Category: Trauma

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Treatments Available to Long Term Abduction Victims

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

Source: artmajor24//Flickr

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Copyright Robert T. Muller

This article was originally published on Psychology Today

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Forgetting PTSD: How Genes Affect Memory

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

Source: Jared Rodriguez // Flickr

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Copyright Robert T. Muller

Photo Credit:Jared Rodriguez // Flickr

This article was originally published on Psychology Today

Slavery

Human Trafficking Remains Widespread Form of Slavery

00Bias, Featured news, Gender, Health, Law and Crime, Politics, Sex, Stress, Therapy, Trauma April, 15

Source: Bruno Casonato//Flickr

Despite being mostly illegal, slavery remains a global reality.  It is estimated that over 20.9 million people are currently enslaved and involuntarily trafficked within their own countries and across borders.

In an interview with Mark Lagon, Chair of International Relations and Security at Georgetown University’s foreign service program, former Ambassador, and Adjunct Senior Fellow for Human Rights at the Council on Foreign Relations, The Trauma & Mental Health Report learned about human trafficking and the traumatic experiences survivors encounter.

Q:  What is human trafficking?

A:  Human trafficking is a contemporary form of slavery – whether for sexual exploitation or forced labour.  It’s not a general form of exploitation that we sometimes see with globalization, but rather, an extreme version.

It involves appealing to someone who is desperate for a better life and looking for economic opportunities.  The work however, often onerous and violent, is very different from what was promised.  It’s important in terms of mental health and trauma to understand that while human trafficking often involves violence, especially for sexual exploitation, much of the control is psychological by the recruiter or trafficker.

Q:  Who is most vulnerable to becoming a victim of human trafficking?

A:  Those who are desperate for a new life and wooed into a situation that is exploitative are most vulnerable.  These groups are denied access to justice; they are not treated as human beings in full under the law, women or minorities – or in South Asia, those of a lower caste.  Migrants are also particularly vulnerable.  It’s not just undocumented workers around the world, but even some legal guest workers who are, through fraud, indebtedness, and having their papers seized, vulnerable to human trafficking.

Q:  How do gender stereotypes play a role in human trafficking?

A:  Females are particularly vulnerable to human trafficking.  Public attitude that “men have always bought women for sex and they always will” is based on gender stereotypes.  Society regularly tolerates women being turned into near commodities.

But women and girls are also victims of human trafficking for labour – in agriculture and domestic services.  In Kuwait, I met a woman who had been victimized as a domestic servant.  She showed me photographs of herself taken weeks earlier.  Her employers treated her any way they wanted.  In cases like these, women and migrant workers are seen as property.

Q:  What are some signs of people stuck in trafficking situations?

A:  There are some clear danger signs.  The one key sign is people who are intimidated and afraid.  Often, victims seem isolated.  Their boss, whether a pimp or supervisor, keeps them from having access to society.

Q:  What are some barriers to receiving help?

A:  Human trafficking victims often don’t identify themselves.  They are afraid that they will be treated as criminals.

Also, aspects of the trauma are not often discovered.  Someone might be rescued but the psychological hold that their trafficker has may not be fully appreciated.  They may flee the shelters and end up going back to their tormentor because of a kind of Stockholm syndrome or post-traumatic stress.  Survivors need mental health treatment, not just shelter and physical health treatment.

Q:  Much of humanitarian work is based on the notion of restoring survivors’ “human dignity,”  Can you elaborate?

A:  All human beings are of equal basic worth and there are places where people are not treated as human beings at all.  So, dignity is key.  Two things human dignity depends on are agency – someone’s ability to thrive and prosper in making choices, and social recognition – being treated like a human being.  Human trafficking is a classic example of agency and social recognition being crushed.

Q:  How can we empower survivors?

A:  Human trafficking victims are treated like slaves, but are very seldom in shackles or in chains.  Their tormentors convince them that they are unworthy or they have no ability to flee.  It is essential to restore survivors’ dignity, giving them the therapy and mental health treatment they need.

Q:  What can the general public do?

A:  They can understand that even a small amount of public funding from the government for human trafficking victims and mental health care goes a very long way to help people have their freedom.

Q:  Tell us about your upcoming co-edited book, “Human Dignity and the Future of Global Institutions”?

A:  It looks at how the proper goal for institutions like the UN and the International Criminal Court, is to fight for human dignity, and how well they serve that goal.

I’ve written a chapter on human trafficking, and the partnerships between governments, international organizations, non-profits, and businesses that attempted to combat this issue.  And I distinguish between those partnerships that are transformative in helping people reclaim their dignity and those that are doing little for this issue.

For more resources and information on fighting human trafficking, visit the Polaris Project.

