Category: Parenting

After a Stillbirth, Interpersonal Support Facilitates Coping

After a Stillbirth, Interpersonal Support Facilitates Coping

00Caregiving, Depression, Featured news, Grief, Health, Parenting, Resilience October, 15

Source: Judit Klein on Flickr

Over 2 million babies are stillborn every year worldwide, resulting from a genetic or physical defect, an illness suffered by the mother, or problems with the umbilical cord. In more than one quarter of cases, no cause can be determined.

In a recent interview with The Trauma & Mental Health Report, Heather, a mother and mature student shared her experiences surrounding stillbirth and commented on the services provided for families.

I chose to name my baby Benjamin.  I didn’t return to work after I got the ultrasound results and eventually I resigned.  I didn’t want to face the office, or their sympathy.

Immediately after a stillbirth, parents are offered various services to help manage their grief.

I was given a private room for the induction – an artificially stimulated labour – and received options for grief counselling and the services of priests and rabbis at the hospital.  We had him cremated, and the tiny basket of ashes was buried on my grandmother’s grave.  My husband and I also received genetic counselling to try to find the cause of the loss.

Parents of stillborn children have the option to see, touch, or hold their baby.  Memories that validate their experiences as parents can be created through handprints or footprints, pictures, or keeping locks of hair.  It can be overwhelming to make these decisions while coping with the reality that your child is gone, but these options may help parents make sense of their grief.

I was 21 weeks pregnant, so I was already making plans, thinking of names, and my daughter was looking forward to having a sibling.  I also looked physically pregnant… I was ready to have a baby, and in a fleeting moment he was gone.  It was so hard to move forward after that, and it was hard to reach out for help.

Interactions with hospital staff following the death of the child may influence how parents cope.  A 2013 study by Soo Downe, an associate professor at the University of Central Lancashire, found that parents believed there was only one chance to create an environment conducive to coping.  This means that positive memories and outcomes following a stillbirth depend as much on caring attitudes and behaviors of staff as on high-quality clinical procedures.

When interactions with hospital staff did not create a supportive environment, parents became distressed, which added to their grief and affected their ability to manage their jobs, family life, and mental health.  This additional stress can ultimately impact couples’ willingness to seek help.  When these interactions were more compassionate, parents were more likely to have positive, healing memories that aided their psychosocial recovery.

It is also common for parents to develop poor coping strategies, and to adjust differently after the loss of a child. Those who do not seek out services because of shame, fear, or anger tend to suffer in silence. A study by social worker Joanne Cacciatore, Faculty Associate at Arizona State University, shows that women who attend a support group develop fewer post-traumatic stress symptoms than those who do not.

Opening up to other bereaved mothers is helpful for reducing grief and other mental health difficulties.  Partners may also find reaching out to religious or spiritual leaders, funeral homes, and support groups helpful.  Online resources like blogging can also be useful for parents looking to connect in an anonymous way.

Heather was lucky to have the support and experience of the women in her family, which played a critical role in how she managed her grief.

I was grateful that my mother came out to stay with me during the termination.  Talking with her helped.  Other family members also began opening up for the first time about their experiences with miscarriage and stillbirth.  I didn’t feel so alone.

Some organizations are working to educate marital partners on coping styles and seeking out support.  The International Stillbirth Alliance works to improve stillbirth prevention and bereavement care for those who have lost a child.  Although they do not provide individual services, they work with other organizations to connect locally and globally to improve standards of care.

Women who have had a stillbirth can benefit from bereavement services and support of their loved ones.  Those who suffer in silence will likely do so much longer than they have to.

– Danielle Tremblay, 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

Book Review: “Drop the Worry Ball”

Book Review: “Drop the Worry Ball”

00Anxiety, Attachment, Featured news, Parenting, Perfectionism, Resilience July, 15

Source: Stephan Hochhaus/Flickr

Parents are inundated with conflicting advice on how to raise their children. Pediatrician William Sears’ attachment parenting couldn’t be more different from the approach taken by “tiger mother” Amy Chua.  The range of “how-to” styles can leave parents scratching their heads about what’s best.

Research tends to support an authoritative parenting style, a balance of clear guidelines and expectations paired with warmth and attentiveness.  But in this age of perfected parenting, we are seeingan increase in anxiety and depression in children. Some think that caregivers are overparenting, and that this over-attentiveness may be causing problems.

