Category: Trauma

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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

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Myth Busting the Not Criminally Responsible Defense

00Altruism, Empathy, Ethics and Morality, Featured news, Guilt, Health, Law and Crime, Psychiatry, Psychopathy, Psychopharmacology, Therapy, Trauma December, 14

“I thought he must die. He had no future, nothing good. I thought I was saving the child.”

Nerlin Sarmiento had expressed disturbing thoughts about her children long before tragedy struck her small family of four. On many occasions the 32-year-old Edmonton mother had confessed to doctors and family members that she had thoughts of harming herself and her children.

Precautions were taken: Sarmiento was admitted to hospital several times, prescribed psychiatric medication, discharged, and had her mother move in to help care for the children. 

On the morning of February 12th 2013 in Edmonton, Alberta, Sarmiento sent her ten-year-old daughter to school, then forced her seven-year-old son into the bathroom where she held him under water until he stopped breathing.

Sarmiento did not deny murdering her son. She called the police herself to report the crime. Her lawyers, however, argued that she should not be held responsible on account of her mental illness that prevented her from appreciating the moral wrongfulness of her actions.

Two psychiatrists testified at Sarmiento’s trial. They explained that she was experiencing a severe depressive episode as part of her previously diagnosed bipolar disorder. She felt despair so extreme she became convinced she was committing an altruistic act, saving her son from a life of predestined poverty and hardship. 

On September 12th, 2013, Justice Sterling Sanderman agreed. Nerlin Sarmiento was found not criminally responsible (NCR) on a charge of first-degree murder. 

The public outcry against the ruling was reminiscent of the aftermath of the Vincent Li and Guy Turcotte trials; they were found NCR on charges of second-degree murder and first-degree murder respectively.

NCR has been a hot topic featured prominently in the press following several high profile cases, but is often misunderstood.

In Canada, if the court decides that an individual has committed a criminal act (i.e., they are guilty), but lacked the capacity to know that their actions were not only criminally wrong, but also morally wrong at the time, a verdict of not criminally responsible may be given.

Psychiatrist Robert Dickey with Correctional Service Canada and the University of Toronto helped the Trauma & Mental Health Report gain a better understanding of NCR and bust some of the myths surrounding the defense. 

Myth 1: Almost anyone can claim they have a mental disorder and use the NCR defense.

Technically, this is true. But whether or not they would be successful is another story, says Dickey, explaining that if you don’t have a severe mental illness, it is very hard to malinger your way through an NCR assessment and defense.

He further explains that the finding of NCR is based on the exact mental state of the accused at the time of the crime. By the time someone is referred for assessment by the courts, their state of mind may be quite different than it was when the offense was committed. 

A good clinician will seek clear corroborating information that the individual was suffering from a psychotic illness at the time they were arrested. The police, jail and institutional records should give information as to the individual’s mental state at the time.

This is not a matter of being a little depressed, states Dickey. The individual must be so ill that they would not have been able to tell right from wrong, appreciate the wrongfulness of their actions or engage in rational choice when the crime occurred.

Myth 2: The NCR defense is a tactic for offenders to skirt the justice system.

Mostly false, says Dickey. If an individual does not suffer from a psychotic illness, pure psychopathy or criminality alone is not considered – by the law – to be a disease of the mind severe enough to qualify for a finding of NCR.

If the NCR defense is successful, the individual is remanded to the custody of the Provincial Review Board, where the offender is encouraged to receive treatment. Interestingly, the board itself has no power to order the accused to engage in treatment. 

But if an accused does refuse, they are often detained in a secure facility. Dickey explains that with cases of major mental illness and the refusal of treatment, the physician can refer the offender to the Consent and Capacity Review Board. And the individual may be declared incapable to refuse psychiatric treatment and treated against their will.

Myth 3: When a person is found NCR for a crime, they essentially walk free. 

False. The vast majority of offenders found NCR spend a lot more time detained in a secure facility than if they had been found guilty and served a regular prison sentence, Dickey explains. Because the consequences of NCR are more restrictive and more ensuring of treatment, the issue is now more readily raised by the crown (prosecution) than the defense.

After the individual has been remanded to the Provincial Review Board, the forensic psychiatrist will testify as to the necessary level of security needed to manage the offender and their psychiatric care, while still ensuring the safety of the community.

So what’s in store for Nerlin Sarmiento?

When her trial concluded, she was remanded to the custody of the Alberta Review Board (ARB). At a hearing within 45 days from the end of her trial, the ARB determined whether she would receive an absolute discharge, a conditional discharge or be detained in custody. The results of Sarmiento’s hearing have yet to be made public.

