Category: Trauma

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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

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Fear of Ebola Leaves Orphaned Children Abandoned

00Anxiety, Child Development, Cognition, Deception, Diet, Fear, Featured news, Grief, Health, Parenting, Politics, Post-Traumatic Stress Disorder, Sleep, Stress, Teamwork, Trauma October, 14

13-year-old Jennette’s (name changed by UNICEF) grandmother died from Ebola. Shortly after attending the funeral, Jennette began to feel sick. When fever developed, she was taken to a local treatment center along with her mother and sister. All three family members tested positive for Ebola. Against all odds, they were successfully treated and released.

Jennette broke down in tears as she spoke about her experience as a victim of Ebola to Timothy La Rose, a Communication Specialist with UNICEF Guinea. Despite being healthy again, Jennette could not feel good about her recovery, now facing the stigma of being an ‘Ebola contact’.

“I cannot return home [to] my aunt who threatened me a lot when I was sick. So far she has never asked about my fate.”

The WHO (World Health Organization) estimates Ebola fatality rates between 25 and 90 percent. Passed on through contact with the bodily fluids of an infected person, symptoms are gruesome and can include internal and external bleeding. Currently, there are no approved vaccines, and the 2014 outbreaks in Guinea, Liberia, and Sierra Leone have created immense fear among those living in affected regions. Even in the United States, by October 2014 a handful of cases have quickly led to panic in some regions.

Jennette is only one of the many children facing the consequences of neglect due to the distrust surrounding Ebola survivors. UNICEF estimates that about 3,700 children have lost one or both parents to the current outbreak.

UNICEF’s regional director for West and Central Africa, Manuel Fontaine, said, “these children urgently need special attention and support; yet many of them feel unwanted and even abandoned.”

After surviving Ebola or losing a family member to the virus, these children are being shunned by surviving relatives due to fear of reinfection. “Orphans are usually taken in by a member of the extended family, but in some communities, the fear surrounding Ebola is becoming stronger than family ties,” Fontaine told CNN.

Orphans—some as young as two years old—are in the streets alone, lacking proper shelter, healthcare, and nutrition. Many of these children have undergone extreme trauma. Some have spent weeks in isolation wards without caregivers or proper mental healthcare. The New York Times reported a gut-wrenching scene:

In the next ward, a 4-year-old girl lay on the floor in urine, motionless, bleeding from her mouth, her eyes open. A corpse lay in the corner — a young woman, legs akimbo, who had died overnight. A small child stood on a cot watching as the team took the body away, stepping around a little boy lying immobile next to black buckets of vomit. They sprayed the body and the little girl on the floor with chlorine as they left.

Surviving children must also struggle with the grief of losing parents and siblings. “The hardest part of the job is telling parents their children have died or separating children from their parents,” Malcolm Hugo, a psychologist working in Sierra Leone, told the Guardian.

Many children are displaying symptoms of Post-Traumatic Stress Disorder, a condition that may develop after exposure to trauma. Intense grief, changes in eating and sleeping patterns, and extreme cognitive impairment are being reported in children who are most affected. Symptoms of depression and anxiety are also common.

The WHO reports that the most severely affected countries, Guinea, Sierra Leone, and Liberia lack resources to help those affected by the outbreak.

Many humanitarian aid agencies like Doctors Without Borders have sent physicians and healthcare workers to help in the treatment and containment of the disease. However, very little psychological or medical help is available for orphaned survivors. UNICEF has appealed for $200 million to provide emergency assistance to affected families but has only received a quarter of the amount so far.

Currently, the organization is looking at unique ways to provide emotional support. In Liberia, they are working with the government to train mental health and social workers. UNICEF will also be working with Ebola survivors who are now immune to the disease to provide support to children quarantined in health centres.

In a statement to Al Jazeera, Fontaine explained, “Ebola is turning a basic human reaction like comforting a sick child into a potential death sentence.” Further work needs to be done to abolish the harmful distrust surrounding Ebola survivors, and strengthen family and community support. Without this support, orphaned children face a harsh and unwarranted emotional toll, alone.