In his latest book Drop the Worry Ball (2012, Wiley),clinical psychologist Alex Russell says that children no longer grow up; nowadays we raise them, placing all responsibility on the parents.  This results in caretaking that is too protective, too involved.  At the extreme, this becomes helicopter parenting.  Parents “hover” nearby, hyper-aware of the risks and needs of their child before the child is able to evaluate a situation or make decisions on their own.

Russell’s observation of the two outcomes of over-parenting:  too little or too much anxiety in children, parallel research of Ellen Sandester, professor at Queen Maud University College of Early Childhood Education in Norway.  Sandester argues that it is through risk that children expose themselves to fearful situations, and the thrill experienced from coping with anxiety helps develop the child’s evaluation of their ability to cope with future challenges.  When children are prevented from engaging in these non-catastrophic risks, they become either hypo-anxious or hyper-anxious.  With the first, there is too little realistic perception of consequences, so the child seeks greater thrill or tries out more dangerous situations.  With hyper-anxiety, the lack of experience leads the child to become phobic of novel situations.

Similar, but not identical to Sandester, Russell argues that we are seeing two kinds of children develop as a result of over-parenting.  First, there are those who become disengaged or avoidant of stress and anxiety and don’t want to take on the adult world. And second, there is the hyper-anxious child, the pleaser and perfectionist.  The imbalance of anxiety is created by anxious parents who hold the worry for their children –essentially shielding them from normal developmental experiences.  Similar to Sandester’s analysis, these children are deprived of the opportunity to cope with healthy, necessary levels of stress and anxiety.

That anxious parents could produce anxious children is not surprising, but that over-attentive parenting leads to hypo-anxious, disengaged children seems counterintuitive.  A lot of media attention has been given to the increasing numbers of children who are disengaged.  Russell argues however, that the same parenting style can create this avoidance of anxiety.  The parents make the adult world appear stressful and unmanageable, so why grow up?

Russell acknowledges that there is no quick fix, and that all parents make mistakes.  He recommends a mindful approach to parenting.  That is, a shift back to listening and reflecting on what the child says and does, instead of giving advice or actively taking over.

Parents need to appreciate that the child has the ability to cope with everyday risks, and need to give the child the space he or she needs to solve problems.

This book is a worthwhile read for parents.  Sometimes we need to remind ourselves that raising kids is about being “good-enough,” not perfect.

After all, children do grow up, and seem to do this best with a little space to explore and learn from mistakes.

– By Heather Carter-Simmons, 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

Dysregulation: A New DSM Label for Childhood Rages

Dysregulation: A New DSM Label for Childhood Rages

00Anger, Child Development, Cognition, Featured news, Health, Parenting, Self-Control, Stress July, 15

Source: Mary Anne Enriquez/Flickr

With the many changes in the newest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), among the most significant has been the inclusion of Disruptive Mood Dysregulation Disorder (DMDD)—a direct response to the dramatic increase in the diagnosis of bipolar disorder in children and adolescents during the 1990s.

Diagnosing bipolar illness in children is considered elusive at best.  Characterized by extreme and distinct changes in mood, bipolar illness ranges from depressive symptoms to manic “highs.”  In younger populations, the shift between manic and depressive episodes is not so clear.

Children often experience abrupt mood swings, explosive and lengthy rages, impairment in judgment, impulsivity, and defiant behavior.  Such parent-reported symptoms became a popular basis for childhood bipolar disorder diagnoses.

In recent years, Ellen Leibenluft, a senior investigator at the National Institute of Mental Health and an associate professor at Georgetown University, developed the concept of “severe mood dysregulation” as distinct from bipolar disorder.  Her research highlights the difference between unusual intense rages, and the distinct mood swings in bipolar disorder.

Anchored in her research, the DSM-5 task force attempted to develop a new classification for a disorder that shared some characteristics with bipolar disorder but did not include the abrupt shifts in mood.  By doing so, the task force hopes the rate of diagnoses for bipolar disorder in children will decline.

The DSM-5 characterizes DMDD as severe recurrent temper outbursts that are “grossly out of proportion in intensity or duration” to the situation.  Temper outbursts occur at least 3 times per week and the mood between outbursts remains negative.  To separate DMDD from bipolar disorder, children must not experience manic symptoms such as feelings of grandiosity, and reduced need for sleep.

Differentiating between bipolar disorder symptoms and rages unrelated to mood swings may very well be a step in the right direction.

