Category: Parenting

Grieving the Loss of a Child: The Five Stage Myth

Grieving the Loss of a Child: The Five Stage Myth

00Caregiving, Featured news, Grief, Identity, Memory, Parenting, Resilience, Trauma June, 15

Source: Bethan/Flickr

When we think of death, dying and grief, no one therapist has had the impact and staying power as that of Elisabeth Kübler-Ross. Her five stage model, presented in her classic, On Death and Dying, has been an influential voice on the topic for decades.

But in the last few years, work in the field has put the universality of that model in question. Some, such as Russell Friedman, therapist and director of the Grief Recovery Institute argue that with many kinds of loss people don’t grieve in five stages at all.

Originally intended to describe experiential stages of people facing their own impending death, mental health providers as well as school counsellors and educators seem to have generalized the Kübler-Ross model to a multitude of situations, some applicable, some not so much.

In a recent interview, The Trauma & Mental Health Report spoke with Katherine, who described her personal reactions throughout the first year after the loss of her son, Ben, who was killed in a car accident ten days shy of his twenty-first birthday. Like many coping with loss, her grief did not follow the patterns described by Kübler-Ross, it was much less predictable.

Katherine: I decided to see a social worker a few months after Ben died. We talked about grief after loss and the counsellor recited Elisabeth Kübler-Ross’s five stage grief model: denial, anger, bargaining, depression, and acceptance. This didn’t describe how I was feeling at all…

During the first few months after the accident, the only way I can describe how I was feeling is that there was no ‘feeling.’ It was as if my heart was ripped out and stomped on. There was nothing left, but a complete numbness.

According to clinical psychologists Jennifer Buckle and Stephen Fleming, co-authors of Parenting after the Death of a Child: A Practitioner’s Guide, this feeling of numbness described by Katherine, is often the first grieving experience reported by bereaved parents. Coupled with this sense of numbness, bereaved parents, especially mothers, feel vulnerable and unprotected in what is now considered to be an unfair world.

Eventually the numbness subsides and the unsettling and preoccupying images of the child’s death take over. Almost all bereaved parents make reference to traumatic memories. Even parents not present when their child died describe the trauma experienced as if they were physically there and directly involved.

Katherine: The nightmares just didn’t want to go away. I would have the same reoccurring dream. I would see a red traffic light and hear cars crashing, and then I would wake up in panic. It came to the point where I was anxious every night before bed; I knew what was coming, another nightmare or barely any sleep. I can’t recall having a peaceful sleep the first few months.

Katherine’s nightmares became less frequent over time, but still crept up on occasion. In Buckle and Fleming’s view, the impact of trauma can lessen for some over time; but for others, the images and violent memories may vividly persist.

Grieving parents also fight with recurring flashes of past memories they shared with their deceased child. After a child’s death, most parents feel as if a part of their life has been erased, this is a very frightening. To cope, some parents will resort to avoiding places they associate with the deceased child.

Katherine: It took me over a year to set foot in another hockey arena. Ben was coming home from hockey the night of the accident… just the idea of going into an arena was painful. All the memories… watching him learn how to skate, going to hockey practices, and going with the family to hockey tournaments. I was trying to avoid that pain.

Bereaved parents put a lot of energy into avoiding feelings, memories and places that remind them of the child. At times they also ruminate, thinking about what could or should have been.

Katherine: Sometimes I can’t help it, something will remind me of Ben, and I immediately think about what things would be like now if he was still around. It gets really hard at family get-togethers and around birthdays and holidays. Not having him there… a parent can never get used to that.

Psychology professor Susan Nolen-Hoecksema, on faculty at Yale University, reports that women tend to ruminate more if they were battling depression before their child’s death, in comparison to women who were not. Elderly bereaved parents also tend to ruminate more than younger bereaved parents. With more free time on their hands, there is occasion to think about what might have been.

So why do some parents have an easier time adjusting after the loss of a child, compared to others?

To move forward, grief counsellors tend to agree that parents need to experience their own pain, keep the deceased child’s memory alive, and accept the loss, a notion that aligns well with the Kübler-Ross “acceptance” stage. Parents who continue to avoid don’t adjust so well.

