Category: Post-Traumatic Stress Disorder

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Male Rape Victims Face Difficulty Finding Support

00Depression, Featured news, Post-Traumatic Stress Disorder, Suicide, Therapy, Trauma April, 17

Source: Fabrizio Lonzini on flickr, Creative Commons

In October 2015, Sweden opened the world’s first male rape center. It is the only known center that provides emergency medical care for men and boys who are victims of rape or sexual abuse. Although most rape centers don’t turn male victims away, there are no others that cater specifically to the physical and emotional needs of men who undergo such trauma.

The issue of male-on-male, and especially female-on-male rape and sexual abuse is largely unacknowledged in part because these forms of trauma are much less common than those involving a female victim. Statistics Canada reports that approximately 8% of sexual assaults involve a male victim.

In the 1980s, the word “rape” was removed from the Criminal Code of Canada and replaced by three different levels of sexual assault, specified by whether or not force or threats were involved and to what degree they were present. The problem with this approach is that “sexual assault” sounds like a lesser issue; it doesn’t carry the same weight as “rape”.

In October 2013, Kirk Makin wrote in an article for The Globe and Mail:

“Instead of the loaded word rape—with all its moral and social baggage—three levels of sexual assault were written into law, each level escalating in gravity. But getting rid of the legal term ‘rape’ didn’t stop it. In fact, many argue that it profoundly defanged the justice system and has resulted in lighter—not tougher—sentencing.”

Terminology may partly account for a lack of male rape centers, but so might the negative cultural view of a man being raped, particularly by a woman.

Popular culture and the media typically portray rape as involving penetration, which assumes only a male can perpetrate it. So, the common view is that men cannot be raped by women. For example, if a victim tells a friend he’s experienced unwanted sexual activity, the friend’s reaction is likely to be as congratulatory as horrified. And the victim is less likely to report the crime. An article on rape from Stanford University’s Encyclopedia of Philosophy even states in its premise the assumption that perpetrators are male and that victims are female, disregarding the issue of male rape altogether.

There is a common sentiment that men are always open to sexual advances and, therefore, automatically consent. This misconception can lead to situations where, if a man is intoxicated or otherwise unable to provide consent, he may subsequently be sexually assaulted. Contrary to stereotypes, the common view of “no means no” applies to both genders, and a lack of consent is just as significant as an expression of non-consent.

Another problem focuses on the male-on-male rape that occurs in prisons. Jokes about not “dropping the soap” are rampant in the media, giving the impression that, since these individuals are criminals, they should expect—indeed deserve—sexual assault.

And rape committed in prisons is not even included in national statistics, an omission that has the effect of failing to prevent abuse, as well as diminishing the issue. As a result, there is an insufficient allocation of resources for victims within the prison system. Victims require both emergency medical services, as well as counselling, to address the physical and emotional damage of sexual violence.

The opening of a male rape center in Sweden is a positive step, suggesting some progress toward support for male rape victims. But on a broader scale, the problem goes unacknowledged. Attitudes cannot change without a more systemic shift in how male rape is viewed and addressed.

–Andrei Nistor, 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

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CIA Torture Techniques Harm Interrogators As Well

00Anger, Empathy, Featured news, Intelligence, Post-Traumatic Stress Disorder, Stress, Trauma August, 16

Source: KamrenB Photography on flickr

In December of 2014, the U.S. Senate Intelligence Committee released a tell-all report about the Central Intelligence Agency’s (CIA) detainment and interrogation of suspected terrorists, concluding that the “enhanced interrogation techniques” used were far less effective and ethical than previously thought.

Under the supervision of medical staff, detainees were deprived of sleep for as long as a week, confined inside coffin-shaped boxes for several days, water-boarded multiple times a day, and even subjected to medically unnecessary “rectal feeding” or “rectal hydration” in an effort to assert “total control over the detainee.”

The report shows that, to obtain information, CIA officers intimidated detainees with threats to harm their families, which included, “threats to harm a detainee’s children, threats to sexually abuse the mother of a detainee, and threats to cut a detainee’s mother’s throat.” These individuals were also led to believe they would never be allowed to leave CIA custody alive.

According to Mark Costanzo, professor at Claremont McKenna College, torture used as an interrogation device can have severe, long-lasting effects on physical and mental health.