But some studies suggest that DMDD may not be all that distinct or useful as a diagnostic entity different from those already in use, such as oppositional defiant disorder or conduct disorder.  It may be that DMDD is not a condition of its own, but rather a primary symptom of a larger issue.  Irritability and rages may be an indication of a disorder already established in previous versions of the DSM.

Aside from diagnostic labels, taking social situations into account may lead to a sharper understanding of rages in children.

While the role of biology cannot be discounted in the development of mental disorders, childhood behavioral problems may be affected by social and economic circumstances. Financial hardships and other parental stresses have an effect on children’s mental well-being, and stress may be detrimental to the communication between the parent and child.

Along with biological conditions, the DSM task force should consider the impact of the child’s social experience.  Helena Hansen, assistant professor of psychiatry at the New York University School of Medicine, argues that the recent revisions in the DSM-5 have missed key social factors that trigger certain biological responses.  Her article, published in the journal Health Affair, emphasizes the importance of understanding how social and institutional circumstances influence the epidemiological distribution of disorders.

For example, differing temperaments can explain why some children appear to cope well with life stresses while others develop problem behaviors.  Lashing out in the form of rages and tantrums may be a natural response to intolerable anxiety and stress for some children.

As new terms for disorders are coined, such as DMDD, we need to ask if the development of another category is the best alternative.  Is substituting one label of childhood behavioral problems for another really our best option?

Due to the many possible causes for temper outbursts, giving the child a single label may not be all that helpful.  Instead, determining the core issues surrounding the rages may be more useful in providing the patient with an effective treatment plan.

Also, let’s keep in mind that mental disordersare simply constructs, not unique disease states.  They are developed to allow better understanding of a group of behavioral, emotional, and cognitive symptoms, and are regularly revised based on new research and changing cultural values.  While the DSM is useful for the purpose of understanding the challenges faced by patients, it should not be given “bible” status.

Along with mental health care providers, it is important for parents to get informed about DMDD, to ask questions, and to get involved in discussions when considering treatment options for their child.

– Khadija Bint Misbah, 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

Distinct ADHD Symptoms in Girls Result in Under-Diagnosis

Distinct ADHD Symptoms in Girls Result in Under-Diagnosis

00ADHD, Adolescence, Education, Featured news, Gender, Parenting June, 15

Source: Ojo de Cineasta/Flickr

When my daughter was diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) in the first grade, I was devastated. I didn’t see a hyperactive, impulsive child or one with behavioural issues. I apparently missed the symptoms, now making me wonder how many other parents also don’t know what ADHD looks like in girls.

It’s common to hear stories of young boys being overmedicated and over-diagnosed with ADHD. What we don’t hear is that for every boy diagnosed, there is a girl whose symptoms are being missed.

Patricia Quinn, developmental pediatrician and director of the National Center for Gender Issues and ADHD, says that girls with the disorder often exhibit symptoms in less physical and disruptive ways compared to boys. Girls are raised to internalize their emotions in North American culture, this is likely why they are more commonly diagnosed as having the ADHD inattentive subtype. Quinn notes that even girls with the ADHD hyperactive subtype do not show the same physical energy as boys do with the same subtype, but instead, exhibit symptoms like incessant talking, chewing on hair or clothes, being emotionally reactive or displaying hypersensitivity.

Similar to my experience, Katie, a mother of two girls living in Arkansas, found her daughter Katelyn’s diagnosis surprising. After Katelyn’s second grade teacher noticed her difficulty focusing and staying on task, a psychologist diagnosed Katelyn with the inattentive subtype of ADHD and mild anxiety.

“I thought Katelyn was just a little over-sensitive. She never acted too fidgety or anything. The most she did was talk incessantly, but that wasn’t a big deal,” says Katie.

Katie’s younger daughter, Violet, demonstrated intense and sometimes aggressive behavior. She was diagnosed at age six with combined type ADHD with aggression. The impulsive behavior showed up in Violet as being “mean” and sometimes acting like a bully.

Michelle, a single parent from Toronto, is currently in the process of having her eight-year-old daughter Lisa assessed. Having already been through the assessment process with Lisa’s older brother Nick, Michelle explains, “With Nick we were doing damage control whereas with Lisa, her behavior was more covert and not as extreme.”

Lisa, Katelyn, and Violet are fortunate to have been diagnosed early.

