you have any further suggestions for coping with a TBI?

A:  Here is a list of helpful tips:

Take additional time on activities as needed
Manage fatigue (with exercise/relaxation, sleep)
Ask for repetition of key information and written outlines of key terminology
Repeat back what people tell you to ensure you are understanding
Use your phone or equivalent to make dictated notes and reminders with regularly scheduled playback times
Break down (or ask someone to help you break down) larger tasks into smaller manageable parts
Choose the time of day when you are most able to accomplish tasks that require more obvious mental effort and sustained attention
Recognize the signs that you are losing attention/productivity or becoming overwhelmed and take a break
Exercise can help relieve tension, improve sleep and attention
Seek out a quiet room to complete work or practice techniques as needed
Social support is extremely helpful

– Contributing Writer: Janany Jayanthikumar, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

Photo Credit: Shine In Your Crazy Diamond//Flickr 

This article was originally published on Psychology Today

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One Woman’s Suicide Ignites the Right to Die Debate

00Aging, Dementia, Depression, Ethics and Morality, Featured news, Health, Memory, Politics, Suicide November, 14

“I will take my life today around noon. It is time. Dementia is taking its toll and I have nearly lost myself.”

Gillian Bennett chose the right to die in the backyard of her home on Bowen Island. On August 18th, 2014, wrapped in the arms of her husband of 60 years, she said goodbye with a tumbler of whiskey and a lethal dose of barbiturates. 

At age 85, Bennett had been living with dementia for over three years. During her lucid moments, she would ruminate on the impact of her suffering on family, and the burden she would become on the healthcare system at large.

Bennett wanted to live and die with dignity; she viewed spending her remaining days in a nursing home as anything but.

The retired psychotherapist voiced her wish to end her life on her own terms before losing “an indefinite number of years of being a vegetable in a hospital setting, eating up the country’s money but having not the faintest idea of who [she is].” Her family and friends supported her decision.

“In our family it is recognized that any adult has the right to make her own decision.” 

Bennett’s conversations became the inspiration for deadatnoon.com, a website that hosts her goodbye letter. In it, Bennett explains her reasoning for wanting to die on her own terms and makes a plea to re-open the debate on assisted suicide for the elderly and terminally ill 

Every day Bennett felt she was losing another part of herself. Small lapses in memory were followed by an inability to keep the days straight and a decline in physical capacity. Soon, she would not have been competent enough to make decisions about her life. She wanted out before that happened.

She considered three options. The first was to “have a minder care for [her] mindless body” despite financial hardship on her family. The second, to settle into a federally funded facility at a cost to the country of $50,000 to $75,000 per year. The third, to end her life “before her mind [was] gone.”

She felt compelled to choose the third, dismissing the other options as “ludicrous, wasteful, and unfair.” At the end of her four-page letter, she encouraged readers to consider the ethics of assisted suicide.

Canadians are not unfamiliar with the debate on euthanasia. Beginning with the landmark Rodriguez v. British Columbia decision, euthanasia has been revisited by the courts many times.

In 1991, Sue Rodriguez, who was suffering from ALS, attempted to petition the Supreme Court of Canada to allow assistance in ending her life. The court refused her request.

Despite the decision, she passed away with the aid of an unknown doctor in 1994.

A similar ruling was made in the Robert Latimer case. Latimer was convicted of second-degree murder in 1997 after killing his severely mentally disabled daughter, Tracy, whose condition left her in constant, unmanageable pain. 

In 2011, the B.C. Supreme Court ruled that the ban on assisted suicide was unconstitutional following a challenge from another ALS sufferer, Gloria Taylor. The federal government appealed the ruling and, in 2013, the B.C. Court of Appeal upheld the ban.

Bennett’s decision to end her life revived the debate. Following the publication of Bennett’s letter, Conservative MP Steven Fletcher went on record saying that assisted suicide in Canada has never been properly debated in Parliament. 

Fletcher has recently introduced two private member’s bills on assisted suicide. One will allow physicians to help patients end their lives under certain circumstances. The other will introduce a commission to systematically monitor the practice. 

How these bills will fare in Parliament remains to be seen, but Fletcher claims they have a strong chance of passing a second reading and moving to the justice committee. Additionally, the Supreme Court of Canada began hearing arguments on October 15th, 2014 on whether to uphold or strike down the current ban on assisted suicide. 

Bennett, a woman who saw life as “a party she was dropped into”, made it clear she felt she was losing nothing by committing suicide. Described as smart, funny, and irreverent, she faced death the way she lived life. 

