Trauma | Psychotherapy Toronto - Toronto Psychologist

Prison Executioners Face Job-Related Trauma

October 12, 201800Decision-Making, Empathy, Featured news, Guilt, Law and Crime, Trauma October, 18

When an order of execution is issued by the courts in the United States, the prison warden or superintendent is responsible for the sentence being carried out—often by Corrections Officers (CO) who are unaware they will be tasked with killing a prisoner.

Complicating matters, human connections are frequently formed between guards and prisoners. According to Jerry Givens, who administered the death penalty in Virginia to 62 inmates over 25 years, COs may spend more time with death-row prisoners than with friends or family, and can develop empathy towards these inmates.

With potential bonds between death-row guards and prisoners in mind, a separate team of officers frequently conducts the actual execution. COs directly involved with the prisoners are often given smaller roles, such as walking the prisoners to the execution spot, or putting a hood over their head. This approach aims to reduce the emotionally damaging effects of executions on those in close contact with the inmates.

Authorities also try to disperse feelings of responsibility for the killing by having multiple guards involved in the execution process. With lethal injection, the method of execution used in most States, three COs are assigned to turn a key switch that releases the lethal drug into the prisoner. Only one “live” switch dispenses the fatal chemical. The CO initiating the procedure that ultimately kills the prisoner is not known.

Despite such measures, guards can feel mentally tortured by their participation in executions, both before and after.

As illustrated in Into the Abyss, a documentary detailing the death sentence of convicted killer Michael Perry, many execution guards experience post-traumatic stress disorder (PTSD). One guard explained his acute symptoms at the outset of his descent into PTSD. He began crying and shaking uncontrollably when “the eyes of all the inmates he had executed began flashing before him.” Another developed nightmares, cold sweats, and sleeplessness.

Other guards, like Givens, have reported depression, inability to sustain relationships, and changes in personality. According to Rachel MacNair, author of Perpetration-Induced Traumatic Stress: The Psychological Consequences of Killing:

“The inner lives of guards who execute become like those of battlefield veterans who suppress memories from themselves and others.”

In 2007, two South Carolina COs who developed obsessive compulsive behaviour, nightmares, and other emotional disturbances filed civil lawsuits, claiming that their conditions resulted from performing executions. The COs alleged that they were coerced into carrying out executions and were not given any debriefing or counseling to help them deal with the emotional effects.

For some guards who need psychological treatment, it is simply not available. Other times, guards do not use available psychological help for fear of bei

Source: Feature: Fumigraphik at flickr, Creative Commons

ng labelled ‘weak’ by their colleagues. Additionally, guards may not have the opportunity to talk about their involvement in executions with members of their families. Givens explained:

“When I accepted the job, I never told my wife or kids or anybody. I didn’t want them to go through anything I had to go through. If I told someone, they would tell someone. It would have been like a snowball and gotten bigger and bigger and everyone would know exactly what I was doing.”

This secrecy protects guards from having to explain or defend their actions. But it also prevents them from obtaining help to lessen the ill-effects of the associated trauma. Lack of disclosure precludes obtaining support.

The unacknowledged stress experienced by guards on execution teams risks dangerous mental-health consequences. As Givens, who now campaigns to end the death penalty, put it:

“It’s not an easy task to do. If I had known what I had to go through as an executioner, I wouldn’t have done it. You can’t tell me I can take the life of people and go home and be normal.”

– Veerpal Bambrah, Contributing Writer. The Trauma and Mental Health Report.

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

This article was originally published on Psychology Today

Using Art to Heal from Sexual Assault

September 27, 201800Anger, Creativity, Featured news, Relationships, Self-Control, Therapy, Trauma September, 18

Source: Safi, Frizz kid,used with permission

Frizz Kid (Hana Shafi), a writer and visual artist based in Toronto, Canada, deals with themes of feminism, sexual violence, and self-care. Shafi first came to prominence through social media after the high-profile Jian Ghomeshi sexual assault trial in Toronto. Prominent radio personality Ghomeshi was charged with, but subsequently acquitted of, multiple counts of sexual violence.