– Contributing Writer: Khadija Bint-Misbah, The Trauma and Mental Health Report

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

Copyright Robert T. Muller

Photo Credit: Bruno Casonato//Flickr

This article was originally published on Psychology Today

Child Criminals, Feature2

Children Who Kill Are Often Victims Too

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Copyright Robert T. Muller

Photo Credit:torbakhopper/Flikr

This article was originally published on Psychology Today

love is war, feature2

Love Is War: Post Infidelity Stress Disorder

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Copyright Robert T. Muller

Photo Credit: Daquella Manera/Flickr

This article was originally published on Psychology Today

Brain Trauma, feature2

Coping With Traumatic Brain Injury

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

Source: Shine In Your Crazy Diamond//Flicker

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

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

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

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

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

Q:  How is a TBI diagnosed?

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

Q:  What is involved in rehabilitation following a TBI?

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

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

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

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

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

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

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

Q:  What advice can you offer someone with TBI?

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

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

A:  Here is a list of helpful tips:

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

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

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

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

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

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

Q:  How is a TBI diagnosed?

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

Q:  What is involved in rehabilitation following a TBI?

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

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

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

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

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

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

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

Q:  What advice can you offer someone with TBI?

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

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

A:  Here is a list of helpful tips:

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

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

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

Copyright Robert T. Muller

Photo Credit: Shine In Your Crazy Diamond//Flickr 

This article was originally published on Psychology Today

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Ritual Abuse, Cults and Captivity

00Child Development, Diet, Environment, Fear, Featured news, Gratitude, Identity, Post-Traumatic Stress Disorder, Sleep, Therapy, Trauma February, 15

It is almost impossible to imagine the realities endured by victims of ritual abuse:  multiple abusers with systematic motives coordinated with the sole purpose of perpetrating and maintaining a cycle of abuse.  Cults and organizations such as David Koresh’s Branch Davidians use torture and sexual abuse to control their members and force them into compliance.

Behind The Abuse

The Ritual Abuse Task Force of the L.A. County Commission for Women defined ritual abuse as involving:

“…repeated abuse over an extended period of time.  The physical abuse is severe, sometimes including torture and killing.  The sexual abuse is usually painful, humiliating, intended as a means of gaining dominance over the victim.  The psychological abuse is devastating and involves the use of ritual indoctrination.  It includes mind control techniques which convey to the victim a profound terror of the cult members…most victims are in a state of terror, mind control and dissociation.”

According to psychologist Louis Cozolino of Pepperdine University, ritual abuse is characterized by a number of perpetrators of both sexes and the presence of many victims.  The abuse is often carried out in contexts where children are in groups, and within families or groups of families.

Often seen are mind-control techniques that involve combinations of extreme abuse and “brainwashing.”  For example, “psychic driving” is defined by psychologist Ellen Lacter (who runs www.endritualabuse.org) as taped messages that are played for hours non-stop, while the victim is in a state of consciousness altered by sleep deprivation, electro-shock, sensory deprivation, and inadequate nutrition.

Researcher Patricia Precin of the New York Institute of Technology, alongside Cozolino, report that many ritual abuse survivors suffer from PTSD.  Clinicians also see a high frequency of Dissociative Identity Disorder (DID) among such adolescent and adult patients.

And in an Australian study of workers at the Center against Sexual Assault (CASA) including psychiatrists, psychologists, and other clinicians, 70 percent of all counselors agreed with a single definition of ritual abuse and 85 percent agreed that ritual abuse was an indication of genuine trauma.  CASA workers were much more likely to believe their client’s ritual abuse and marginally more likely to identify ritual abuse cases than other therapists.

Cozolino references a vast amount of corroborating evidence for the existence of ritual abuse, such as police reports and therapeutic case studies.  In one of his papers he describes one such case:

“A five-year-old victim in the Country Walk case related that one of his abusers at his day-care setting had been killing birds.  This young boy spontaneously repeated the following well-rehearsed prayer to his startled father:

‘Devil, I love you.

Please take this bird with you

and take all the children up to hell with you.

You gave me grateful gifts.

God of Ghosts, please hate Jesus and kill Jesus because

He is the baddest, damnedest person in the whole world.

Amen.

We don’t love children because they are a gift of God.

We want the children to be hurt.’ ”

Although such accounts are well documented, not everyone believes ritual abuse exists. Bernard Gallagher from the Centre for Applied Childhood Studies at the University of Huddersfield considers ritual abuse a result of erroneous diagnosis made by agency workers:

“This includes pressuring children into making disclosures, the misinterpretation of children’s statements and an over-reliance upon preconceived ideas concerning the existence of ritual abuse.  This results in what psychologists and statisticians might refer to as ‘false positives, ” writes Gallagher.