“Each of us is born uniquely and dies uniquely. I think of dying as a final adventure with a predictably abrupt end. I know when it’s time to leave and I do not find it scary.” 

– Contributing Writer: Magdelena Belanger, The Trauma and Mental Health Report 

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report 

Copyright Robert T. Muller

Photo by #300091984/Flickr

This article was originally published on Psychology Today

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For Families Touched by Homicide, the Media Prolongs Pain

00Featured news, Grief, Health, Law and Crime, Media, Memory, Parenting, Resilience, Stress, Trauma October, 14

On January 1st, 2008, fourteen year old Stefanie Rengel was murdered a few meters outside of her Toronto home.

After receiving a mysterious phone call from someone she believed may have been a friend, Stefanie put on her shoes, told her younger brother that she would be right back, and ran out the door. She never returned.

Leading a normal life one day, and suddenly being thrust into the inevitable bureaucracy that follows a murder is excruciating for families affected by homicide.

The Trauma & Mental Health Report had the chance to speak with Stefanie’s mother, police officer Patricia Hung, who discusses how media involvement and court proceedings sometimes prolonged the healing after her teenage daughter’s murder. She also commented on support available for bereaved parents.

Patricia: Trying to get justice for Stefanie, in some ways… it kept her alive. It gave us something to focus on. I don’t know if that prolonged the grieving, but it certainly spread it out. When a child dies in a car accident, and there are no reporters or trial, you have no choice but to deal with it all right then. For us, we dealt with it a little at a time.

For families affected by homicide, the grief is drawn out. The media, bail hearings, preliminary trials, adjournments, mental health assessments, impact statements, perhaps a trial and hopefully a sentencing, all act as constant reminders of the tragedy. Prolonged investigations and legal processes have these families re-living the trauma of what happened to their loved ones.

Patricia: The day after Stefanie died the reporters were there –it was terrible– it felt like an attack, when all we wanted was privacy. They would come to our door at all hours of the day and night. They would go to my children’s schools and would piece together a false relationship between Stefanie and her killer.

Following a high profile murder case, reporters can unwittingly create chaos for families. The constant questioning, often well intentioned, can turn into intrusive and harmful reminders of the trauma.

Patricia: In the beginning, the press is really friendly to you because they want the gory details and all the juicy information. If you say one wrong word, they can turn on you [for a story]. The last thing grieving families need is to feel tried in the newspapers.

Unfortunately, most bereaved parents aren’t sure what it is they need right after their child’s death. They often feel as though no stranger is going to be able to help them and are unaware of how important it is to reach out for help.

Victim Crisis Assistance and Referral Services (VCARS) is a Canadian charitable service, with 48 sites in Ontario alone that provide immediate on-site assistance to victims affected by tragedy. Bereaved families can use victim services at any point during their recovery even if they initially decline assistance. Victim services offer a variety of support programs for long term assistance and can even help families deal with the media.

Patricia: Being a police officer and having to go through the legal system, I realized how scary it must be for other families who have absolutely no idea what to expect. So to those families who are feeling lost and overwhelmed, know that someone from victim services can be taking notes for you at the preliminary trial, someone can guide you while preparing for your impact statement, and can sit with you during trial.

One of the great difficulties at trial for bereaved parents is informing the judge or jury on how their child’s death affected their life. Impact statements can help determine the offender’s sentence, and parents feel the pressure; victim services help families write these. 

Patricia: Testifying and giving an impact statement was very difficult. I was trying to make sure that I wouldn’t mess it up. You’re so worried that if you say something wrong it could screw everything up. 

And adding to the heartache: 

Patricia: There are things that you don’t expect to happen that do. When I was at court, I went to the washroom and the accused’s mother was in there. It was just so hard. At the time, it wasn’t me against her. I actually felt quite sorry for her… it was a whirlwind of emotions.

Trial is very draining for families. Not only do they hear details of the child’s death, but also the accused is just feet away. Having external support such as VCARS ensures that bereaved families are aware of what steps they need to take and provides comfort at a time when family ties can become strained. 

Once a verdict is made, bereaved families still have much to deal with. Grieving the loss of a child never really ends. As time passes, families fill their lives with new memories and the moments of grief become more intermittent.

But of course, as parole hearings approach, families have to face the trauma of losing their child all over again.

– Contributing Writer: Tessie Mastorakos, The Trauma and Mental Health Report 

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

 Copyright Robert T. Muller

This article was originally published on Psychology Today