– 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

This article was originally published on Psychology Today

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For Families Touched by Homicide, the Media Prolongs Pain

00Featured news, Grief, Health, Law and Crime, Media, Memory, Parenting, Resilience, Stress, Trauma October, 14

On January 1st, 2008, fourteen year old Stefanie Rengel was murdered a few meters outside of her Toronto home.

After receiving a mysterious phone call from someone she believed may have been a friend, Stefanie put on her shoes, told her younger brother that she would be right back, and ran out the door. She never returned.

Leading a normal life one day, and suddenly being thrust into the inevitable bureaucracy that follows a murder is excruciating for families affected by homicide.

The Trauma & Mental Health Report had the chance to speak with Stefanie’s mother, police officer Patricia Hung, who discusses how media involvement and court proceedings sometimes prolonged the healing after her teenage daughter’s murder. She also commented on support available for bereaved parents.

Patricia: Trying to get justice for Stefanie, in some ways… it kept her alive. It gave us something to focus on. I don’t know if that prolonged the grieving, but it certainly spread it out. When a child dies in a car accident, and there are no reporters or trial, you have no choice but to deal with it all right then. For us, we dealt with it a little at a time.

For families affected by homicide, the grief is drawn out. The media, bail hearings, preliminary trials, adjournments, mental health assessments, impact statements, perhaps a trial and hopefully a sentencing, all act as constant reminders of the tragedy. Prolonged investigations and legal processes have these families re-living the trauma of what happened to their loved ones.

Patricia: The day after Stefanie died the reporters were there –it was terrible– it felt like an attack, when all we wanted was privacy. They would come to our door at all hours of the day and night. They would go to my children’s schools and would piece together a false relationship between Stefanie and her killer.

Following a high profile murder case, reporters can unwittingly create chaos for families. The constant questioning, often well intentioned, can turn into intrusive and harmful reminders of the trauma.

Patricia: In the beginning, the press is really friendly to you because they want the gory details and all the juicy information. If you say one wrong word, they can turn on you [for a story]. The last thing grieving families need is to feel tried in the newspapers.

Unfortunately, most bereaved parents aren’t sure what it is they need right after their child’s death. They often feel as though no stranger is going to be able to help them and are unaware of how important it is to reach out for help.

Victim Crisis Assistance and Referral Services (VCARS) is a Canadian charitable service, with 48 sites in Ontario alone that provide immediate on-site assistance to victims affected by tragedy. Bereaved families can use victim services at any point during their recovery even if they initially decline assistance. Victim services offer a variety of support programs for long term assistance and can even help families deal with the media.

Patricia: Being a police officer and having to go through the legal system, I realized how scary it must be for other families who have absolutely no idea what to expect. So to those families who are feeling lost and overwhelmed, know that someone from victim services can be taking notes for you at the preliminary trial, someone can guide you while preparing for your impact statement, and can sit with you during trial.

One of the great difficulties at trial for bereaved parents is informing the judge or jury on how their child’s death affected their life. Impact statements can help determine the offender’s sentence, and parents feel the pressure; victim services help families write these. 

Patricia: Testifying and giving an impact statement was very difficult. I was trying to make sure that I wouldn’t mess it up. You’re so worried that if you say something wrong it could screw everything up. 

And adding to the heartache: 

Patricia: There are things that you don’t expect to happen that do. When I was at court, I went to the washroom and the accused’s mother was in there. It was just so hard. At the time, it wasn’t me against her. I actually felt quite sorry for her… it was a whirlwind of emotions.

Trial is very draining for families. Not only do they hear details of the child’s death, but also the accused is just feet away. Having external support such as VCARS ensures that bereaved families are aware of what steps they need to take and provides comfort at a time when family ties can become strained. 

Once a verdict is made, bereaved families still have much to deal with. Grieving the loss of a child never really ends. As time passes, families fill their lives with new memories and the moments of grief become more intermittent.