 – 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: Shutterstock

This article was originally published on Psychology Today

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State of Emergency: Suicide in First Nations Communities

00Addiction, Anger, Depression, Education, Featured news, Grief, Health, Identity, Politics, Post-Traumatic Stress Disorder, Spirituality, Suicide, Trauma December, 14

On April 17th 2013, Chief Peter Moonias declared a state of emergency in the community of Neskantaga. Two suicides within days of each other are only the most recent in a string of sudden deaths that have ravaged the group. 

In the four months prior, seven people died, four of them from suicide, and twenty more made suicide attempts. In a community as small and remote as Neskantaga (the reserve is home to 300 people and is only accessible by plane), the residents are tight-knit. And the losses of their family members, friends and neighbours have left many struggling to cope.

Suicide is disturbingly common among some Inuit and First Nations groups, with the rate in some communities eleven times higher than the Canadian average. Overall, First Nations peoples have a suicide rate twice the norm in Canada, a statistic that has been stable for at least three decades.

Colonization of the Americas has had a profound effect on Indigenous populations. In the centuries since first contact, 90% of the American Indigenous population has been wiped out due to plagues, warfare, and forced relocations. The legacy of land seizures and residential schools still haunts these groups.

The immediate survivors of these incidents would undoubtedly be traumatized, but many of the people who have committed suicide in recent years were not personally exposed. How can trauma inflicted centuries ago have an impact on current suicide rates?

The answer lies in the concept of historical or collective trauma, which Maria Yellow Horse Brave Heart, Associate Professor at the University of New Mexico, defines as “cumulative emotional and psychological wounding over the lifespan, and across generations, emanating from massive group trauma experiences.”

Also known as generational grief, the trauma results from suffering profound losses in areas such as culture and identity, without resolution. Unresolved, deep seated emotions like sadness, anger and grief are passed on from generation to generation through parental practices, relations with others and culture-wide belief systems.

In everyday life, the trauma manifests itself through social problems like drug use, familial abuse and violence. These events can cause traumas of their own and result in depression and PTSD, both of which increase suicide attempts.

Young people are especially at risk. In the cohort of 15-24, the rate of completed suicides is five to seven times the national (Canadian) average, and suicide attempts are even more frequent 

Chris Moonias (no relation to Chief Peter Moonias), an emergency response worker in Neskantaga, told the CBC that since the end of 2012, “We average about ten suicide attempts per month, and at one time we surpassed thirty attempts in one month.”

In addition to unresolved grief, Cynthia Howard of Laurentian University identifies several factors that contribute to suicides in Aboriginal communities. These include: attendance at residential schools and abuse experiences there, forced assimilation, displacement, and adoptions. These experiences have left legitimate feelings of distrust towards dominant American and Canadian cultures and feelings of loss of culture.

Some people also feel strung between two cultures (dominant culture and their own band’s culture) while essentially belonging to neither. Feeling alienated and lacking a sense of belonging can leave many people depressed and feeling that their lives lack a sense of purpose.

Other issues such as low socioeconomic status and extreme poverty, along with low levels of education and lack of opportunity have lead to feelings of hopelessness and helplessness.

“Learned helplessness” occurs when a group or individual, usually after a series of disastrous events, believes they have no control over the outcome of any situation, and that perceived failures in the present will likely continue into the future. Without hope, people sometimes feel that living is worse than not living. This feeling is only exacerbated by a shared history of trauma and its consequences, and can culminate in suicide.

Unfortunately, many people suffering do not receive adequate help. Their families and friends are also left without professional support, continuing the cycle of unresolved grief.

Perhaps it is fitting that Chief Moonias of Neskantaga called a state of emergency. His community has reached a tipping point and must be healed in order to move forward. 

As of now, the federal Canadian government has offered some monetary and human aid, but unless we go beyond band-aid solutions, frequent suicides and their consequences will continue to haunt Neskantaga.

– 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: https://www.flickr.com/photos/kittysfotos/6235090832/”>Kitty Terwolbeck</a

This article was originally published on Psychology Today

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Book Review: Becoming Trauma Informed

00Addiction, Anxiety, Child Development, Cognition, Empathy, Environment, Featured news, Health, Leadership, Parenting, Psychopharmacology, Race and Ethnicity, Stress, Therapy, Trauma, Treatment December, 14

Red, and your heart starts to race. Red, and your palms sweat. Red, and the sounds around you blur together. Imagine becoming emotionally aroused or distressed at the sight of simple stimuli, like the colour red, without knowing why.

Because triggers like this can take the form of harmless, everyday stimuli, trauma survivors are often unaware of them and the distress they cause in their lives. And clinicians who practice without the benefit of a trauma-informed lens are less able to help clients make the connection.

