Category: Trauma

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Remote Northwest Territories Lacking Mental Health Care

00Environment, Featured news, Health, Self-Harm, Suicide, Therapy, Trauma November, 16

Source: Gloria Williams on Flickr, Creative Commons

On April 26, 2015, 19-year-old Timothy Henderson, a resident of the North West Territories in Canada, was taken off life support after sustaining self-harm injuries, the culmination of a long battle with depression and other mental health issues.

Beginning in adolescence, Timothy struggled with symptoms of ADHD and Asperger’s syndrome (Autism spectrum). When he felt overwhelmed by his condition, he reached out for support, but felt dismissed, and began to lose hope that the help he needed would be available.

Shortly before his death, Timothy admitted himself to Stanton Territorial Hospital for the fifth time in a year, where he again disclosed details about a tendency to self-harm. He was released two days later, without adequate follow-up or a long-term care plan. Later that month, he sustained self-inflicted injuries that led to his death.

Timothy’s case is not uncommon in the Northwest Territories, a remote region of northern Canada. The NWT Mental Health Act states that a medical practitioner can only detain an individual for psychiatric assessment for a maximum of 48 hours. This time limitation often results in rushed and insufficient care—a result of a system that is understaffed and overworked.

The territory’s current Mental Health Act, introduced in June 1988, has been cited as a main cause of inadequate services for individuals suffering from mental illness. The act is out-of-date and has not been modernized with strategies to address the current mental health climate of the NWT.

In a report by the Alternative North Health Coalition, the mental wellbeing of residents in the NWT is shown to be much lower than that of the average Canadian, with a national rate of suicide three times greater than those living in the more populous south. Lack of access to staff, resources, and community-based treatments are all relevant aspects of the act that impede adequate treatment and prevention strategies.

Timothy’s mother, Connie Boraski, believes Timothy’s mental health began to worsen when he turned 17, and no longer qualified for the pediatric healthcare program. This transition resulted in lengthier waits for treatment and drastic changes in privacy laws that prevented Timothy’s parents from having access to information about their son’s treatment. Mental health legislation regarding the legal rights of family members and other caregivers is an aspect of the Mental Health Act that restricts parents, like Timothy’s, from intervening to support their children.

After being repeatedly dismissed, Timothy eventually stopped asking for help. Boraski explains:

“Timothy never wanted to be a burden to anyone. That was a real challenge for him, to ask for help.”

Deficiencies in the quality and quantity of staff and resources reflect the isolation and socioeconomic climate of the NWT. Due to the small and relatively isolated nature of the region, accessing facilities within the community can be difficult. Timothy had to travel between hospitals in the NWT and Alberta to obtain psychiatric help, which resulted in seeing a different doctor on each occasion. This kind of disjointed doctor-patient relationship makes it difficult to stay connected.

The public outrage following Timothy’s death eventually drove NWT Health Minister, Glen Abernethy, to open a review into Timothy’s case and bring changes to mental health legislation. In addition to other important components, the new act will include information on services such as Assertive Community Treatment (ACT), which will allow patients to have access to specialized treatment and supervision within remote communities of the NWT.

The revised act, if passed, is expected to come into effect sometime in 2016. Though implementation of a new mental health act is too late for Timothy Henderson, the hope is that a new mandate will provide the Northwest Territories with better preventative measures and resources for residents suffering with mental illness.

– Nonna Khakpour, 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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Death Penalty May Not Bring Peace to Victims’ Families

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Copyright Robert T. Muller

This article was originally published on Psychology Today

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Semicolon Punctuates Mental Health Awareness

00Addiction, Featured news, Health, Resilience, Self-Harm, Suicide, Trauma September, 16

Source: Brittany Inskeep on Flickr

Sure, writers dismiss it. But the semicolon—the otherwise underwhelming punctuation mark—has had its share of fans like American physician and poet Lewis Thomas, who said the semicolon leaves “a pleasant little feeling of expectancy; there is more to come; read on; it will get clearer.”