The ability to learn from bereavement helps parents take responsibility for creating a new purposeful life. Irvin Yalom, author of Existential Psychotherapy posits that when parents find it too painful to learn from their bereavement experience, they are unwilling to “feel true feelings guiltlessly.” For parents to adjust well, realising that it’s okay to be happy again is crucial.

The loss of a child is likely the most difficult thing a parent can endure. Perhaps it is fitting that a life experience so profound would turn out to be complex and hard to fit into predictable stages.

– Tessie Mastorakos, Contributing Writer, The Trauma and Mental Health Report

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

Copyright Robert T. Muller

This article was originally published on Psychology Today

When a Parent is Incarcerated

When a Parent is Incarcerated

00Behaviorism, Child Development, Featured news, Law and Crime, Parenting, Trauma May, 15

Source: Restless Mind / Flickr

The wildly popular television drama Breaking Bad followed the evolution of a high school chemistry teacher and father turned drug kingpin.  The series came to an explosive end in the Fall of 2013; shows like this often end when the protagonist-criminal’s story ends.

But from a mental health standpoint, just as this occurs new stories begin, particularly for the family.

When parents are arrested or convicted their children face many challenges, one of the most important being the disruption of parent-child attachment.  Research shows that parent-child attachment directly affects cognitive and behavioural development in children, and this disruption can lead to social and behavioural problems later in life.

When a parent goes to prison, young children often develop emotional responses such as sadness, fear and guilt as a reaction to the parent’s incarceration.

These emotional reactions can turn into severe behavioural problems, triggering conflicts between the child and others.  Many children of incarcerated parents develop feelings of anger and aggression, leading to failed friendships in school.  Some may also become depressed and anxious, bringing academic and social challenges.

The child’s attachment to caregivers is important in the development of what psychologists call social cognition (the study of how our thoughts and perceptions of others affect how we think, feel and interact in our everyday life).  Our earliest thoughts about others are learned through our parents.  Children raised without a sufficient parent-child interaction may lose this important experience.  The child may have a difficult time socially, often when they approach adolescence.

The media tend to overlook children of criminals.  In 2005, it was estimated that more than 2.3 million children in the U.S. had a parent in prison.  How can children in this position be helped?

A two-step process, adapted by education professor Glen Palm of St. Cloud State University and the Inside-Out Connections Project, was developed to decrease these children’s odds of developing negative behaviours.

Step 1: Understanding and Awareness

When a parent is incarcerated, the child’s remaining caregivers often don’t know if or how they should explain the parent’s absence to the child.  Once a child understands the situation, they are more likely to adapt to the changes in their life in a positive way.

Clinical psychologist Deonisha Thigpen’s book When a Parent Goes to Prison helps explain incarceration to a younger audience.  It defines what breaking the law is, presents easy-to-understand definitions regarding the justice system, and even provides support to children by explaining that they are not the only one who is experiencing this situation.

And popular children’s television shows like Sesame Street have developed episodes for children with incarcerated parents.  They provide a visual explanation that helps to explain incarceration and how children can eventually explain it to their peers.

Step 2: Visiting the Incarcerated Parent

Once a child understands incarceration and what it means for them, they may be able to visit their parent in prison.  Prison visitations are often portrayed on television and in film, but reality often differs.

Visitors may have to wait an extended period of time before seeing an inmate, which can be challenging when visiting with young children.  Sometimes families of inmates wait for hours, to discover the visiting request has been denied.  When a visit is granted, most correctional facilities have large visiting rooms shared between many inmates and visitors, limiting close parent-child interaction.

A more viable prison visitation program for nurturing a parent-child bond is filial play therapy.  It is only an option for inmates who are not sex offenders and who have not committed any serious violations at their institution.  Once accepted into the program, they are taught how to create a safe and open environment with their child.  Then they meet with their child for one hour a week in a private setting, utilizing these new skills.