To address this and other concerns, researchers Nancy Poole and Lorraine Greaves in conjunction with the Centre for Addiction and Mental Health (CAMH) in Toronto recently published Becoming Trauma Informed, a book focused on the need for service providers working in the substance abuse and mental health fields to practice using a trauma informed lens.

Becoming Trauma Informed provides insight into the experiences, effects, and complexity of treating individuals who have a history of trauma. Without a clear understanding of the effect traumatic experiences have on development, it is challenging for practitioners to make important connections in diagnosis and treatment.

The authors describe how someone who self-harms may be diagnosed with bipolar disorder, possibly insufficiently treated with only medication and behaviour management. But using a trauma informed lens, the practitioner would more likely identify the self-harming patient as using a coping mechanism common to trauma survivors, giving rise to trauma informed care.

Such care involves helping survivors recognize their emotions as reactions to trauma. And helping clients discover the connection between their traumatic experiences and their emotional reactions can reduce feelings of distress. 

Throughout the text, the authors describe an array of treatment options, pointing to ways they can be put into practice; for example, motivational interviewing to provide guidance during sensitive conversations, cognitive behavioural therapy for trauma and psychosis, and body centred interventions to allow clients to make connections between the mind and body, an approach that has become increasingly popular in recent years. 

Importantly, the authors emphasize that a single approach to trauma-informed care is unrealistic and insufficient. While all treatments should include sensitivity, compassion, and a trusting relationship between therapist and client, specific groups require unique approaches. 

The authors devote chapters to specific groups, including men, women, parents and children involved with child welfare, those with developmental disabilities, and refugees. They outline different approaches necessary for trauma informed care in various contexts, such as when working in outpatient treatment settings, in the treatment of families, and when working with women on inpatient units, where treatment requires sensitivity to both the individual’s lived experiences and environment

A unique and compelling feature of this book is the focus on reducing risk of re-traumatization, an often neglected topic. Responding to the need for trauma survivors to feel safe, the authors outline how trauma informed care minimizes the use of restraints and seclusion (practices that can be re-traumatizing), and they offer ways to reduce the risk of re-traumatization by placing trauma survivors in less threatening situations, where they are less likely to feel dominated. This may involve matching female clients to female therapists or support groups comprised of only females. 

The numerous case studies help illustrate specific scenarios, challenges, and outcomes of trauma informed care and highlight the growing recognition of the link between substance abuse, mental illness and traumatic experiences.

While the text is theoretically grounded, the authors convey information in a way that is accessible to wider audiences. It provides critical information for those working in the field by underscoring the relationship between past experiences and current functioning.

Becoming Trauma Informed delivers a deeply informative look into the field of trauma therapy.

– 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: https://www.flickr.com/photos/auntiep/4450279893/

This article was originally published on Psychology Today

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LGBTQ Refugees Lack Mental Health Care

00Addiction, Depression, Education, Featured news, Gender, Health, Identity, Politics, Psychiatry, Psychopharmacology, Sexual Orientation, Stress, Suicide, Trauma November, 14

In 2012, the Canadian government introduced cuts to the Interim Federal Health Program (IFHP), which provides health coverage for immigrants seeking refuge in Canada. Coverage was scaled back for vision and dental care, as well as prescription medication. At the same time, the introduction of Bill C-31, the Protecting Canada’s Immigration System Act, left refugees with zero coverage for counselling and mental health services.

The bill affects all refugees and immigrants, but individuals seeking asylum based on persecution for sexual orientation or gender identity have been hit especially hard by these cuts.

LGBTQ refugees are affected by psychological trauma stemming from sexual torture and violence aimed at ‘curing’ their sexual identity. Often alienated from family, they are more likely to be fleeing their country of origin alone, at risk for depression, substance abuse, and suicide.

On arrival in Canada, refugees struggle with the claim process itself, which has been cited by asylum seekers and mental health workers as a major source of stress for newcomers. For LGBTQ individuals, the process is even harder, having to come out and defend their orientation after a lifetime spent hiding and denying their identity.

In 2013, six Canadian provinces introduced individual programs to supplement coverage. The Ontario Temporary Health Program (OTHP) came into effect on January 1, 2014, and provides refugees and immigrants short-term and urgent health coverage. But it still lacks provisions for mental health services.

Envisioning Global LGBT Human Rights, an organization and research project out of York University in Toronto, has been collecting data from focus groups with LGBTQ refugee claimants both pre- and post-hearing. A recent report by lawyer and project member Rohan Sanjnani explains how the refugee healthcare system has failed. LGBTQ asylum seekers are human beings deserving respect, dignity, and right to life under the Canadian Charter of Rights and Freedoms. Sanjnani argues that IFHP cuts are unconstitutional and that refugees have been relegated to a healthcare standard well below that of the average Canadian.