Amy Bleuel echoed this sentiment when she founded Project Semicolon on April 16, 2013. This global non-profit movement is dedicated to providing support for those struggling with mental illness, suicide, addiction, and self-injury.

In a recent interview with the Trauma and Mental Health Report, Amy shared the meaning behind the semicolon:

“It represents continuance. Authors usually use the semicolon when they choose not to end the sentence. You are the author and the sentence is your life, and you’re choosing to continue.”

In 2003, Amy lost her father to suicide.

“I’m kind of continuing his story by telling it to raise awareness. It took 10 years for me to do it but I was able to use his story to bring hope to others and that was my inspiration.”

Since the project’s humble beginnings, the semicolon has evolved into something much bigger. After one of Amy’s blog posts went viral, many decided to get inked with the symbol. What’s more: they started sharing their stories online and creating awareness around mental illness.

But according to Amy, Project Semicolon was not intended to become a tattoo phenomenon:

“It was not meant at all to be a tattoo campaign. It was just picked up as that. I got a tattoo. People started getting a tattoo. It became something people apparently wanted to say.”

It also became something people were willing to stand behind. As a registered charity, Project Semicolon raises funds to help fight stigma and present hope and love to those in need. Dusk Till Dawn Ink, a tattoo shop in Calgary, even donates a portion of the proceeds from semicolon tattoos to the Canadian Mental Health Association.

But the semicolon isn’t the only mental health tattoo out there. Casidhe Gardiner, 20, has an eating disorder recovery symbol tattooed on the inside of her arm, alongside the words “take care.” To her, the tattoo serves as a reminder to look after herself and to avoid relapse:

“If I branded myself with a recovery symbol in a place that I could see all the time, it would remind me in a hard time when I’m spiraling down again that I’ve recovered. I’ve done all this hard work to get there. Why go through the negative parts of the disorder when I have all these amazing parts of recovery?”

What is it about mental health tattoos that help in the healing process?

According to Casidhe, the tattoo works as a conversation piece—sparking discussion when it might not happen otherwise. When asked about the role the semicolon tattoo plays in her healing process, Amy felt the concept was more opaque:

“You know I’m not really sure how that works. I have a lot of people say they look at the semicolon and it gives them inspiration. It’s a reminder that says you get to keep writing. Yeah it sucks sometimes but you get to keep going and choosing how you write that story.”

Supporters of the project have declared April 16th ‘National Semicolon Day.’ On this day, everyone is invited to post their semicolon tattoo on social media platforms like Twitter and Pinterest with the hashtag #ProjectSemicolon, raising awareness and celebrating the network of people who believe in moving forward despite their challenges.

On their website, the project states that they are not a helpline, nor are they trained mental health professionals. But what makes Project Semicolon special, according to Amy, is that it emphasizes the importance of community and non-judgmental support in recovery:

“These people need somebody who cares, who understands them. Not just people who say everything will get better. I wanna be open and honest about my own struggles, I don’t want them to think I’m a person who doesn’t struggle. I want people to be able to come up and say, ‘I struggle too.’ Why do we need to hide?”

A simple punctuation mark; a tattoo; a network of support. Perhaps by wearing a symbol that represents the struggles and victories of the human spirit, the invisible becomes visible. And visibility is important when striving for universal acceptance.

 “Stay strong; love endlessly; change lives.” The phrase appears on the mission statement on the project’s website. It was borne of a phrase close to Amy’s heart:

“I use the phrase “love endlessly” and I truly believe that it’s love that can save a life. And my father showed me that in the short time I had with him.”

–Marjan Khanjani, 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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Transgender Homeless Youth Victimized by Shelter System

00Bias, Featured news, Gender, Resilience, Sexual Orientation, Stress, Transgender, Trauma August, 16

Source: RAJVINOTH JOTHINEELAK on Flickr

At the age of three, Gale started to challenge gender norms, insisting on wearing dresses and tiaras; by age four, sobbing at his mirror image wearing pants. He began calling himself “a boy and a girl,” and later chose to identify with the female gender.