Most girls are not diagnosed until puberty, and even then, their symptoms can be mistaken for other disorders like depression, anxiety, and bipolar disorder. Quinn highlights that in a 2002 nationwide survey by Harris International, 14% of adolescent girls who had ADHD were [improperly] treated with antidepressants before their ADHD treatment, compared to only 5% of males with ADHD.

Even once a diagnosis is made, parents can go through various stages of denial, grief, and blame. Child psychologists, Alexandra Harborne and Miranda Wolpert at CAMHS in England, and neuropsychologist, Linda Clare, at the University of Wales Bangor say that it is common for parents to blame themselves for their children’s bad behaviour. In addition to dealing with self-blame, parents may unintentionally delay an assessment for their child.

In Katie’s situation, she says Katelyn’s grandfather did not believe that there was anything wrong with her, causing Katie to question her decision to have her daughter assessed as well as her choice of a medication based treatment plan. So too, Violet’s daycare initially attributed her misbehaviour to poor parenting, rather than an inability to regulate her emotions and behavior.

Receiving a diagnosis can bring relief to parents as it provides an explanation for the behaviors they’ve experienced. But, it can also cause grief as parents deal with the loss of a “normal” child and anxiety over what the future holds for the family.

A key part of the assessment process should include some support for the parents. But this is sometimes hard for parents to find. CHADD, Children and Adults with ADHD is a network throughout the U.S. and Canada that provides support groups and parenting classes. ADDitude magazine is another helpful resource. These networks allow parents to share the process of understanding the diagnosis and learning new parenting skills.

Michelle says that after researching ADHD she has come to see her children as simply being wired differently. She refers to the reactions and behaviours of ADHD as her child’s “guidance system”. She believes triggers occur when the environment or situation is a poor fit for the child, but that they can find what they need, and learn what to avoid.

Katie thinks that ADHD is not a problem per se, but part of who her children are. She considers her girls’ different ways of thinking as leading to creativity and innovation, underscoring the idea that a diagnosis of ADHD is not necessarily a negative label. As Michelle and Katie demonstrate, just being able to accept and understand the differences created by ADHD can be empowering. It’s neither a curse, nor a gift, just a different way of thinking.

Quinn notes that ADHD is highly treatable regardless of whether it is present in girls or boys.

What we need now is a better understanding of gender differences so we don’t miss early signs, and can better treat ADHD in girls.

– Heather Carter-Simmons, 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

When a Parent is Incarcerated

When a Parent is Incarcerated

00Behaviorism, Child Development, Featured news, Law and Crime, Parenting, Trauma May, 15

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The wildly popular television drama Breaking Bad followed the evolution of a high school chemistry teacher and father turned drug kingpin.  The series came to an explosive end in the Fall of 2013; shows like this often end when the protagonist-criminal’s story ends.

But from a mental health standpoint, just as this occurs new stories begin, particularly for the family.

When parents are arrested or convicted their children face many challenges, one of the most important being the disruption of parent-child attachment.  Research shows that parent-child attachment directly affects cognitive and behavioural development in children, and this disruption can lead to social and behavioural problems later in life.

When a parent goes to prison, young children often develop emotional responses such as sadness, fear and guilt as a reaction to the parent’s incarceration.

These emotional reactions can turn into severe behavioural problems, triggering conflicts between the child and others.  Many children of incarcerated parents develop feelings of anger and aggression, leading to failed friendships in school.  Some may also become depressed and anxious, bringing academic and social challenges.

The child’s attachment to caregivers is important in the development of what psychologists call social cognition (the study of how our thoughts and perceptions of others affect how we think, feel and interact in our everyday life).  Our earliest thoughts about others are learned through our parents.  Children raised without a sufficient parent-child interaction may lose this important experience.  The child may have a difficult time socially, often when they approach adolescence.

The media tend to overlook children of criminals.  In 2005, it was estimated that more than 2.3 million children in the U.S. had a parent in prison.  How can children in this position be helped?

A two-step process, adapted by education professor Glen Palm of St. Cloud State University and the Inside-Out Connections Project, was developed to decrease these children’s odds of developing negative behaviours.

Step 1: Understanding and Awareness

When a parent is incarcerated, the child’s remaining caregivers often don’t know if or how they should explain the parent’s absence to the child.  Once a child understands the situation, they are more likely to adapt to the changes in their life in a positive way.