Arguments like these have brought legal challenges, encouraging courts and policy makers to consider LGBTQ rights within the framework of global human rights.

In July of this year, Bill C-31 was struck down in a federal court as unconstitutional, but the government filed an appeal on September 22. Only if the appeal fails could immigrant healthcare be reinstated to include many of the benefits removed in 2012.

Reversing the cuts to IFHP funding would not solve the problem entirely. LGBTQ asylum seekers face the challenge of finding service providers who can deal with their specific needs. The personal accounts collected by Envisioning tell a story of missed opportunity, limited access to essential services, and ultimate disappointment.

In the last two years, programs have sprung up to address these special needs. In Toronto -one of the preferred havens for LGBTQ refugees- some health providers now offer free mental health services to refugees who lack coverage. Centers like Rainbow Health Ontario and Supporting Our Youth have programs to help refugees come out, and to assist with isolation from friends and family back home, and with adjusting to a new life in Canada.

Still, the need for services greatly outnumbers providers; and accessibility issues persist.

Organizations like Envisioning try to create change through legal channels, but public opinion on LGBTQ healthcare access needs to be onside for real change to occur. Recent World Pride events held in Toronto were a step in the right direction. But specialized training of healthcare professionals and public education would go a long way in providing the LGBTQ community with the care they need.

– Contributing Writer: Sarah Hall, The Trauma and Mental Health Report 

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

Copyright Robert T. Muller

Photo Credit: https://www.flickr.com/photos/vhhammer/3238712773/

This article was originally published on Psychology Today

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U.S. Government Fails to Support Families of Hostage Victims

00Anger, Anxiety, Appetite, Ethics and Morality, Featured news, Parenting, Politics, Post-Traumatic Stress Disorder, Resilience, Sleep, Stress, Teamwork, Trauma November, 14

On August 19, 2014, a YouTube video of American journalist James Foley’s beheading was released by the terrorist organization ISIS (Islamic State in Iraq and Syria). Weeks later, two more videos were released, showing the execution of American journalist Steven Sotloff and British aid worker David Haines. Each victim was taken hostage years ago and ransom demands for their release were directed at their families in the months prior to their deaths.

But their families faced more than the pain of watching their loved ones die. The US government pressured relatives of hostages to do nothing to help.

According to Sotloff’s parents, a member of President Obama’s National Security Council threatened the family with criminal prosecution if they attempted to pay a ransom to ISIS for Sotloff’s release. A similar conversation was held with Foley’s family.

The US government emphasizes that they do not negotiate with terrorist organizations. But is threatening the families of hostages justifiable?

Families in hostage situations feel powerless, especially when information about their loved one is scarce. Government officials exacerbate this sense of powerlessness. Along with initial anxiety, feelings of isolation, loss of appetite, and trouble sleeping, families of hostage victims who are denied the ability to intervene are more likely to develop long-term conditions like Post-Traumatic Stress Disorder and Generalized Anxiety Disorder.

Furthermore, the US government may actually be stepping outside of its own legislation by forcing victims’ families into inaction.

According to an FBI report from April 2014 that discusses the protocol for helping families in overseas hostage situations, the ideal scenario is very different from what took place. The report states that a highly experienced operational psychologist should be put on the case to help the victim’s families by providing them with a sense of hope. 

“We [should] let them know there are people actively working to recover their family member and that we aren’t giving up”, says Carl Dickens, an operational psychologist with the FBI. In addition to emotional support, families should also be provided with temporary living accommodations and emergency expenses. 

When asked if they felt the US government gave them adequate support, the Sotloffs responded, “Not at all. We never really believed that the administration was doing anything to help us.”

The British government has also stood strong on their position to not pay ransom money to terrorist organizations. But the Haines family was never threatened. Despite their anger toward the law, friends and family of Haines did not experience the same pressure their American counterparts faced. “The government and foreign office did their best,” said Mike Haines, brother of the fallen aid worker, “we have complete satisfaction with what they did. We felt very much part of the team.”

The White House has denied all accounts of threatening the Sotloff and Foley families. Yet the Obama administration has become more attentive to families of the latest overseas hostages and the latest victim, Peter Kassig. The famiy of an unidentified female aid worker who is presently being held hostage by ISIS recently had personal meetings with Obama to discuss the situation.