In 2010, Gale was found dead on an Austin Texas sidewalk, right outside a homeless shelter, having been denied housing. Shelter staff considered Gale’s male genitalia inconsistent with a female identity. She would have to stay with the other men. Unable to accept these terms, Gale decided to spend the night on the sidewalk, but froze to death.

A heartbreaking story; across the U.S. and Canada, it is hardly unique.

Every year, new names are added to the memorial list of transsexual people who have been killed due to transphobia. Founder of the Transgender Day of Remembrance, Gwendolyn Ann Smith explains, over the last decade at least one person has died every month due to anti-transgender hatred and violence.

Research conducted by the Canadian Observatory on Homelessness shows the reality transgender individuals face: elevated levels of daily stress resulting in missed school and work, addiction, self-harm, and chronic mental illnesses, which can lead to poverty and an inability to build a healthy, successful life.

The most vulnerable of the transgender community are its youth. Many are thrown out of their homes by parents unable to accept their gender identity. Many leave to escape daily abuse.

There is a much higher prevalence of homelessness among transgender youth as compared to other minorities.

In Canada, many transgender youth from rural areas leave unsafe home environments and come to Toronto in hopes of discovering freedom and acceptance in the city, even if it means spending a few days or weeks on the streets. But they are quickly exposed to the harsh reality of discrimination in the shelter system.

Housing discrimination is a significant concern for the transgender community. Most homeless shelters are segregated by sex. Shared shelters usually separate women and men by placing them on different floors.

Placement on the male or female floor is based on shelter staff perceptions of the youth, regardless of which gender the individual identifies with. This is problematic for those whose gender identity is not congruent with their biological sex.

Forcing transgender individuals into shelter housing with those who identify as the opposite gender falls under the definition of transphobia, the consequences on physical, mental, and emotional health are severe.

Research has shown that transgender youth are three times more likely to develop major depression, conduct disorder, and posttraumatic stress disorder. Transphobia can also lead to greater risk of developing substance abuse and self-harming tendencies.

A large study called TransPULSE investigated the current health conditions of transgender people in Canada. Results showed that, in Ontario, 77% of the transgender population had seriously considered suicide, while 45% had made an attempt to end their life. Transgender homeless youth in particular were found to be at greater risk for suicide, and LGBT homeless youth committing suicide at a rate 62% higher than heterosexual homeless youth. Based on the New York City model of the two LGBTQ shelters, the Ali Forney Center and the New Alternatives Centre, Toronto will soon be welcoming its first 54-bed shelter reserved for the gender-queer population, a promising achievement but not nearly enough.

There are many social and personal issues that accompany being young and transgender. While the personal trauma suffered by these individuals will only change with shifting views, it is up to us to provide safe spaces for this at-risk population.

– Sara Benceković, 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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Teaching Children about Trauma: The “River Speaks” Series

00Child Development, Emotion Regulation, Family Dynamics, Featured news, Grief, Therapy, Trauma March, 16

Source: Freaktography on Flickr

In her latest series of children’s books, River Speaks, author Sandy Stream conveys the emotional turmoil that children and families go through when dealing with trauma.

Children who have undergone loss, abuse, and other traumatic experiences are often unable to fully understand or express their feelings. Their inability to verbalize the emotional impact the crisis had on them makes it difficult for therapists to determine how to best help them heal.

Although research has shown children’s literature to be a helpful tool in therapy, its use is still not particularly common.

The stories found in Stream’s books are meant to help therapists provide relatable experiences for children to help them come to terms with their own trauma. They revolve around a baby bird, Sparky, who is snatched away from his family. In dealing with his captivity, escape, and eventual return, Sparky and his family learn to articulate the complex feelings they experience.