Clinical psychologist Deonisha Thigpen’s book When a Parent Goes to Prison helps explain incarceration to a younger audience.  It defines what breaking the law is, presents easy-to-understand definitions regarding the justice system, and even provides support to children by explaining that they are not the only one who is experiencing this situation.

And popular children’s television shows like Sesame Street have developed episodes for children with incarcerated parents.  They provide a visual explanation that helps to explain incarceration and how children can eventually explain it to their peers.

Step 2: Visiting the Incarcerated Parent

Once a child understands incarceration and what it means for them, they may be able to visit their parent in prison.  Prison visitations are often portrayed on television and in film, but reality often differs.

Visitors may have to wait an extended period of time before seeing an inmate, which can be challenging when visiting with young children.  Sometimes families of inmates wait for hours, to discover the visiting request has been denied.  When a visit is granted, most correctional facilities have large visiting rooms shared between many inmates and visitors, limiting close parent-child interaction.

A more viable prison visitation program for nurturing a parent-child bond is filial play therapy.  It is only an option for inmates who are not sex offenders and who have not committed any serious violations at their institution.  Once accepted into the program, they are taught how to create a safe and open environment with their child.  Then they meet with their child for one hour a week in a private setting, utilizing these new skills.

Play therapist, Garry Landreth, of the University of North Texas, believes that filial play therapy improves a child’s self-worth and self-esteem, despite the parent’s incarceration.  After a 10-week study, Landreth found that the children began to see themselves as more capable and valuable individuals.

Of course it’s fair to expect convicted criminals to pay for their crimes.  But no child should have to suffer for their parent’s mistakes by being left to grow up on their own.

And when those we incarcerate leave children behind, we’d be wise to consider the kind of future we want for the next generation.  Perhaps a future that gives a shot at something better…for their sake, and for ours.

– Alessandro Perri, 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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Treatments Available to Long Term Abduction Victims

10Animal Behavior, Cognition, Depression, Dreaming, Family Dynamics, Featured news, Health, Parenting, Psychiatry, Psychoanalysis, Sleep, Stress, Therapy, Trauma April, 15

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Between 2002 and 2004, 16-year-old Amanda Berry, 21-year-old Michelle Knight, and 14-year-old Georgina DeJesus were abducted from the streets of Cleveland, Ohio. They were lured into the home of Ariel Castro where they spent the next 11 years in captivity.

Often kept in restraints and locked rooms, the women regularly had their lives threatened to deter any plans of escape.  They were given little food or the opportunity to bathe. Sexual abuse led to Knight being impregnated several times, only to be beaten and starved in order to force miscarriage.  It wasn’t until May 2013 that the women were finally rescued and Castro arrested.

Other cases popularized by the media include that of Elizabeth Smart, held captive for 9 months, and Jaycee Dugard who was held captive for 18 years. These victims are now free, but living with the emotional aftermath.

In a 2000 study by the Department of Neurological and Psychiatric Sciences at the University of Padova, interviews with kidnap victims showed common after-effects of abduction including vivid flashbacks of the events, nightmares, and feelings of depression, all common symptoms of Post-Traumatic Stress Disorder.  Hypervigilance was also reported, where individuals anticipated danger and frequently felt guarded, leading to trouble sleeping, eating, and social withdrawal due to difficulty trusting others.

Mental health professors David A. Alexander and Susan Klein, from the Aberdeen Centre for Trauma Research in the UK also add that some victims end up “shutting off’ their emotions or denying that they even experienced a traumatic event, which may stem from a desire to avoid anything that reminds them of their trauma.

How does someone this traumatized even begin to recover?  Clinicians who work with these victims help them find opportunities to make their own decisions, to slowly understand that they are no longer powerless.

Clinical psychologist Rebecca Bailey, therapist to Jaycee Dugard, is the author of, “Safe Kids, Smart Parents: What Parents Need to Know to Keep Their Children Safe.” In an interview with the Trauma and Mental Health Report, Bailey explained: “Number one is helping victims find their voice.  When you’ve been kidnapped, so much of your world is about having choices made for you…From day one you have to give them choices for everything, Do you want a glass of milk, or do you want a glass of water? Things like that.”

Another important aspect to recovery is the role of the family.  It is through a strong connection with the family that the victim can feel safe, comforted, and empowered.  Bailey mentions “tribal meetings” with families soon after rescue to reunify both parties and create a support system. Through these family systems, further recovery is possible.