In the Senate report, one detainee, Abd al-Rahim al-Nashiri, was initially deemed compliant, cooperative, and truthful by some CIA interrogators. Yet after years of intense interrogations, he was diagnosed with anxiety and major depressive disorder and was later described as a “difficult and uncooperative detainee, who engaged in repeated belligerent acts, which included attempts to assault CIA personnel and efforts to damage items in his cell.”

Al-Nashiri accused CIA staff of “drugging or poisoning his food, and complained of bodily pain and insomnia.”

Yet the report failed to thoroughly investigate the long-term psychological consequences such techniques may inflict upon not only detainees, but interrogators as well.

CIA personnel involved in the interrogations also experienced psychological distress. Some even elected to be transferred out of the interrogation sites until the CIA stopped using torture as a form of interrogation.

Costanzo notes that research on the psychological consequences of partaking in torture is limited. Most studies have analyzed medical professionals who previously supervised torture to identify the psychological consequences.

In 1986, psychiatrist Robert Jay Lifton interviewed Nazi doctors who participated in human experimentation and mass killings. Lifton concluded that after years of exposure, many of the doctors experienced psychological damage similar in intensity to that of their victims. Anxiety, intrusive traumatic memories, and impaired cognitive and social functioning were all common consequences.

Costanzo believes that interrogators who use torture techniques may have similar experiences. In February 2007, Eric Fair, an American interrogator who was stationed at the Abu Ghraib prison in Iraq, confessed to participating in and overseeing the torture of Iraqi detainees. In his memoir, Consequences, Fair discusses how those events continue to haunt him—leading to martial problems, reoccurring night terrors and insomnia, substance abuse, and depression.

The U.S. public seems split on the issue of torture use, with many believing that enhanced interrogation techniques are warranted if they help prevent future terrorist attacks. Days after the Senate Intelligence Committee released the report, the Pew Research Center polled 1,000 Americans and discovered that 51% believed the CIA’s interrogation techniques were justified.

But according to Costanzo, many who survive torture reveal false information in order to appease the torturer and stop the pain. The Senate Intelligence Committee supported this finding when they discovered that none of the 39 detainees subjected to the enhanced interrogation techniques produced useful intelligence.

Senator Dianne Feinstein of California, head of the Senate Intelligence Committee, further argues that the CIA’s techniques are amoral:

“Such pressure, fear and expectation of further terrorist plots do not justify, temper or excuse improper actions taken by individuals or organizations in the name of national security.”

Feinstein is now proposing a bill to reform interrogation practices in the United States. The bill suggests the use of techniques designed by the High-Value Detainee Interrogation Group, which rely on building rapport and empathy as opposed to relying on physical and psychological pressure. This model has seen great success in both law enforcement and intelligence gathering in countries like Norway and the United Kingdom. Feinstein explains:

“It is my sincere and deep hope that through the release of these findings and conclusions, U.S. policy will never again allow for secretive indefinite detention and the use of coercive interrogations.”

–Alessandro Perri, 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

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Exercising Your Way to PTSD Recovery

00Featured news, Health, Post-Traumatic Stress Disorder, Stress, Therapy, Trauma August, 16

Source: Wounded Warrior Regiment on Flickr

Recent headlines about suicide, domestic violence, and shootings have brought public awareness to the mental health strain that is placed on the men and women in our military.

Post-traumatic stress disorder (PTSD) can drastically alter the lives of sufferers and is particularly common in veterans. The condition has been documented in 8% of Canadian soldiers who served between 2001 and 2008 in Afghanistan.

Effects include flashbacks, high anxiety, personality changes, startle responses, mood swings, and disturbed sleep, with typical treatment involving antidepressants and psychotherapy.

In an effort to develop treatment options, many are looking to physical remedies such as intense exercise to help those suffering from PTSD. We know that those who exercise regularly are less likely to suffer from anxiety and depression. But research by Mathew Fetzner and Gordon Asmundson at the University of Regina found that two weeks of stationary biking can be helpful in reducing PTSD symptoms and improving mood.

Further, researchers at Loughborough University have reviewed multiple studies that looked at the impact of sport and physical activity on combat veterans diagnosed with PTSD. Their findings: physical activity enhances well-being in veterans by reducing symptoms and improving coping strategies.