Ghomeshi’s victims were essentially blamed for the assaults, and their stories were discounted as inconsistent or false. Following the trial, numerous artists and activists joined together under the hashtag #WeBelieveSurvivors—Shafi among them. And her craft was deeply affected and altered by the outcome of the trial.

In an interview with the Trauma and Mental Health Report, Shafi discussed the impact on her art:

“The period after the trial was really difficult. The constant media coverage of what happened to these women and the ultimate lack of justice was hurtful, particularly to survivors of sexual assault. A compassionate perspective was missing. The trial turned into an attack on their characters instead of focusing on the wrong that was done to them.”

In reaction, Shafi began her most well-known work: her Positive Affirmation Series. Shafi combined drawn images with words to assert comforting phrases, such as “healing is not linear,” “it’s natural to have emotional baggage,” and “you are worthy of love.”

According to Shafi:

“The series has been a way for me to express solidarity with victims of sexual assault. I never expected the art to get as big a reception as it has.”

Her art serves several purposes. She creates it to cope, as well as to help others:

“All my pieces have a purpose for me as much as for others. I find it personally healing to create, but I also want to help others and create a community of people around art where we can heal together, be angry together, be sad together, and create together.”

To engage more closely with her audience, Shafi recently collaborated with Ryerson University as their artist-in-residence. There, she conducted free workshops on making zines, which are short, self-published magazines made by photocopying and binding artwork, poetry, or other writing.

Participants were invited to answer the following:

“Have you ever thought about what you would say to the person who sexually assaulted you? What would you want your peers to know? What would you like to remind yourself?”

These works were compiled for an art installation, titled “Lost Words.” In an Instagram post, Shafi explained:

“Through these questions, we can communicate the lost words; all the things that have been left unsaid but need to be heard.”

When speaking with the Trauma and Mental Health Report, she added:

“I really wanted there to be a platform for people impacted by sexual violence to speak about their experiences. To say the things they never had an opportunity to say, or felt they couldn’t say. I wanted people to get the sense that they could say whatever they wanted in that space and that they would be safe doing so. This is them talking back. I think having an outlet like this is critical for the healing process.”

Shafi also stressed the important role that participant anonymity played in “Lost Words:”

“There’s safety in anonymity. People are not super understanding about this subject matter; there needs to be anonymity.”

Some may be familiar with the therapeutic practice of writing a letter to a person who has hurt them, then destroying the letter. These so-called “hot letters” are used as a form of emotional catharsis.

Similar ideas were explored by Shafi in this exhibit. “Lost Words,” however, dealt with having private and painful thoughts read by the public. These works were exhibited in conjunction with the Sexual Assault Roadshow, a travelling art gallery that aims to change the public’s perception of survivors of sexual assault. This decision to exhibit to the general public was tactical. Shafi explained:

“I think through viewing the works, they begin to understand; they get a small glimpse into the reality of a survivor; they see the injustice, trauma, and frustration.”

Survivors of sexual assault benefit from the exhibit too, Shafi argued:

“They express what they’ve always wanted to say but never had the platform for. It may have been unsafe for them to say things before, but they are now excited that their work will be seen—that they can speak in a public setting while remaining anonymous.”

The reception to the exhibit was overwhelmingly positive, with many reaching out to Shafi to express their gratitude. Others, Shafi said, were genuinely surprised by the exhibit, which she suspected was a reality check for them.

Shafi stressed that she is not giving survivors a voice because they have their own voice.

“I think what I’m doing is giving them a space to feel heard and validated. Giving them art that emphasizes their experience, highlights their issues, and provides a compassionate space.”

– “Fernanda de la Mora, 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

What if Your Father Were a Pedophile?

August 30, 201800Embarrassment, Family Dynamics, Featured news, Psychiatry, Punishment, Relationships, Trauma August, 18

Source: Feature: enki22 at flickr, Creative Commons

“Between You and Me,” a documentary by director Chase Joynt, examines what it feels like to discover a family member has done a terrible thing. In this short film, Chase accompanies his friend Rebekah Skoor as they travel to visit Rebekah’s father, Michael, a convicted pedophile.