After The Cult

Escaping the torment of a cult is perhaps the most difficult part for a survivor, but recovery and rehabilitation can be just as challenging.  Cozolino and colleague Ruth Shaffer interviewed survivors, focusing questions on recovery.  They reported that the majority considered participation in support groups a necessary adjunct to psychotherapy.

It may seem counterintuitive to treat ex-cult members as a group because their abuse took place in a group setting.  However certain precautions may be taken to make treatment effective.

For example, British researcher Nicole Durocher notes that organizers must take care not to construct a group that resembles a cult gathering in any way.  The support group has to be sensitive to the special needs of each ex-cult member and to the particular context of the cult from which they exited.

The professional in the group must differ from those in other support groups, acting as an advocate-mediator to observe the group, identifying conflicts, clarifying alternatives for resolution, and negotiating compromises.  These support groups occasionally have the professional co-lead the group with an ex-member acting as an observer, guide, and consultant.

One survivor of multi-generational ritual abuse who wishes to remain anonymous, has written a public letter to the Stop Mind Control and Ritual Abuse Today (S.M.A.R.T) organization, reflecting on his own struggle with PTSD.

“My PTSD often reminds me of what it is to be a soldier.  On the battlefield when every moment is life and death, a soldier will do many things and anything to survive.  When the soldier returns to a normal, non-war society he can’t understand why he did the things he did.”

He goes on to say that with the help of therapy, his shattered life and sense of self can be pieced together again:

“I cry, I sing, play guitar, listen to music, sleep normal hours instead of being awake all night, and more than anything else, I try to change who I was… into who I am.”

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

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

Copyright Robert T. Muller

Photo Credit: https://stocksnap.io/photo/YN5H0VTR6O/

This article was originally published on Psychology Today

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Virginity Tests Place Physicians in Quandary

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Copyright Robert T. Muller

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

This article was originally published on Psychology Today

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Methadone Treatment May Prolong Addiction

00Addiction, Diet, Environment, Fear, Featured news, Health, Motivation, Psychopharmacology, Resilience, Sleep, Spirituality, Stress, Trauma January, 15

The conventional treatment for opioid dependence is to prescribe methadone.

Similar to morphine, methadone is a synthetic opioid sometimes referred to as a narcotic. It is useful at preventing opioid withdrawal, minimizing drug cravings, and is said to reduce the risk of HIV, Hepatitis C and other diseases associated with intravenous drug usage. Methadone is also cheap, and best of all legal.

Despite the advantages, methadone is highly addictive, and has many side effects such as dry mouth, fatigue, and weight gain.

Treatment involving methadone requires a weekly medical visit to renew the prescription, sometimes leading those who are addicted back to the very environment and people that they need to avoid to stay clean.

The Trauma & Mental Health Report recently spoke with Leslie (name changed for anonymity), a patient who has been receiving methadone maintenance treatment (MMT), who says, “Sometimes I wait all day to see the doctor. During that time, you can’t help but associate with other users, hear “drug talk”, or even see drugs being passed around. The methadone doctor doesn’t push counseling and is not there for support. I’m only going to get my prescription.”

Toward the end of treatment, methadone dose is slowly tapered to prevent withdrawal. But most users don’t wean off completely. Leslie says she didn’t have the motivation or tools to do so until she started seeing her drug addictions counselor:

“I’ve been trying to get off of methadone for 18 months now. It has helped with the withdrawal symptoms, and life is easier to manage since I’m not running the street 24/7 looking for my next fix. And I have more time to get my life on track. But, In order to ‘knock’ the addiction you need to figure out what your personal triggers are. My counselor has helped me with this. She also provides a safe place for me to go and discuss my problems and any issues I have with MMT.”

The greatest fear is relapse. Although part of the recovery process, relapse can have physical and emotional consequences. But it helps to identify personal triggers: cues that provoke drug-seeking behavior, the most common of which are stress, environmental factors such as certain people or places, and re-exposure to drugs.

The most important missing link in MMT is drug counseling. Meeting with a counselor is not mandated and patients seldom see one. Those who seek counseling benefit from help determining personal triggers, and preparing for potential relapse. A counselor may help create a healthy living plan that focuses on improving mental health with nutrition, exercise, sleep, building healthy relationships, and spiritual development.

Better family relationships also help with recovery. Including family members in treatment increases commitment to counseling and also helps family members understand what the person is going though.

Opioid addiction is more than physical dependence. Initial detox is a start. Methadone helps with the physical aspects of withdrawal, and helps users lead a more normal life. But without the help of a drug counselor, MMT isn’t enough.