Symptom reduction in these studies seems to occur through a renewed sense of determination and hope, increased quality of life, and the cultivation of positive self-identity. The researchers explain that participating in sports and physical activities helps combat veterans gain or regain a sense of achievement.

Exercise also increases respiratory sinus arrhythmia. This naturally occurring variation in heart rate is linked to higher levels of emotion-focused coping—an ability disrupted in those with PTSD.

Treatment adherence is often a problem for PTSD sufferers, given that formal therapy is not always appealing to them, Fetzner claims. Low dropout rates of therapies involving physical exercise make the intervention feasible.

But the positive effects of intensive exercise on PTSD may be suitable only for some combat veterans: those with the physical ability to participate.

According to Veterans Affairs in Canada, psychiatric conditions are the second-most common cause of disability among returning soldiers. Debilitating physical injuries, such as amputations, and traumatic brain and spinal chord injuries are more common. And in addition to PTSD, the two most common mental health problems among returning soldiers are substance abuse and depression. More than 80 percent of the time, combat veterans have more than one diagnosis.

While aerobic exercise significantly reduces depression symptoms and helps prevent the abuse of drugs, the high rates of physical impairment in returning soldiers complicates the optimistic picture of exercise’s benefits on PTSD.

Less physically demanding exercise may be an option. Recent research shows that yoga, for example, may help individuals with PTSD focus on the present, reduce rumination, and combat negative thinking patterns.

While strenuous physical exercise may only be helpful for some returning veterans, milder forms of exercise and physiotherapy may be a useful adjunct to traditional treatment for many others. In either case, it is important for researchers and clinicians alike to take note of alternative ways of treating PTSD in an effort to provide options to those affected with the debilitating disorder.

–Veerpal Bambrah, 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

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Killing the American Hero, Killing the Fair Trial

00Attention, Featured news, Health, Law and Crime, Media, Post-Traumatic Stress Disorder, Psychiatry, Psychopathy April, 16

Source: Quadraro on DeviantArt

Was he “insane” or not? That is the question jury members in Erath County, Texas addressed, on February 25th, 2015, during three hours of deliberation in the Eddie Ray Routh case.

Routh, a veteran of the Iraq war, was convicted of murder after he shot two fellow veterans, Chad Littlefield and Chris Kyle, who was famously known as the most prolific sniper in American history and whose memoir inspired the blockbuster film, American Sniper. Kyle, who worked to help veterans cope with post-traumatic stress disorder (PTSD), was asked by Routh’s mother to see if there was anything he could do for her son. When Routh, Littlefield, and Kyle went to a shooting range—a routine practice used by Kyle to help veterans ‘blow off steam’—Routh opened fire, killing both men.

Routh’s defence lawyers pursued an insanity plea, citing a diagnosis of paranoid schizophrenia as the reason for his actions.

According to section 8.01a of the Penal Code of Texas, an individual may successfully plea not guilty by reason of insanity if evidence proves that at the time of the incident, the accused, as a result of “severe mental disease, did not know that his conduct was wrong.” Citing a police interrogation that took place after the incident—not before, as outlined by law—where Routh answered that he knew what he did was wrong, prosecutors argued that the defense was invalid. The jury agreed, and Eddie Ray Routh was sentenced to life in prison with no chance of parole.

Decisions in so-called insanity cases are often controversial. Routh’s case calls into question the legal system’s impartiality and treatment of mental health issues, in particular.

The case was widely publicized for its duration, which coincided with the release of American Sniper. The film was highly acclaimed and portrayed Chris Kyle as a hero, especially for the townspeople in Erath County. Typically, when a jury from a particular area is likely to be biased, it is common practice for defense lawyers to move the trial outside the district in which the crime was committed. In Routh’s case, this motion was denied, despite some jurors even admitting to having seen American Sniper before making their decision.

In addition to lacking impartiality, the Texas court also failed to properly account for Routh’s mental health.

Routh was diagnosed with paranoid schizophrenia by a psychiatrist prior to the incident at the shooting range. His medication was found when police raided his home. According to Routh’s family and friends, he had also experienced episodes of aggression, irritability, suicidal thoughts and attempts, and psychotic episodes. These episodes consisted of extremely erratic delusions ranging from vampires and werewolves, to him believing he was God and Satan.