Specific therapeutic approaches for victim recovery really depend on the individual.  In some cases Cognitive Behavioural Therapy can be used, in other cases experiential therapy or a more psychodynamic approach can be implemented.  Common techniques used in therapy with kidnapping victims are role-playing, therapeutic pets, music, or even walking through the wilderness in an attempt to trigger underlying feelings that must be dealt with.

Often, different therapies are combined to see which works best for the individual. Bailey reminds, however, that client interaction with the therapist also has a large impact on recovery.

Bailey: The most important thing is for the therapist to be mindful, authentic, and purposeful. Counterproductive would be having a therapist who says very little.  This could almost reinjure [the victim] because they need a certain amount of modelling as well.

Modelling how to have an authentic healthy relationship—after the abusive one they had with their abductor—is crucial to helping the victim integrate aspects of normal everyday life.

Still, even with proper therapy and a strong support system, the trauma of being abducted and held captive for years is unlikely to be erased.  In the case of the young women in Cleveland, along with many others, the journey to recovery has been a challenging one, but one that has been described as worth taking:

“I may have been through hell and back, but I am strong enough to walk through hell with a smile on my face and my head held high,” says Michelle Knight in a YouTube video addressed to the public.  “I will not let the situation define who I am.  I will define the situation.”

– Contributing Writer: Anjali Wisnarama, 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

Child Criminals, Feature2

Children Who Kill Are Often Victims Too

00Adolescence, Attachment, Caregiving, Child Development, Empathy, Ethics and Morality, Featured news, Law and Crime, Parenting, Psychiatry, Punishment, Self-Control, Therapy, Trauma March, 15

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In 1993, in Merseyside, England, Jon Venables and Robert Thompson were charged with the abduction and murder of 2-year-old James Bulger.  Bulger had been abducted from a shopping mall, repeatedly assaulted, and his body left to be run over by a train.  Both Venables and Thompson were 10 years old at the time.

The public and the media called for justice, seeking harsh punishment and life imprisonment for the murder of a child.  The boys were labeled as inherently evil and unrepentant for their crimes.

When there are crimes against children, it is common for the public to view the victims as innocent and the perpetrators as depraved monsters.  But what do we do when the accused are also children?

Instances of children (12 years of age and younger) who have killed other children are extremely rare.  In a study conducted by University of New Hampshire professors David Finkelhor and Richard Ormrod for the Office of Juvenile Justice and Delinquency Prevention (OJJDP), murders of children committed by those aged 11 and under accounted for less than 2 percent of all child murders in the US. Cases also tend to differ significantly, so conclusions can be difficult to make.  But there are some similarities that have emerged, telling us about the minds of child murderers.

Children who murder have often been severely abused or neglected and have experienced a tumultuous home life.  Psychologist Terry M. Levy, a proponent of corrective attachment therapy at the Evergreen Psychotherapy Centre, notes that children who have severe attachment problems (which often result from unreliable and ineffective caregiving) and a history of abuse may develop very aggressive behaviours.  They can also have trouble controlling emotions, which can lead to impulsive, violent outbursts directed at themselves or others.

Other similarities among child murderers include having a family member with a criminal record, suffering from a traumatic loss, a history of disruptive behaviour, witnessing or experiencing violence, and being rejected or abandoned by a parent.  Problems in the home can be particularly influential.  If a child witnesses or experiences violence, they are likely to repeat violence in other situations.

What a child understands at the time of the crime is of great importance to the justice system.  The minimum age of criminal responsibility (MACR) is the age at which children are deemed capable of committing a crime.  The MACR differs between jurisdictions, but allows any person at or above the set chronological age to be criminally charged, and receive criminal penalties, which can include life imprisonment.

Many courts consider criminal responsibility in terms of understanding.  So they may consider someone criminally responsible if, at the time of the crime, they understood the act was wrong, understood the difference between right and wrong or understood that their behaviour was a crime.  But this approach has been criticized as being too simplistic.  Criminal responsibility requires the understanding of various other factors, many of which children cannot appreciate.

Children may know that certain behaviours are ‘wrong’, but only as a result of what adults have taught them, and not because they fully understand the moral argument behind it.  Morality and the finality of death are abstract concepts, and according to theorists such as Swiss psychologist-philosopher Jean Piaget (whose theory of child development has seen much empirical support), most children under 12 are only able to reason and solve problems using ideas that can be represented concretely.  It is not until puberty that the ability to reason with abstract concepts (like thinking about hypothetical situations) develops.