But of course, as parole hearings approach, families have to face the trauma of losing their child all over again.

– Contributing Writer: Tessie Mastorakos, 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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No Place to Be a Child

00Anxiety, Child Development, Cognition, Depression, Education, Empathy, Environment, Featured news, Grief, Health, Meditation, Resilience, Social Life, Stress, Therapy, Trauma, Treatment October, 14

“If we are to teach real peace in this world, and if we are to carry on a real war against war, we shall have to begin with the children” – Mahatma Gandhi

Over 18 million children are currently living in regions affected by war. While most humanitarian aid groups focus on meeting the basic physical needs of these children, in the midst of armed conflict, cognitive, social and emotional development is often inhibited and overshadowed by regional chaos.

Exposed to violent, traumatic and stressful situations that threaten their sense of stability and well-being, children have few places to simply be children, where they can play, learn and socialize safely. And few resources are in place to help them heal from the psychological burdens of war.

As the need for rehabilitative and restorative measures gains greater recognition by the international community, a growing number of child rights advocates, organizations and researchers are stepping forward to understand the implementation of psychologically therapeutic programs for war-affected children. The challenge is in figuring out what is needed, what is available and what will work across a variety of cultures, contexts and settings.

Seeking to bring psychological care on a tight budget, academics and policy advisors have emphasized evidence-based programs. Theresa Betancourt, professor and director of the research program on children and global adversity at Harvard’s school of public health, and her colleagues are evaluating the effectiveness of child trauma programs based in countries such as Uganda, Sierra Leone, Chechnya, Gaza, Sudan, Kosovo, Bosnia and Croatia.

Individual therapeutic interventions such as trauma focused therapy and narrative exposure therapy have shown promise among children affected by war and are approved by UNICEF as preferred techniques.

Group interventions have been used to accommodate the psycho-social needs of a greater number of children. These include Interpersonal group therapy for depression, creative play, mother-child psycho-education and support, and torture group psychotherapy with cognitive behavioural techniques.

Some other psycho-social initiatives have focused on the creation of Child Friendly Spaces (CFS’s) and Temporary Learning Centers (TLC’s) within refugee camp settings or local communities. These provide a child-centered environment for play, basic education and socialization; and they identify children in psychological distress.

But some concerns have been noted. The focus on trauma can lead to community stigmatization. In addition, these therapies are hard to carry out on a large scale due to the high costs of employing highly-trained professionals. Individualized services are rare and reserved for severely distressed children, usually demobilized child soldiers.

Problems arise when trying to apply western definitions and measures of distress that are not necessarily applicable to other cultures and contexts. And in understanding any given child’s psychological functioning, it is important to factor in ongoing stressful events and the social dynamics that a war-affected child must deal with on a daily basis.

There has been a movement away from a traditional western “clinical treatment” model toward a more inclusive, holistic framework of “psycho-social intervention,” termed to reflect the complex interplay between a child’s psychological and social development.

More effective group interventions for children have tended to be those that involve a school setting, address everyday stressors, utilize a form of trauma/grief-focused psychotherapy or use mind-body relaxation and coping techniques such as meditation, biofeedback and guided imagery.

Benefits include decreases in posttraumatic stress disorder, improved coping skills, and greater psychological relief and psycho-social adjustment.

Still, universal, comprehensive, culturally-sensitive psychological services for war-affected children remain a long way off. For more information on mobile psycho-social and education programs for war-affected children, please check out The Freedom to Thrive Foundation. Email FreedomToThriveFoundation@gmail.com to find out how you can get involved.

– Contributing Writer: Adriana Wilson, 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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I Do but I Don’t Have To: Marital Rape

00Divorce, Environment, Ethics and Morality, Featured news, Gender, Law and Crime, Marriage, Punishment, Religion, Stress, Trauma October, 14

Rape is often thought of as forced sexual intercourse by a stranger. So as a crime within marriage, rape is often overlooked.

Worse, many consider it a husband’s right to have intercourse at will.