But the insanity exclusion in Texas does not take a holistic view of an individual, instead using narrow and limiting language to define insanity. While Routh may have agreed that his actions were wrong after the event, there is no way to know what he was experiencing throughout. And if his previous psychotic episodes are representative, he may have been psychologically removed from reality at the time of his actions, possibly believing he was acting to save his own life.

Some argue that Routh and others like him should still be held responsible for their actions, despite their mental health problems. But, what many do not understand, is that being found not guilty by reason of insanity does not mean the individual walks free. In many cases, such a verdict could lead to extremely long detention in a psychiatric institution, where individuals are kept under close watch as they undergo treatment for their disorder.

In refusing to accept Eddie Ray Routh’s insanity plea, the Texas legal system is doing more than just punishing an individual who may not have been aware of his own actions, they are also denying treatment to a seriously ill person. At this rate, many mentally ill individuals will continue to be punished for actions they did not intend or understand, never receiving treatment and never having a chance to recover.

For more details about the Not Criminally Responsible Defense (as it is known in Canada), see our article entitled Myth Busting the Not Criminally Responsible Defence.

– 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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Srebrenica Massacre Continues to Haunt Victims

10Featured news, Law and Crime, Politics, Post-Traumatic Stress Disorder, Resilience, Trauma March, 16

Source: Sara Benceković

The defendant entered the courtroom, giving a thumbs-up to the judges and clapping mockingly at the spectators watching from a glass-walled gallery. His name: Ratko Mladić, a 70-year-old former Bosnian Serb army general whose troops committed the single largest war crime in Europe since the Second World War.

In July 1995, a 15-square-kilometre area around the city of Srebrenica had been designated to offer shelter to Muslims fleeing Serbian armed forces. 400 Blue Berets were deployed by the United Nations to safeguard the area and over 10,000 people from all over Bosnia flocked to it for safety.

When Mladić’s troops arrived, they overcame the UN forces and most of the men and boys were slaughtered, while women were forced to flee. Over the course of four days, eight thousand people died.

After 16 years of hiding from UN accusations, Mladić was arrested in 2011 and has been on trial for his involvement in the massacre since June of the same year. He is accused of persecution on political, racial and religious grounds, extermination, murder, deportation, inhumane acts, terror, unlawful attacks on civilians, and taking peacekeepers as hostages.

Prosecutors have been building a case against Mladić, claiming that he led a coalition to ethnically cleanse parts of Bosnia of non-Serbs. His intentions, they say, were guided by the Serbian nationalist ideology of the Great Serbia, which aspired to claim territories of modern-day Croatia, Bosnia, Montenegro and Macedonia. However, his defence counsel describes Mladić as a patriot who merely fought to defend his people.

Although Mladić denies the allegations, many survivors consider him directly responsible for their trauma. Nineteen years have passed since the end of the war, but the sorrow still hangs heavy over Srebrenica. Over four hundred witnesses flew in from all over Bosnia to testify against him before the tribunal.

In witness testimony during the trial, one survivor said: “My neighbours have gone to live in some other world, my schoolmates lie buried beneath the old playfields. My husband, once warm and loving, now lies bloodless and breathless. My life is an illusion; I died long before I will be buried.”

To this day, mass graves continue to be discovered across Bosnia. So far, nearly 5,000 victims of the bloodshed have been laid to rest, yet similar numbers remain undiscovered. A list with the names of missing people has since been compiled and published in the hope of gathering information from the public that could bring closure to family members.

Despite these efforts, many victims and their families have not yet found peace.

Elvedin Pašić, a witness at the UN trial, testified about being separated from his father when they were captured by Serbian soldiers. Women and children were forced onto buses to be dispatched from what is now Serbian territory, while men, including Pašić’s father, were required to stay behind. Most of them were never seen again.

During Pašić’s testimony, Mladić did not react and later denied feeling any guilt for his participation. His defence team claims that he suffers from a memory disorder that makes it impossible for him to differentiate between truth and fiction.

If the allegations against Mladić are proven in court, he will face a life sentence in prison. Many of those affected by the Srebrenica massacre see his captivity as justice that would end their suffering.

Witnesses have called for a restoration of the region back to its pre-war state. The area of south-eastern Europe used to be a mosaic of overlapping minorities, in which residents rarely had a sense of their neighbours’ nationality. Inter-marriage was common, children were bi-religious, and conflict was far from people’s minds.