Sparky does return home, but the series does not employ the conventional happily-ever-after ending. Instead, the stories address the turmoil felt by everyone both during his captivity and after his return.

The seven books in this series, Sparky Can Fly, Sparky’s Mama, Tweets and Hurricanes, Feathers, Flex, Roots, and The River, all feature a different main character, retelling the narrative from the perspective of the victim, the parents, the siblings, and the therapist. Each book also deals with different emotional themes, including grief, loss, isolation, and acceptance.

Many of the communication strategies seen in River Speaks can be linked to Jean Piaget’s work on child development. According to Piaget, healthy coping and a sense of self cannot exist without establishing trusting relationships during childhood. Trauma can interrupt this process, and the River Speaks series is intended to restart and re-establish healthy connections.

Research, including that of psychiatrist Bessel van der Kolk, professor at Boston University, shows that children must understand the emotions caused by trauma. This research emphasizes that therapists should teach children to regulate emotional distress, with the first step being acknowledgment of the distress’ severity.

Stream’s metaphorical approach helps children grasp the complex concepts that make the healing process. Comparing Sparky’s inability to express anger and grief to “hurricanes” and “tweets” helps make the abstract more tangible.

This strategy allows the River Speaks stories to personify complex psychological issues such as emotional defense mechanisms like denial, fear of abandonment, and Stockholm syndrome, making her books well-suited to children as young as three or four years of age.

Stream’s stories are accompanied by illustrations from Yoko Matsuoka. The colourful drawings were designed to keep the oftentimes-dark subject matter child-friendly, and work well in conjunction with Stream’s metaphorical portrayals of emotions and trauma.

Such illustrations are a common tool in dealing with childhood trauma. The use of visual art to depict emotional reactions has been found to benefit children during the normal grieving process. A paper by Cynthia O’Flynn at North Central University explains that art therapy can be especially beneficial for children suffering from serious traumatic grief.

The article cites numerous other studies reporting that art allows children to bypass the language and vocabulary needed to explain their grief or loss, making self-expression much easier. The children are able to perceive greater control over their emotions and feel safe while reflecting upon their experiences.

Alexa S. Rabin of Alliant International University reinforced these findings in 2012, stating that art is an exercise which allows children to assert themselves and their boundaries. Rabin explained that such therapy significantly decreases acute stress symptoms, noting that the purpose of trauma treatment is to help children find a way to cope.

Stream’s books bridge the two sets of findings—using both art and language to reach out to children and better their self-expression across both media. A therapist using Stream’s books would be more flexible in tailoring the therapeutic style to the child’s age and individual needs.

Feedback from psychologists such as Jacqueline A. Carlton and fellow author Cheryl Eckl, applaud Stream’s attempt at tackling such difficult subject matter. And while research would be needed to gauge the helpfulness of her specific stories, existing research suggests that her books may ease therapy for both clinicians and children.

– Olivia Jon, 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

Pregnancy Centers

Crisis Pregnancy Centers Traumatize Women Through Deception

10Deception, Featured news, Gender, Politics, Pregnancy, Religion, Trauma February, 16

Source: Heartbeat International on Flickr

In 2002, U.S. President George W. Bush enacted a policy allowing faith-based organizations to receive government grants to provide social services. America’s Crisis Pregnancy Centers (CPCs) were a major beneficiary, receiving an estimated $60 million in federal grants for abstinence promotion between 2001 and 2006.

More recently, access to abortion clinics has become a great concern in the United States, with 70 laws cutting abortion funding passed in 2013. It is estimated that as of 2014, CPCs outnumber abortion clinics five to one.

Founded on Christian ideology, CPCs are at the forefront of the pro-life movement and are gaining popularity among American conservatives. Often presenting themselves as abortion clinics, they claim to offer free pregnancy tests, sonograms and abortions to attract women facing unwanted pregnancies.