This is an important step towards finding a balance between respecting victims of terrorists and protecting the public good. But in the meantime, where the government has failed, the families of victims are trying to help others like them. Foley’s parents are establishing an organization to aid families of overseas hostage victims through counselling and support. The James W. Foley Legacy Fund will help build a resource center for families of American hostages and foster a global dialogue on government policies in hostage crises.

– Contributing Writer: Alessandro Perri, The Trauma and Mental Health Report

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

Copyright Robert T. Muller

Photo Credit: https://www.flickr.com/photos/babasteve/4705515039/

This article was originally published on Psychology Today

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Womb Wounds: Fetal Alcohol Spectrum Disorder

00ADHD, Alcohol, Child Development, Education, Empathy, Featured news, Guilt, Health, Neuroscience, Parenting, Pregnancy, Psychiatry, Stress, Trauma November, 14

“Fifteen years ago there were very few people who knew about FASD. If you were to go to court and say, ‘My son or daughter has FASD,’ a judge wouldn’t even know if it was a real thing.” – Jonathan Rudin, Justice Committee Co-Chair at the FASD Ontario Network of Expertise

Recently referred to as an “invisible condition” by the popular Canadian newspaper, The Globe And Mail, Fetal Alcohol Syndrome Disorder (FASD) often goes undiagnosed.

A supervisor at the Toronto Children’s Aid Society described to the Trauma & Mental Health Report the stream of FASD cases that have recently found their way into youth care and justice systems.

“You often don’t know a child has FASD because the mother is not around to confirm alcohol exposure during pregnancy. With one case, we suspected it, and did some digging. The grandparents of the child confirmed that the mother did consume alcohol during pregnancy. It was the grandparent’s report that changed everything. Nobody would have known.”

Characterized by growth deficiencies and central nervous system damage, FASD is an incurable condition. According to Ernest Abel, Professor of Obstetrics and Gynaecology at Wayne State University and Ronald Sokol, Professor of Paediatrics at the University of Colorado, FASD is the leading cause of mental retardation.

The Canadian Academy of Child and Adolescent Psychiatry explains that mothers often feel intense guilt and are typically blamed for damage to the child. For this reason, they are not always forthright about drinking habits. Stigma also plays a powerful role in motivating mothers to withhold information. And often, mothers consumed alcohol before they knew they were pregnant and are therefore unable to recall precise quantities and timing of drinks.

Adelaide Muswagon, a single mom, was featured in the Winnipeg Free Press in an article on FASD. “It took a lot of courage for me to get help. I know behind my back I was called an alcoholic and druggie. I can’t change what I have done; I already harmed my child. But I want expecting mothers to know my story, realize the consequences, and not make the same mistakes I did.”

The diagnosis of FASD is only given at birth for the most extreme cases. More often than not, symptoms are mild and fall within the normal range of development. For a firm diagnosis, confirmation of alcohol use during pregnancy is required. Because FASD can look like other medical, psychosocial and psychiatric conditions, children can be mistakenly labelled with Attention Deficit Hyperactivity Disorder (ADHD) or a behavioural disorder.

Fortunately, the behavioural symptoms associated with FASD are becoming better known. As we learn more about the hardships associated with the condition, mothers may question their decision to be vague or dishonest about drinking.

Liz Kulp, award winning author, advocate, and person living with FASD speaks candidly about her experiences in her book, The Best I Can Be: Living with Fetal Alcohol Syndrome-Effects.

“Finding out [why life was so hard for me] didn’t change how hard life is, but it did make me believe I was not a bad person. When I ask a question, it is because I don’t understand, not because I have not been listening, sometimes there is a blank space and I can’t get across it. I may look really normal and I work really hard to maintain. That is really stressful and sometimes I get frustrated. Sometimes the stress just builds up, especially when different people put different expectations on me all at the same time.”

For students, FASD manifests with attention problems and difficulties understanding instructions and rules. Common sense can be lacking, along with a tendency to take things literally. Learning issues lead to high drop-out rates. Youth with FASD often become involved in criminal justice systems, and many such individuals are overrepresented in prison populations. Jonathan Rudin, an Ontario lawyer and chair of the FASD Justice Committee says people with FASD are “usually not the mastermind behind the crime” but they are “easily convinced to take the rap.”

Catching the condition early in life and understanding its effects can help with education, parenting strategies, and legal provisions.

Moving through life without knowing why things are harder for you and why everyone else seems to be able to function with ease can be devastating. Sadly, people with undiagnosed FASD often grow up using alcohol to cope, possibly giving birth to a child with FASD.

Alleviating stigma around FASD by providing mothers with a non-judgemental space to speak about their drinking may help with diagnosis and treatment.

– Contributing Writer: Anjani Kapoor, 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