Rape scenes on television and film are commonplace. Even AMC ‘s award-winning show, Mad Men, known for its poignant showcase of gender issues in the 1950’s tackles the topic of marital rape in graphic difficult-to-watch dramatic scenes.

There’s a Difference

Marital rape is often regarded as less traumatic than stranger rape but studies show this to be false; survivors experience long lasting effects.

Unlike stranger rape, marital rape is often a reoccurring event. Raquel Kennedy Bergen, Professor and Chair of Sociology at Saint Joseph’s University in Philadelphia, notes that marital rape victims are “more likely to experience multiple assaults and often suffer severe long-term physical and emotional consequences.”

There is also a difference in the type of abuse suffered. Married perpetrators may use verbal and psychological means of control, for example, anal or oral rape to humiliate the spouse.

The psychological trauma can also spread through the family when children become witnesses to sexual abuse. In a study by researchers Jacquelyn Campbell and Peggy Alford, the authors found that five percent of the women indicated that their children had been forced by their partners to participate in sexual violence and 18% of the women indicated that their children had witnessed an incident of marital rape at least once.

Now considered a global problem, findings from the National Violence Against Women Survey, University of Minnesota, indicate that an astounding 20 percent of rape survivors were victimized by a spouse or ex-spouse, and four percent were raped by a current or previous cohabitating partner.

Why Don’t They Just Leave? 

Believing that the perpetrator might change results in general underreporting of sexual abuse by family members. 

Women under misconceptions -rape myths- believe the crime is only committed by strangers. So help-seeking is hindered by their failure to recognize being crime victims at all.

Even if they recognize the husband as abusive, there are barriers to escape. Social and religious shaming can represent obstacles to separation or divorce.

The nature of the spousal relationship can serve to imprison many women. Financial dependence and in some cases photographs and film taken of the sexual abuse are used as blackmail, also limiting options. 

Punishment

Criminalization of marital rape didn’t take place in many countries for decades after the feminist movement brought it to the forefront in the 1960s with countries such as Canada, Israel, and Australia waiting until the early 1980s to create laws against it. In the United States, it wasn’t until 1993 that rape laws in all 50 states had removed a marital rape exemption, which allowed a husband to legally rape his wife. 

Even with the removal of the exemption, marital rape is still often dealt with differently in the legal system from other rape crimes. An Illinois Victim’s Services Newsletter describes a case from 2005 in which a wife reported being raped by her husband. Although the average conviction for rape in Illinois is five years, he only served 19 months.

You Don’t Own Me 

Misogynistic beliefs, the view that women’s bodies are owned by their husbands, and victim blaming attitudes (“she was asking for it”), serve to slow progress.

Certain religions may encourage the dominance and status of males over females, especially in the context of marriage. This cultivates a sense of ownership and religious right to do with wives as some husbands see fit. 

Outrage over a proposal of a marital rape law in the Bahamas had many Bahamian men confused with one stating, “It is ridiculous for them to try to make that a law, because I don’t think a man can rape his own wife. After two people get married, the Bible says that they become one –one flesh. How is it possible to rape what is yours?” 

It is just this culture of justified rape that perpetuates silence.

At its core, marital rape needs to be recognized for what it is -a violation of human rights, rooted in misconceptions that must be amended for the sake of our mothers, sisters, and daughters.

– 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

This article was originally published on Psychology Today

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Acid Attacks: The New Gender Terrorism

00Dreaming, Ethics and Morality, Fear, Featured news, Gender, Law and Crime, Marriage, Parenting, Punishment, Resilience, Trauma September, 14

With her head bent down staring at the floor, saliva running down her chin, a woman is unable to lift her head or close her mouth. Acid has melted her skin.

An estimated 1500 people per year are victims of acid attacks; 80 percent of whom are female and 40 percent are under the age of 18. Although acid attacks are becoming increasingly common in countries such as India, Cambodia and Afghanistan, they occur more in Bangladesh than anywhere else in the world.