Although it will likely take more than the imprisonment of war criminals to heal the trauma endured, Srebrenica survivors have united under the collective vision of rebuilding for the future. By seeking redress in the Mladić trial, the survivors of the region have generated empathy and support from those around them.

They continue to challenge the official history of events and in doing so have become prosecutors and judges in their own right, seeking justice for these crimes.

– Sara Benceković, 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

Female Inmates and Psychological Impacts

Prisons Perpetuate Trauma in Female Inmates

40Bullying, Featured news, Health, Law and Crime, Post-Traumatic Stress Disorder, Therapy, Trauma January, 16

Source: r. nial bradshaw on Flickr

In May 2012, the Equal Justice Initiative (EJI) filed a complaint with the U.S. Justice Department for maltreatment of inmates in Alabama’s Julia Tutwiler Prison for Women. EJI urged an investigation of the Alabama Department of Corrections, claiming they fail to protect inmates from sexual violence.

After an on-site inspection, federal investigators confirmed allegations that officers were frequently engaging in sexual violence against inmates.

Instances of repeated rape, sodomy, fondling, and exposure were reported.

According to its website, “The mission of the Alabama Department of Corrections is to confine, manage and provide rehabilitative programs for convicted felons in a safe, secure and humane environment.”

But the reality of the modern prison system paints a very different picture.

Allen Beck, Senior Statistical Advisor for the Bureau of Justice Statistics (BJS) reported that “of the 1.4 million adults held in prison, an estimated 57,900 said they had been sexually victimized.” Statistics of abuse in local jails are similar.

Even more startling is a report by the BJS stating that 49% of nonconsensual sexual abuse in prisons involves staff sexual misconduct or sexual harassment toward prisoners.

Among those who experience the most damaging effects of sexual abuse are female inmates with preexisting mental health disorders or past trauma. These women make up a large number of prison inmates.

Charlotte Morrison, a senior attorney with the EJI, explains that to participate in the prisons’ rehabilitative programs, women are required to go through an invasive strip-search in front of male officers each day, a distressing experience for any woman, but especially difficult for those with a history of trauma or abuse.

And mental health services in prisons are either nonexistent or inadequate in supporting prisoner needs. BJS found that only 22% of prison abuse victims receive crisis counseling or mental health treatment.

The consequences are devastating. Higher rates of posttraumatic stress disorder, anxiety, depression, and suicide are frequently reported in female inmates, as well as exacerbation of preexisting psychiatric disorders.

“The key takeaway here is the levels of impunity in detention facilities” says Jesse Lerner-Kinglake, spokesperson for Just Detention International. Prison guards are often exempt from any punishment after assaulting or sexually abusing prisoners.

According to the BJS report, only 46% of sexual assault cases between staff and prisoners were referred for prosecution. In about 15% of cases, staff members were allowed to keep their jobs.

Lerner-Kinglake goes on to say that women underreport abuse because of limited legal options, and because they fear segregation and retaliation by staff.

In 2003, the Prison Rape Elimination Act (PREA) was passed into law to analyze the incidence and effects of prison rape and to provide resources, recommendations, and funding for protection. Yet a decade later, abuse persists and statistics have barely improved.

This may soon change, however, as May 15, 2014 marked thedeadline for U.S. states and territories to submit certificates or assurances agreeing to comply with PREA standards. Those not following PREA regulations face potential reductions in grant funding.

While the U.S. government is finally enforcing prisoner safety laws, inmates still suffer from limited access to mental health services.

Many organizations recognize the limitations of the prison system and work to make these services available to prisoners. For example, Just Detention International (JDI), a health and human rights initiative, provides prisons with links to community hotlines and crisis counseling for rape victims. Public ads from such organizations are also being aimed at addressing the stigma surrounding prison rape.

While these may be positive steps to improve prisoner safety, further advocacy and legislation is necessary to protect inmates’ legal rights and to facilitate rehabilitation.

– Eleenor Abraham, 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

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

When A Loved One Attempts Suicide

When A Loved One Attempts Suicide

10Depression, Featured news, Forgiveness, Post-Traumatic Stress Disorder, Suicide, Therapy, Trauma January, 16

Source: Wayne S. Grazio/Flickr

About two years ago, I personally came face to face with the suicide attempt of my best friend, Bella.  Distraught, she had called to tell me she loved me and that I was the best thing that ever happened to her.  I listened to her cry for a few minutes until she suddenly disconnected.  I was immediately filled with a sense of fear and dread.