Play therapist, Garry Landreth, of the University of North Texas, believes that filial play therapy improves a child’s self-worth and self-esteem, despite the parent’s incarceration.  After a 10-week study, Landreth found that the children began to see themselves as more capable and valuable individuals.

Of course it’s fair to expect convicted criminals to pay for their crimes.  But no child should have to suffer for their parent’s mistakes by being left to grow up on their own.

And when those we incarcerate leave children behind, we’d be wise to consider the kind of future we want for the next generation.  Perhaps a future that gives a shot at something better…for their sake, and for ours.

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

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

Copyright Robert T. Muller

This article was originally published on Psychology Today

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Treatments Available to Long Term Abduction Victims

60Animal Behavior, Cognition, Depression, Dreaming, Family Dynamics, Featured news, Health, Parenting, Psychiatry, Psychoanalysis, Sleep, Stress, Therapy, Trauma April, 15

Source: artmajor24//Flickr

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Copyright Robert T. Muller

This article was originally published on Psychology Today

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Children Who Kill Are Often Victims Too

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

Source: torbakhopper/Flikr

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Copyright Robert T. Muller

Photo Credit:torbakhopper/Flikr

This article was originally published on Psychology Today

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Family Storytelling: Good for Children (and Parents)

00Anxiety, Family Dynamics, Featured news, Parenting, Resilience, Self-Esteem March, 15

Source: Heather Carter-Simmons

I recently received an envelope of photos from my mother; each image came with a story.  My daughters’ favourite turned out to be one about their Uncle David.  Living on a farm in Arkansas, David was four when he got new, slightly too-large, cowboy boots. The clomping noise drove my mother nuts, so she told him to take the boots off or go outside. Hearing the clomp-clomp yet again, she yelled at David; but there was no reply.  She marched into the kitchen only to find it wasn’t David at all but their horse in the kitchen…eating the chocolate chip cookies my mother had laid out to cool.

My daughters like the story because it’s funny.  And embedded within is the message that parents are not always right—a popular theme with children.

But in the context of so much else we have going on, how important is it to share a story about an uncle my daughters have never met?

Quite important, it turns out.  Research shows that writing about family events and expressing emotions around them can be healing. And Marshall Duke and Robyn Fivush, on faculty at the Emory Center for Myth and Ritual in American Life, found that telling and listening to family stories has value as well.  Key factors in sharing family stories are the life lessons and traditions that are passed on, but there are other benefits too.

Duke and Fivush found that sharing family stories creates resilience in children.  Their “Do You Know?” questionnaire assesses how much children know about their family, knowledge they couldn’t have acquired unless they had been told, like “Do you know where some of your grandparents met?”  Children who knew a lot about their family history also scored high for levels of self-esteem and feelings of control and capability.

Duke and Fivush also found lower levels of anxiety and depression and fewer displays of aggressive behaviour in children whose families shared family stories.  The same relationship was not found for families who just talked about daily events.

Stories pass on life lessons, instilling a sense of capability.  And the shared history and time taken to tell stories also fills the need to connect, providing, in Fivush’s view, a sense of belonging in our families, becoming a part of something larger than ourselves.

Telling stories in an interactive way, where the child or parent asks for assistance in conveying the story is important to building storytelling skills.  Elinor Ochs, professor of anthropology at UCLA, discusses storytelling as “theory building”.  The act of creating a story and having family members challenge your “theory” of events being related helps children develop the skills needed to create and test explanations.

It also highlights something my mother pointed out—there are many versions of the same event. When she and her sisters get together, they argue over each other’s renderings:  “That’s not what I remember…”  Yet each may be accurate for the teller.

And some stories just need embellishment. My great-grandmother would correct her son about stories he’d be telling, often prompting him to say, “Another good story ruined by a durned eyewitness.”

Factually accurate or not, the act of engaging in family storytelling brings richness to one’s sense of family, and with that, a connection to a shared past.  I tried to give my daughters a strong foundation from which to create their own stories, and I hope to be there to challenge another tall tale.