 About 60 cents a bottle, acid (hydrochloric, nitric or sulfuric) has become the weapon of choice against women in countries where their rights are still limited.

 In November 2012, the BBC reported a story about a 15-year old girl, attacked by her own parents because she turned her head to look at a boy passing on a motorcycle. Claiming that she “dishonoured her family,” the parents together beat her and then poured acid over her. After two days without being taken to a hospital, the young girl died of her injuries.

 Rarely resulting in death, the horror of the attacks is nevertheless striking. Within seconds, the acid melts skin, fat, muscle and sometimes bone. Women may be left blind, some with sealed nostrils, shriveled ears and damage to their airway from inhaling the fumes. In time, formed scar tissue tightens and pulls what is left on the face and neck, causing intense physical pain and discomfort.

 Why do the attacks occur? Most show a common theme: a woman stepping out of her subordinate gender role thereby causing dishonour to her husband or family. Choices many of us make without thinking, such as rejecting a marriage proposal or a sexual advance, are enough to instigate an attack.

The violent act is a threatening message not only to the victim, but to women in general, leaving many in a permanent state of fear.

 Victims are left permanently disfigured, socially isolated, and emotionally scarred. With the end results so extreme, some have called for punishment of death for those who inflict this on others. Yet in most cases, the perpetrator is left to carry on as if nothing happened. Laws have been passed with jail sentences as high as 14-years. But inefficiencies and corruption within the legal systems where these attacks occur mean that fewer than 10 percent of cases make it to court.

Many human rights agencies have advocated banning the sale of acid to decrease its availability. But for those who are motivated, acid can be found; many attackers are now using the inside contents of car batteries.

Sital Kalantry, the Cornell international human rights clinical director has called the phenomenon a form of “gender terrorism.” Unless women are able to step into a role of equality of rights and freedoms, the problem will persist.

Worldwide, many are taking action to raise awareness, provide treatment and ease pain. The 2012 Oscar award winning documentary Saving Face, tells the stories of Pakistani women who were victims of acid attacks, and follows them through their fight for justice, through their battle to get their lives back.

Featured in the film is British plastic surgeon Mohammad Jawad who has devoted countless hours to reconstructing the faces and bodies of women damaged by acid. He is one of many who have donated their time to try and heal these women.

The Acid Survivors Foundation, established in 1999, is a non-profit organization dedicated to helping women find a place again by connecting them with treatment and rehabilitation services offered by people such as Jawad.

Still, surgeons cannot repair everyone. For some already suffering from malnutrition, an acid attack can leave their skin almost fossilized, with scar tissue left to take over. For those who are able to undergo surgery, it can take over 20 procedures to restore basic functioning, a process unaffordable to many already living in poverty.

In addition to the physical damage, acid attacks inflict emotional damage and can destroy hopes and dreams. Uli Schmetzer, a Chicago Tribune foreign correspondent, told a story in 1999 of a 20-year old girl, Sufia, who became the victim of an acid attack meant for her sister who had turned down a marriage proposal. Having been accepted into university, Sufia had plans to become an agronomist; following the attack, she was likely to end up a beggar.

Often living as social pariahs following mutilation, these women are left with little hope. Seeing perpetrators get off without consequence, others are left to live in a state of fear that they will be next.

 – Contributing Writer: Crystal Slanzi, 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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New EEG Technology Makes for Better Brain Reading

00Cognition, Featured news, Health, Intelligence, Mind Reading, Neuroscience, Optimism, Personality, Post-Traumatic Stress Disorder, Sleep, Sport and Competition, Therapy, Trauma September, 14

Clinical psychologists have a long tradition of attempting to understand what is “on the mind” of their clients by use of psychological tests. The Wechsler Adult Intelligence Scales, for example, have been used for decades to assess intelligence levels. And other empirically valid psychometric measures are commonly used to understand patient mood or personality functioning.

To this point, direct examination of brain activity as a window into the client’s mind has remained elusive. But advances in the field of brain examination using electroencephalographs (EEGs) may be changing all that.