Prepubescent children are also not fully emotionally developed, and less able to use self-control and appreciate the consequences of their actions.  This, in combination with the fact that many child murderers are impulsive, aggressive, and unable to deal with their emotions, suggests that when children kill, they are treating their victim as a target, as an outlet for violence.  Most victims are either much younger than or close to the same age as the perpetrators, which may suggest they were chosen because they could be overpowered easily.

Research to date suggests that child murderers don’t fully understand the severity or implications of their crimes.  And psychiatric assessments have shown intense psychological disturbance, making true appreciation of the crime even less likely.  Yet many children have been found criminally responsible and sentenced in adult courts.

Jon Venables, Robert Thompson, and Mary Bell received therapeutic intervention while incarcerated, and have since been released.  As far as the public knows, only Venables has reoffended.  However, Eric Smith (convicted of killing 4-year-old Derrick Robie) remains behind bars today, even though he was imprisoned at 13.

Critics of judicial leniency for children accused of murder often cite the refrain ”adult crime; adult time,” choosing to focus on the severity of the crime rather than the age and competency of the offender.  Make no mistake; the murders of these children were brutal, depraved acts that caused intense suffering for the victims, their families, and communities.

But in our zeal, in our outrage, do we dehumanize these children?  Children who—like their victims—can be victims too.

– Contributing Writer: Jennifer Parlee, The Trauma and Mental Health Report

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

Copyright Robert T. Muller

Photo Credit:torbakhopper/Flikr

This article was originally published on Psychology Today

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Family Storytelling: Good for Children (and Parents)

00Anxiety, Family Dynamics, Featured news, Parenting, Resilience, Self-Esteem March, 15

Source: Heather Carter-Simmons

I recently received an envelope of photos from my mother; each image came with a story.  My daughters’ favourite turned out to be one about their Uncle David.  Living on a farm in Arkansas, David was four when he got new, slightly too-large, cowboy boots. The clomping noise drove my mother nuts, so she told him to take the boots off or go outside. Hearing the clomp-clomp yet again, she yelled at David; but there was no reply.  She marched into the kitchen only to find it wasn’t David at all but their horse in the kitchen…eating the chocolate chip cookies my mother had laid out to cool.

My daughters like the story because it’s funny.  And embedded within is the message that parents are not always right—a popular theme with children.

But in the context of so much else we have going on, how important is it to share a story about an uncle my daughters have never met?

Quite important, it turns out.  Research shows that writing about family events and expressing emotions around them can be healing. And Marshall Duke and Robyn Fivush, on faculty at the Emory Center for Myth and Ritual in American Life, found that telling and listening to family stories has value as well.  Key factors in sharing family stories are the life lessons and traditions that are passed on, but there are other benefits too.

Duke and Fivush found that sharing family stories creates resilience in children.  Their “Do You Know?” questionnaire assesses how much children know about their family, knowledge they couldn’t have acquired unless they had been told, like “Do you know where some of your grandparents met?”  Children who knew a lot about their family history also scored high for levels of self-esteem and feelings of control and capability.

Duke and Fivush also found lower levels of anxiety and depression and fewer displays of aggressive behaviour in children whose families shared family stories.  The same relationship was not found for families who just talked about daily events.

Stories pass on life lessons, instilling a sense of capability.  And the shared history and time taken to tell stories also fills the need to connect, providing, in Fivush’s view, a sense of belonging in our families, becoming a part of something larger than ourselves.

Telling stories in an interactive way, where the child or parent asks for assistance in conveying the story is important to building storytelling skills.  Elinor Ochs, professor of anthropology at UCLA, discusses storytelling as “theory building”.  The act of creating a story and having family members challenge your “theory” of events being related helps children develop the skills needed to create and test explanations.

It also highlights something my mother pointed out—there are many versions of the same event. When she and her sisters get together, they argue over each other’s renderings:  “That’s not what I remember…”  Yet each may be accurate for the teller.

And some stories just need embellishment. My great-grandmother would correct her son about stories he’d be telling, often prompting him to say, “Another good story ruined by a durned eyewitness.”

Factually accurate or not, the act of engaging in family storytelling brings richness to one’s sense of family, and with that, a connection to a shared past.  I tried to give my daughters a strong foundation from which to create their own stories, and I hope to be there to challenge another tall tale.