Soon in my car breaking the speed limit, I was yet unaware how my life was about to change.

Bella suffered from clinical depression and although she kept it a secret from most, I was well aware of her struggles.  She had two kinds of days:  bad and terrible.  Her boyfriend had just broken up with her, which sent her into a tailspin.  She was in an inescapable depressive state, filled with thoughts of suicide.

Many parents who experience such episodes with their children are plagued with mixed emotions of self-blame, anger, shock, and grief.  They often feel powerless, not knowing how to help their children, and the threat of losing them is ever present.  Bella’s parents were no different.  They were emotionally exhausted and needed a break.  When I got to Bella’s house I told her parents that I would stay with her for a couple of hours.

We watched TV in silence, and soon Bella looked toward me decidedly, as if she had finally settled on a course of action.  She told me she had to go to the washroom downstairs.

Minutes passed and she had not returned.  An overwhelming anxiety came over me, I had to check on her.  As I walked down the stairs –my heart beating rapidly and my mind venturing to the unthinkable– I saw her.  Face blue, eyes red.  She was attempting to strangle herself with a rope she had found in the basement.

Although sparse, research on the effects of witnessing a peer’s suicide attempt shows that the event can have a strong impact on the witness.  Individuals may develop varying degrees of post-traumatic stress disorder (or PTSD) or other anxiety disorders.  Experiencing powerful and recurrent memories of the event and avoiding situations that may remind one of the trauma, create a cycle of negative thoughts and emotions that can make treatment challenging.

According to clinical psychologist, Daniel Hoover of Baylor College of Medicine, anyone in direct contact with a suicide attempt should seek out treatment following the event (which doesn’t necessarily have to be one-on-one counseling to be effective).

When I saw Bella trying to kill herself, I immediately rushed over, removed the rope and hugged her.  She cried, gasping for air, furiously yelling at me for stopping her.

For a long time afterward, this image of Bella was embedded in my mind.

And I felt profoundly guilty after the incident:  If I had not let Bella leave my sight, she might not have attempted suicide.  This thought often came to mind.  A vicious cycle of uncertainty plagued my daily activities.  I was holding myself accountable for actions that were ultimately out of my control.

I kept her suicide attempt a secret from everyone in my life.  I didn’t want to hurt her reputation or break her trust, and I became tormented by the trauma, but I couldn’t confide in family or friends for fear of having to explain Bella’s story.  For the first time in my life, I felt utterly alone.

Brian L. Mishara, author of The Impact of Suicide, suggests that telephone support programs can reduce the emotional burden on family and friends.  Counselors build a relationship with their client and provide information on healthy coping strategies and useful resources –all over the telephone.  Counseling calls tend to continue weekly over a period of time until the person feels comfortable coping with their traumatic experience.

Although challenging, recovery is possible.  Two years later, I’m doing much better.  For one thing, I needed to realize that Bella’s suicide attempt was not my fault.  You can only do so much to help a loved one when they are suffering from suicidal thoughts.  We want to protect our friends and family members, but we also need to protect ourselves.

And, suffering alone doesn’t work.  Withholding your thoughts after a traumatic event can compromise your physical, emotional, and psychological health.

Coping with a loved one’s suicide attempt is not easy.  Finding someone you trust and expressing your thoughts is helpful.  It’s much easier to cope when you have a trusted ally by your side.

– 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

Trauma Survivors at Risk for Future Abusive Relationships

Trauma Survivors at Risk for Future Abusive Relationships

10Child Development, Domestic Violence, Featured news, Identity, Post-Traumatic Stress Disorder, Relationships, Trauma January, 16

Source: David Dávila Vilanova/Flickr

In her 2012 TED talk on domestic violence, Leslie Morgan Steiner discusses what she calls “crazy love,” the irrational and often deadly tendency to be oblivious to the red flags that indicate you are sharing your life with an abusive partner.

After discussing the typical situations that often lead to an abusive relationship, Steiner states that by asking the  question, “Why doesn’t she just leave him?” we are blaming the victim for falling in love with someone who would go on to abuse them.

While Steiner was not a victim of childhood abuse, many women and men who find themselves in similar situations are.