The first EEG was developed in the 1920’s by the German psychiatrist Hans Berger. He developed it to test the biological electricity produced in the brain, and first used it during brain surgery performed in 1924 on a 17-year-old boy.

If the EEG has been around for almost a century, why is it so important now? Recent technological advancements may soon have a profound impact on how mental health practitioners diagnose mental illness.

Currently, we know that the EEG records activity in the brain through electrodes attached to the scalp. When neurons (electrical pulses the brain uses to send messages) fire, they produce a small current. The EEG reads and records this current between 250 and 2000 times a second. The graphs it makes of these readings are what we know as ‘brain waves.’

The EEG is primarily used to diagnose epilepsy. As of 2005, 70% of EEG referrals were for epilepsy. During an epileptic seizure there is a large spike in brain activity that the EEG has little difficulty detecting. Even then, it is used in conjunction with a clinical examination by a physician, not as the sole means of diagnosis.

The second most common use is to diagnose sleep disorders such as narcolepsy and sleep apnea. The EEG is effective at reading the brain waves produced during sleep, which show special patterns in those with sleep disorders.

Biomedical engineering professor Hans Hallez of Flanders’ University writes, “during the last two decades, increasing computational power has given researchers the tools to go a step further and try to find the underlying sources which generate [brain waves]. This activity is called EEG source localization.”

Source localization is the technique that tells us which part of the brain is communicating. With advances in neuroscience and imaging techniques, we know what activities are represented by different parts of the brain. For example, activity in the primary visual cortex in the occipital lobe is related to vision and activity in special areas of the temporal lobe is associated with speech.

If you know what part of the brain is communicating and what it is responsible for, then you can start to build a picture of what brain waves from different parts of the brain mean. In theory, this is what some experts consider akin to mindreading

But the game-changer is this: recent developments in the field have led to a portable EEG that is relatively cheap, effective, and requires no human scoring.

Philip Low, who is the founder, CEO, and chief scientific officer of NeuroVigil Inc., developed a complex algorithm in 2007 that allows one electrode to do the work of many. His company has developed what they have named the iBrain. It uses one wireless electrode sensor the size of a quarter to record brain activity with an app that works on a smartphone.

Low says, “our vision is that one day people will have access to their brain as routinely and as easily as they currently have to their blood pressure.” He hopes to code brain wave profiles of those suffering from mental illnesses into a database at NeuroVigil that receives information from iBrain users’ cell phones. The iBrain 3 is expected to cost around $100 and be available to the public in the next few years.

Low isn’t the only one pushing the boundaries of EEG technology using single electrode devices. Hashem Ashrafiuon, a mechanical engineering professor at Villanova University’s College of Engineering has developed similar technology. His work is being used in sports helmets that can instantly diagnose concussions by detecting large changes in brain waves that occur immediately after impact.

Ashrafiuon sees many applications for his work. “It can basically be used to diagnose any health problem that affects brain activity. We hope to monitor brain health in patients with mild traumatic brain injury, post-traumatic stress disorder, Alzheimer’s disease, mild cognitive impairment, and sleep and circadian disorders.”

It is the belief of technology developers Low and Ashrafiuon that we will one day have brainwave profiles of all mental illnesses stored. Diagnosing a mental illness would be assisted by comparing brain wave profiles of a patient to a database of stored sample profiles, allowing for rapid diagnosis.

Does it sound too simple? Perhaps. Diagnosis of mental illness involves a substantial behavioral component. What the brain looks like may be a far cry from the choices a given individual makes, and how those choices affect later functioning. 

Still, there is reason for guarded optimism about the developments in EEG technology. The portability and improved accuracy will help with the diagnosis of epilepsy and sleep disorders, allowing patients to be comfortable at home and still be monitored. The more physically and economically accessible it is the better.

In a few years you may be the proud owner of Low’s iBrain 3. But in all likelihood, it won’t replace mental health practitioners any more than a good toothbrush replaces a dentist.

– Contributing Writer: Bradley Kushnier, 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