– Contributing Writer: Heather Carter-Simmons, The Trauma and Mental Health Report

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

Copyright Robert T. Muller

Photo Credit: Heather Carter-Simmons

This article was originally published on Psychology Today

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Virginity Tests Place Physicians in Quandary

00Embarrassment, Ethics and Morality, Featured news, Gender, Marriage, Parenting, Religion, Trauma January, 15

In October of 2013, the College of Physicians in Quebec, Canada, ordered doctors to stop performing virginity tests on women.

Remarkably, it took a formal directive from a governing agency to stop the degrading practice. Over the 18 months preceding the announcement, there were five reports in Quebec alone of requests for virginity tests. But physicians note that the tests are actually a hidden taboo practice occurring at a very high frequency.

Requests are often made by a woman’s family, seeking to fulfil traditional requirements of providing proof of ‘innocence’ for marriage. Physicians are actively pressured by families to conduct these tests and sign certificates for review by both families, putting doctors in a moral quandary: refusing to perform the test or giving a negative result can dishonour a woman in the eyes of her family, but going along with the procedure represents collusion.

Practiced all over the world, virginity tests are a longstanding tradition. Many African nations uphold the custom, purportedly as a means of controlling AIDS by checking which women are ‘safe’ to marry. But tests do not definitively determine the presence of HIV or AIDS as it is possible for people to become infected through other means—sharing needles or from parents.

And the test is highly subjective. In addition to many women being born with negligible hymens, stressful activities and even tampons can lead to ‘loss of virginity’. Other versions of the test, such as checking for overall laxity of the vagina, are painful and embarrassing.

In 2011, women attending protests in Egypt were rounded up and subjected to virginity tests and other forms of sexual assault and humiliation by police and armed forces. In Indonesia, high-school officials are considering implementing virginity tests as a way of controlling student behaviour and encouraging chastity. In Iraq, virginity tests are regularly ordered by the courts, whereupon husbands can sue their wives and their families for damages and dissolution of marriage. And in India, not only is it common practice to put brides-to-be through the procedure, but even rape victims are subjected, which, if they fail, may mean shunning by families and others.

In Canada, requests for virginity tests have come from parents concerned about daughters’ choices, as well as from educated professionals afraid of disappointing husbands-to-be. While it may seem a relief that the procedure now has been deemed outside the scope of physician practice, pressure remains in some communities, leading many physicians to give out fake ‘virginity certificates,’ to placate families and protect the privacy and dignity of the women in question.

As witnessed by Canadians just over two years ago, traditions like these can escalate with tragic consequences. In June of 2009, Mohammad Shafia, reportedly incensed at his ex-wife’s and daughters’ behaviours, engaged the help of his new wife and son in brutally murdering the four women. Known as honour killing, this practice views women as male property. Similar beliefs hold female chastity and obedience in high regard, with violations of cultural norms being equated with treason, to be cleansed only through death.

In Montreal, Quebec, it was recently discovered that hymenoplasties—surgeries which artificially recreate the hymen so as to cause bleeding during intercourse—have become the second-most popular plastic surgery. Alarmingly, private medical organizations have stepped up and begun offering secret, cash-paid procedures for several thousand dollars to interested parties.

It is hard for physicians to agree on the moral dilemma of virginity testing. One televised discussion shows some doctors stressing the inaccuracy of virginity tests, and how the inherent pain and humiliation associated with them is enough to justify abolishing them entirely. In contrast, Rachel Ross, physician and sexologist, points out that virginity tests can be useful in criminal cases involving children to determine whether sexual abuse took place.

The biggest quandary facing physicians is whether to let virginity tests and hymenoplasties be available to the public. The reasoning behind both has been examined extensively by medical ethicist Marie-Eve Bouthillier, who explains that banning these procedures may seem like the best step to end these women’s pain and humiliation, but it may also subject them to violent retribution or even more demeaning tests conducted by family members or religious leaders.

Conversely, Bouthillier states that “sometimes the virginity certificate will be the ticket for a forced marriage,” meaning that physicians who perform the tests or even give false results may still be condemning these women to a life of suffering.

A difficult choice indeed. Right where the paths of medicine, ethics, and culture collide.

Contributing Writer: Nick Zabara, The Trauma and Mental Health Report

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

Copyright Robert T. Muller

Photo Credit:<a href=”https://www.flickr.com/photos/proimos/6869336880/“>Alex E. Proimos</a>

This article was originally published on Psychology Today