But these centres are not medical clinics and do not offer abortions. Women who walk into CPCs seeking guidance are often bombarded with images of aborted fetuses and religious propaganda to dissuade them from aborting unwanted pregnancies. Often located near actual abortion clinics, CPCs attempt to confuse visitors, induce guilt, and pathologize abortion through misinformation.

Misconception is a short documentary from Vice News that exposes unethical practices occurring in crisis centers. The film features hidden camera footage of lies told to women designed to scare them out of terminating their pregnancies.

The documentary shines light on the psychological distress women experience in these centers. CPC counsellors are seen telling women that abortion causes long-term psychological damage, infertility and can lead to complications for future pregnancies.

“If people die due to an abortion, later on they’re finding parts of the fetus in the lungs or the heart,” one counsellor told a client.

Donna, featured in the documentary, recounted a disturbing experience at a CPC in Texas. Thinking that the White Rose was an abortion clinic, she went in to receive a free sonogram and counselling. When she told her story to Vice, Donna was emotionally distraught: “It didn’t occur to me that there was a catch. It’s an awful feeling, being in that place, and I can’t explain why. You go in asking for help, but they’re not giving you the kind of help that you’re asking for. I feel like I was lied to. I feel like I was tricked.”

While some lie outright, other CPCs use controversial studies to dissuade women from aborting. Care Net, one of the largest American CPC networks, distributes a national brochure that purports a significant correlation between abortion and breast cancer, citing a single study that has since been called into question. Multiple other sources have demonstrated that abortion does not affect a woman’s risk of developing breast cancer.

Allison Yarrow’s August 2014 report, The Abortion War’s Special Ops, documents the emotional trauma that women experience from this ongoing deception. The report speaks of counsellors repeatedly warning clients that abortion can lead to ‘post-abortion syndrome’, a supposed condition that includes a combination of suicidal thoughts and depression. Unsurprisingly, an American Psychological Association report found no significant increase in negative emotions or psychiatric illness as a result of having an abortion.

At a pro-life conference in 2012, Abby Johnson, a supporter of CPCs, explained their main strategy. “We want to appear neutral from the outside. The best call, the best client you ever get, is one who thinks they’re walking into an abortion clinic. The one that thinks you provide abortions.”

In an effort to reveal the deceptive tactics of CPCs, some women are fighting back. Pro-choice activist Katie Stack campaigns against anti-abortion legislation after her own disturbing experience at a local crisis center.

In 2011, she started The Crisis Project which exposes the “medical misinformation, emotional manipulation, and religious doctrine” within these clinics across the United States. As an undercover reporter, Stack frequents CPCs in an effort to reveal the harmful inaccuracies they spread.

The fight to end CPC deception comes with its challenges. Earlier this year, Missouri Bill HB 1848, which would have required clinics to notify patrons that they do not perform abortions or give referrals for abortion services, failed to pass. Many states have faced similar roadblocks in establishing pro-choice legislation.

While anti-CPC activists have a long way to go to acquire legislative change in the United States, they are making some headway on an international scale. Global organizations like Google have agreed to remove CPCs’ deceptive advertisements from search results.

On September 18, 2014, Yarrow told the Huffington Post: “We are all entitled to our own positions on abortion, but I bet many people disagree with taxpayer-funded deception.”

– Lauren Goldberg, 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

Listening to voices

Can Some Lead A Better Life Listening to their Voices?

10Cognition, Cognitive Behavioral Therapy, Featured news, Psychopathy, Therapy, Trauma February, 16

Source: rumeysa babadostu on Flickr

Hearing voices is usually considered a sure sign of mental illness, but recent studies suggest that hearing voices is more common in the general population than previously thought. Though inconclusive, research estimates are that between 2 and 10% of people hear voices, with only 45% actually qualifying for a psychiatric diagnosis.

The notion that hearing voices can be non-pathological is still controversial.  Contemporary psychiatry views hallucinations (auditory or otherwise) as the result of abnormal brain function, representative of a more pervasive psychotic disorder.  Coming from a disordered brain, the content of voices are said to have no inherent meaning.  Treatments minimize or eliminate symptoms (usually through the use of medication) and provide coping strategies through cognitive behavioural therapy (CBT).