– Contributing Writer: Heather Carter-Simmons, The Trauma and Mental Health Report

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

Copyright Robert T. Muller

Photo Credit: Heather Carter-Simmons

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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When You’re Gone: Deployment Effects On Parenting

00Anger, Attachment, Empathy, Featured news, Happiness, Marriage, Parenting, Post-Traumatic Stress Disorder, Stress January, 15

Deployment

“It’s hard, but I think it must be harder for my husband, being away for so long. He missed a lot of firsts when the girls were babies. Thankfully, between deployments he got to see with one, the things he missed with the other.”

Blair Johnson, mother of two, Mackenzie age 5, and Macey age 2, has experienced firsthand the hardships of having a spouse away on deployment, as her husband Nathan, an American marine, has spent half of their marriage overseas and in training.

Deployment, the movement of troops overseas for military action, is a reality for many families in the U.S. and Canada. The American military is deployed in more than 150 countries around the world, with the majority of troops in combat zones.

Deployed soldiers often face great emotional strain as they are forced to separate from their spouses and children. The separation, distance, and heartache make parenting in these families an enormous challenge. Children, who tend to be most sensitive to changes within the family, may react strongly.

“For me, it has been harder with my older daughter during Nathan’s most recent deployment. Since she is such a Daddy’s girl, she acted out a lot in trying to deal with her father being away. She would give me a hard time, almost like she thought I could control whether or not her Dad was home.”

Amy Drummet, a researcher at the University of Missouri explains that military families experience stress at three main junctions: relocation, separation, and reunion. As Blair recalls, separations bring on feelings of parental inadequacy and guilt. “It’s the feeling that I can’t give my girls everything they need when it’s just me; they miss their Dad and I can’t do anything to bring him home.”

To complicate matters, the return home can be just as problematic. “The last time he came back was different than the previous ones. It took a lot longer for everything to return to normal. Jumping back into the role of a full-time father was harder for him.”

One in every five soldiers returning home from Iraq or Afghanistan may suffer from posttraumatic stress disorder (PTSD). This prevalence makes it difficult for the returning parent to carry on normal parenting responsibilities. “When Nathan returned, he was very jumpy, angry, and agitated with every loud sound he heard. He would constantly reach for his gun even though he didn’t even have it once he returned home. He had to learn to let go of the defense mode he was used to.”

Coming home presents many obstacles the family must overcome in order to settle back into a normal and familiar way of living. Apart from the joy of having one’s partner return home, there is plenty of work that must be done to adapt to previous family roles.

“The girls hold a lot of anger towards me after he is home and it is heart breaking; they don’t want anything to do with me for the most part. Since I am the main disciplinarian the majority of the time, they see him as the good guy. They want to spend every moment with him when he is around, because they just miss him so much when he’s gone.”

“I have been blessed to have parents with whom we can stay during his deployments. For us, it helped a bit in filling the void of Daddy being gone. We take advantage of the time we can spend together, so all the family can be a part in their lives,” says Blair.

Military children are especially vulnerable during a deployment due to separation from their parent, a perceived sense of danger, and an increased sense of uncertainty. “I asked Mackenzie what she thought Daddy was doing when he is deployed and she said, ‘he is working…and fighting the bad guys.’”

Despite the difficulties, Blair insists that there are good aspects to deployment, “You have to make a choice to either let it affect you in a bad way or a good one. You can use that time to grow closer instead of growing distant. It is all a matter of choice. I believe something good can come from any situation, no matter how terrible it is. It makes you a stronger person and it helps you realize just how much you can handle.”

Deployment drastically affects family life. While it requires all family members to readjust, children, who are more prone to being agitated by their changing circumstances, may find it harder to cope. As parents battle their own issues and uncertainties, they may unintentionally miss signs that their children need them.

So deployment may have an effect on the attachment with not only the deployed parent, but also with the parent who stays behind. The confusion and uncertainty experienced by children should be treated with love and understanding, while maintaining their normal routine.

“Parents have their bad days, but it’s important to cry, let it all out, and then move on. Happiness is an everyday choice, and choosing it doesn’t mean you miss your spouse any less.”

– Contributing Writer: Noam Bin Noon, 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/dvids/3522556401/

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

40Anger, 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