Without counseling, social support, a drug free environment, and the desire to change, we lead the patient only part way there. And part way isn’t enough.

– Contributing Writer: Jenna Ulrich, The Trauma and Mental Health Report

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

Copyright Robert T. Muller

Photo Credit: www.123rf.com/stock-photo/lonely_man.html

This article was originally published on Psychology Today

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Rape Chants Prevalent on University Campuses

00Education, Ethics and Morality, Featured news, Law and Crime, Social Life, Stress, Trauma January, 15

“Y-O-U-N-G, we like ‘em young, Y is for your sister, O is for oh so tight, U is for underage, N is for no consent, G is for go to jail.”

Frosh week: When nerves and expectations are high, and when first-year students are eager to meet new friends.

In September of 2013, university officials were outraged that some University of British Columbia (UBC) and St. Mary’s University (SMU) students glorified sexual assault by chanting a rape song during frosh week.

Chanting at frosh events is supposed to facilitate school-pride and community. Returning students organize frosh events to represent their schools with dignity. But like every year at UBC and SMU, frosh leaders continue to endorse sexist chants. The president of student council at St. Mary’s, who since resigned, said, “I never thought anything about it” since he heard the chant four years earlier. 

So do students who voluntarily take part in a rape chant actually endorse it? 

The desire to be part of a group can mean surrendering individuality. Social psychologists call this phenomenon deindividuation and it explains why rational individuals can become unruly in crowds. While group chanting is used as a social bonding technique during frosh –where fitting in and making friends is a priority– chanters may not realize they are legitimizing rape.

Historically, rape chanting has been associated with acceptance of violence against women says Otutubikey Izugbara, professor of medical anthropology at the University of Oyo, Nigeria. What’s concerning is that university campuses are unknowingly endorsing this mentality when young women ages 16 to 24 are four times more likely to be assaulted sexually than any other age group.

Political science professor Janni Aragon of The University of Victoria was not surprised by the frosh chants. “We live in a hyper-sexualized world where social justice activists, rape crisis workers, and academics working in women’s studies or other fields continually explain that rape culture thrives.” She explains that an atmosphere of rape culture can turn a rape chant into a “light-hearted moment,” one that underplays the severity of the ritual.

Both UBC and SMU administrators promised sensitivity training, counseling, and anti-rape education for students. Among them, Robert Helsley, dean of the UBC business school voiced concern for student safety and communicated his assurance that such inappropriate events would no longer occur. St. Mary’s appointed a panel to recommend sexual violence prevention on campus, including former politician Laurel Broten, who drafted Ontario’s sexual violence plan.

Education is part of the solution. Jessica Carlson, a psychology professor at Western New England College and Danielle Currier, a sociology and women’s studies professor at the College of William and Mary reported that students who participated in a rape education course were found to have changed attitudes about rape. Students were more likely to see rape as a negative event rather than a neutral or positive one.

But when Helen Lenskyj, professor of social justice at The University of Toronto showed that 60% of Canadian college-aged males would commit sexual assault if they knew they would not get caught, are preventive programs being introduced too late? 

In 2004, the Rand Corporation and Break the Cycle non-profit think tanks, questioned whether violence education programs are appropriately timed for university students. Their research shows that first sexual experiences often occur at a younger age, many of which are forced. High-school students are considered a high-risk group for unwanted sexual encounters.

Since then, rape education grants have increased for middle schools and high schools. Poco Smith, a professor of social work at Wayne State University and Sarah Welchans, a statistician from the U.S. Bureau of Justice Statistics studied rape education in high-school students. They found that using an education peer group to explain male responsibility in sexual assault (as opposed to victim blaming) led high-school students to perceive rape as an objectively harmful event.

Still, it is challenging to reach younger students because parental consent is often a requirement, and there are few knowledgeable counselors to teach abuse prevention. Sexual education in general also tends to focus on heterosexual abuse, labeling the male as the abuser and the female as the victim. There is considerably less research that focuses on abuse in sexually diverse groups.

For victims of sexual assault, there is a social and psychological cost. Male-privileging rape songs can isolate victims, and encourages a celebration of trauma.

When two different universities bordering Canada are singing the same song at frosh week, you might wonder if other universities across Canada are doing it too.

Universities worldwide ought to pay close attention. When I was in high school, I didn’t wonder whether the chant I participated in was wrong. My guess is there are a whole lot of unaware students out there. 

– Contributing Writer: Shira Yufe, The Trauma and Mental Health Report 

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

Copyright Robert T. Muller 

Photo Credit: Andrew Vaughan/The Canadian Press

This article was originally published on Psychology Today