Victims are never at fault; no one asks to be victimized by their relationship partner. But for those who do have a prior history of abuse and who might find themselves in repetitive abusive cycles, what ability do they have to become aware of their vulnerability to future abuse?  And more important, could such awareness be helpful to them?

When children witness or experience abuse, it can have a detrimental effect on their well being as an adult.  Their experiences have been linked to the development of depression, anxiety, substance abuse, as well as eating disorders later in life.  Early exposure can also place individuals at a higher risk of experiencing abusive relationships in the future.

Joanna Iwona Potkanska, a Toronto-based social worker and trauma-informed psychotherapist says, “We tend to remain in patterns that are familiar to us.   We often do not realize that the relationships we are in are abusive, especially if we grew up in dysfunctional families.”

Based on British psychiatrist John Bowlby’s original work on attachment, theorists view the attachment style one develops as a child as related to adult relational patterns.  Internal understanding of how relationships work derives from primary caregivers and is the basis of later interactions.

“It would be foolish to say that observing domestic abuse from a young age doesn’t have an impact on a person’s future relationships.  It contributes to the construction of a child’s belief system – on how a relationship should be and what it should look like,” says Whitney Wilson, a counselor for the Partner Assault Response program at the John Howard Society of Toronto.

Wilson considers exposure to early domestic abuse as altering one’s view of romantic relationships in many ways.  “It’s similar to having a parent that smokes; smoking becomes normalized and may influence your decision to smoke.  Or, you may dislike that your parent smokes and swear off it.  It really depends on your lived experience and how it affects the formation of your beliefs.”

According to Potkanska, when we experience interpersonal trauma, whether physical, emotional, sexual or spiritual, we often lose our sense of self.  The abuse becomes part of our story and is deeply internalized.

She says that when offenders are also caregivers, victims most often blame themselves.  “The idea that we are loved as we are being abused, or that we are being abused because we are loved(many perpetrators use this excuse to justify their actions) can become a template for the way we relate to the world and ourselves.”

So, if a woman grows up with a model of relationships that involved abuse, anger, and shame, will she believe that she deserves a different kind of relationship?  Or might she believe that a relationship based on support and love simply does not exist?

It depends…  The way people make sense of their early relationships, and the conclusions they draw from them, depend a good deal on what occurs in other important relationships in their lives.  And nowhere is this seen more clearly than in the area of counseling and psychotherapy.

By working with a therapist, individuals can learn to identify how they interpret experiences based on ‘old information’ and can learn to recognize the warning signs of an abusive relationship.

Potkanska says that “without learning how to set healthy boundaries, we allow others to harm us and we re-enact conscious or unconscious situations in an attempt to have either a different outcome, or to reinforce what we already believe about ourselves.”

Healthy attachments to other supportive family members and mentors can buffer the effects of childhood abuse.  For those not fortunate enough to experience positive relationships growing up, there are other ways to break the cycle.

The connection a survivor builds with their therapist is meant to act as a model for secure attachment.  This can then translate to the way the individual perceives themselves and how they interact with others.

Potkanska emphasizes safety and space within the therapeutic relationship, noting that “Simple actions like ensuring that adequate physical space exists between myself and my client shows that I respect their boundaries.”

A large part of the therapy process focuses on building an identity that is separate from the abuse.

“Romantic partners and relationships become a way to soothe and regulate, and so when clients are taught to self-soothe, they are less likely to look to their partner to provide what their perpetrator has failed to do. They eventually rely more on themselves and other resources, including healthy relationships, to meet their needs,” says Potkanska.

Even with therapy, breaking the cycle of abuse can be difficult.  Building an identity separate from abuse can take years of self-work, and often people cannot afford therapy or have limited access to resources.

And then there are the socio-political causes that force people to remain in abusive situations.  Potkanska points out, “Without adequate financial support, women and children are reliant on their perpetrators.  Our legal system does a poor job at protecting survivors of violence, even after they leave the abuser.”  Not only that, but it is usually after the victim has left that they are in the most danger.  Simply because, as Leslie Morgan Steiner states, “the abuser has nothing left to lose.”

So what do people who’ve experienced abuse as children, but go on to have normal and healthy relationships do so differently?

According to Wilson, “It’s really an active process for all of us, even those who were not abused.  Because we’ve allowed society to normalize things like verbal or emotional abuse you have to really know what a healthy relationship looks like and know that it’s hard work.”