The ‘Hearing Voices Movement’ challenges the medical model.  Started in the early 1990s, the movement provides an alternative, non-pathological framework, claiming that hearing voices is fairly common in the general population and can exist outside of psychotic disorders.  They view voices as resulting from life events, (e.g., traumatic experiences), and that better coping comes from gaining insight into how the voices relate to unresolved trauma.

In a Dutch study published in 1989, Marius Romme, at the University of Limburg in Maastricht, and science journalist Sandra Escher found that out of 450 participants, about one third reported being able to cope well with their voices.  Of this group, people were more likely to have a positive interpretation of the voices, accepting them as part of their life instead of trying to fight or ignore them.   Although many of these participants still found some voices distressing, they were able to draw firmer boundaries and felt less powerless than the group that did not cope as well.

Building on the fundamentals revealed by their research, Romme and Escher were able to translate their findings into a therapeutic approach.  Known as the Maastricht approach, the aim is to foster curiosity about the content of the voices in order to gain insight, resolve underlying emotional problems due to past traumas, and eventually accept the voices as a part of the client’s life and self.

Voices can be positive, negative or banal –many voice hearers have some combination of the three.   In treatment, the client is asked to set aside a time to listen to the voices nonjudgmentally, as if they were talking to an actual person.  Along with the therapist, they try to unravel when the voices began and why.

In contrast, treatments like cognitive behavioural therapy (CBT) and similar methods aim to reduce the frequency, intensity and believability of hallucinations.  People receiving this type of therapy are encouraged to directly challenge the content of the voices, and cope by focusing on other things in their environment and use distraction to redirect their attention.

But when techniques like distraction and redirecting attention are used incorrectly, they result in people suppressing and fighting their symptoms, rather than learning to live with them.

Several studies show that individuals who try to suppress thoughts and hallucinations may increase their frequency and intensity, and exacerbate distress   (described in the work of Social Psychologist, Daniel Wegner of Trinity College).  Alternatively, the Maastricht approach encourages the client to eventually accept their voices without challenging their content or trying to fight them.

Some claim success for this kind of acceptance-based treatment, even in cases of psychosis.  In a study by clinical psychologists, Patricia Bach and Steven Hayes at the University of Nevada, Reno, 80 inpatients with schizophrenia were assigned to either continue their treatment as usual or engage in four sessions of acceptance and commitment therapy (ACT) in addition to usual treatment.

At the end, patients who attended the ACT sessions were three times less likely to be hospitalized again, and were more likely to question the voices’ control over them and evaluate the reality of the voices’ claims.  Bach and Hayes think the acceptance component allows people to be less distressed overall and view the voices as ‘just thoughts’ that don’t necessarily have meaning or power over them.

While ACT is a widely validated therapy, the Maastricht approach has less research to back up its claims.

The Maastricht approach is still considered peripheral in many circles, especially the idea of voices as an extension of human experience.   And critics of the treatment take issue with the implication that almost all auditory hallucinations are caused by traumatic experiences, overlooking or down-playing evidence regarding genetic and biological influences.  While it is true that many people who hear voices have experienced traumas in their lifetime, there is little evidence that trauma alone can directly cause auditory hallucinations.

And, some claim the Hearing Voices Movement ignores the needs of people with severe mental illnesses such as schizophrenia, which involves a host of other symptoms in addition to hearing voices.  Using the ‘hearing voices therapy’ only addresses one aspect of a multifaceted syndrome and may be harmful if the other symptoms worsen.

Still, when we look at the idea of hearing voices in a way that is not exclusively pathology-based, we open new possibilities, and we engage in what psychologist Andrew Moskowitz (University of Aarhus, Denmark) claims to be a necessary paradigm shift.  Indeed, it may be time for one.

– Jennifer Parlee, 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