Being in a healthy relationship is about giving yourself permission not to have to accept abuse.  And for many, that takes practice.  You have to first identify that you’re stuck in a cycle of violence, and then decide you have the right to break it.

– Jana Vigor, 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

Officers with PTSD at Greater Risk for Police Brutality

Officers with PTSD at Greater Risk for Police Brutality

00Featured news, Health, Law and Crime, Post-Traumatic Stress Disorder, Stress, Therapy, Trauma November, 15

Source: Thomas Hawk on Flickr

After dropping off a colleague on September 14, 2013, Jonathan Ferrell began his journey home.  That night, the North Carolina highway proved more treacherous than he expected.  He veered off an embankment and, shaken but uninjured, made his way over to the first house he saw to get help.  But residents mistook his intentions and called police.

It’s unclear what transpired when three officers arrived 11 minutes later.  In moments, Ferrell lay dead with 10 bullets in his body.  Autopsy reports suggest he was on his knees when shot.

Victims of police brutality have been people of all ages, races, and walks of life – from 84-year old Kang Wong, beaten for jaywalking, to a 14-year-old boy disfigured for shoplifting, to two married university professors, one of whom had undergone open heart surgery only several days prior to being struck and dragged off in handcuffs.

Police violence does not confine itself to any one area.  Hundreds of protestors suffered physical and sexual assaults at the hands of police officers during the 2010 Canadian G20 protests.  Civilians were killed and publicly tortured by police as protestors pushed for democracy in Kiev, Ukraine.

But what puts officers at risk for engaging in police brutality?  New research from the Buffalo School of Medicine and Biomedical Science points to links between police brutality and pre-existing post-traumatic stress disorder (PTSD) in the officers themselves.

PTSD is a diagnosis traditionally used for victims of overwhelmingly stressful experiences, such as rape, combat, and natural disasters.  Many victims of police violence often experience PTSD, which manifests as severe agoraphobia and paralyzing panic attacks.  This creates a downward spiral of isolation, depression, and even suicide.  Treatments for PTSD involve facing the trauma and reconsolidating the memories in more constructive ways.

But the link between PTSD and police violence appears to be a two-way street.  Not only does police brutality have the potential to cause PTSD in victims, but according to psychiatrist, Ben Green of the University of Liverpool, violence among officers may be exacerbated by their prior experiences, their previous high incidence of PTSD, which stems from being exposed to many of the same traumas as soldiers in combat.

Yet because mental health issues continue to be a source of stigma in law enforcement, many police officers suffer in silence.

In the U.S., police officer deaths from gun violence and other causes have gone up by 42% from 2009 to 2011.  And each year, 10% of all law enforcement officials are assaulted, with a quarter of them sustaining injuries.  At the same time, public pressure on police to restrain their use of firearms against the public has reduced the number of bullets fired by officers by over 50% in the last decade.  This means that police officers are finding themselves in life-threatening situations more often, but are less able to respond, creating a state of fear and tension, factors that give rise to PTSD.

For the public, the danger of police officers developing PTSD comes from an increased startle response, suspicion, and aggressiveness.  These tendencies can make officers more likely to lash out at the public and result in the deadly overreactions that sometimes occur.

Symptoms of PTSD are often triggered by the same situations that caused the trauma.  This may be why officers who kill unarmed civilians report feeling confused and suffer from memory loss when they lose control.

While many officers cite unmanageable work stress and traumatic incidents suffered on the job when explaining misconduct, few law enforcement agencies offer comprehensive mental health care for dealing with PTSD.  Among the officers themselves, talking about trauma and mental health is oftentimes discouraged, leaving sufferers isolated or stigmatized.  At the same time, the justice system also serves to cover up the problem, imposing minimum punishments for officers and giving victims of police brutality no closure to initiate their own recoveries.

Better mental health awareness would help.  Allowing police officers to speak freely and receive treatment for their job-related stress would reduce PTSD.  Teaching fellow officers to recognize the symptoms of PTSD –including social withdrawal, personality changes, and poor decision-making – would allow them to help their partners and coworkers before problems escalate.

Giving officers access to treatment and support early on can reduce future incidents of police brutality and ensure that they get the help they need.

And understanding that police officers are often victims of violence is important for continued public trust in law enforcement.  The key is education and access to treatment.

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

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

Copyright Robert T. Muller

This article was originally published on Psychology Today