Michael Skoor, a pastor and family man, was convicted of repeatedly molesting an 11-year old boy. After contemplating suicide, he confessed the abuse to a psychiatrist, who reported him. Michael turned himself in, pled guilty, and was sentenced to 29 years in prison. For many, the story ends there, but for Rebekah and her family, the story just begins.

After her father’s revelations, Rebekah and her family faced social ostracism and stigmatization from their community. And, they felt their own feelings of shame. These repercussions often fall on families of sex offenders. “It was a really scary time,” Rebekah recounts to Chase in the film, as they prepare to travel to see her dad in prison.

A study by Professors Jill Levenson and Richard Tewksbury reported on data from family members of sex offenders. These families experienced financial hardship, housing displacement, and psychological distress. They also met with social repercussions, such as ridicule and teasing, as a result of their loved one’s actions.

In addition to feeling humiliation and shame, family members feared for their personal safety. Of all participants studied, 44% reported they had been threatened or harassed by a neighbor. Children of offenders suffered from depression and anxiety due to being bullied at school by both teachers and fellow students.

The public’s animosity toward these families may have its roots in the belief that family members know about the relative’s crimes, and could have intervened to stop them. It’s not uncommon for some members of law enforcement, the media, and the helping professions, to voice such assumptions, which may influence public opinion.

In an opinion piece by psychologist Seth Myers, he portrays the wife of disgraced football coach Jerry Sandusky as a guilty party to her husband’s crimes, even though she was never charged for any part in the assaults. And, Myers had never clinically assessed Sandusky’s wife. The assumption of guilt-by-association is a dubious claim to make, and may be at the heart of stigma faced by family members of sex offenders.

In an interview with the Toronto Star, psychiatrist Paul Fedoroff refers to the family members of sex offenders as “secondary victims.” These people are often abandoned and left reeling in the aftermath of the crime.

Families must also deal with their own personal feelings and internal conflicts. In the Toronto Star article, Scott Woodside, of the Sexual Behaviours Clinic at the Centre for Addiction and Mental Health (CAMH) in Toronto, explained that children of sexually abusive fathers “don’t like that their father did this to them but they love their father… and do not want their father to be taken away because no one will replace him.” The same can apply when parents abuse outsiders.

While acknowledging the seriousness of the crimes committed by these sexual predators, their families are confronted with the difficult task of trying to reconcile their good memories with the knowledge of the terrible act the relative committed. They are caught in the middle.

And to them, the offense is hard to integrate. In a deleted scene from “Between You And Me,” Rebekah explains her difficulty in trying to convey this dichotomy to others when speaking about her father:

“I feel called to give the back story of the 21 years of awesomeness that was in my life. Not perfection, but good intentional fathering. Before I land this heinous offense on people… I want them to be able to hold with me my dichotomy, that he is in some part hero and in some part this fallen man.”

Rebekah wants to illustrate both sides of her father, the man she knew, and the crimes he committed. Recognizing these two seemingly incompatible aspects leaves Rebekah feeling she is caught between loving her father and condemning his actions. Rebekah’s recollection of his sentencing illustrates the issue well.

“It felt very divided… the people with the ribbons who were there for the [victim] and the people without ribbons who were there for my dad. I really felt this profound sense of, ‘I also want a ribbon. I’m not pro sexual violence. I’m not endorsing my father’s actions.’”

She does not approve of what he did. And yet, “The terrible things don’t undo the love.”

– Stefano Costa, 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

Unforeseen Stress When a Child Receives a Transplant

April 26, 201800Featured news, Guilt, Health, Post-Traumatic Stress Disorder, Stress, Trauma April, 18

Source: debowscyfoto at pixabay, Creative Commons

On April 13, 2016, Bill and Lindsay Brent received the phone call they were desperate for. Their youngest child Nathan would get the liver transplant he urgently needed. Within hours, the family from Barrie, Ontario was heading to The Hospital for Sick Children in Toronto.

By 8:00 the next morning, Nathan’s life-saving surgery was underway. Twelve hours after surgery began, the Brents’ feisty toddler emerged from surgery sedated, but holding his own, and began his road to recovery.

Twenty months earlier, Nathan was diagnosed with Alagille Syndrome, a genetic disorder affecting his liver, and severe enough that his only hope for survival was a liver transplant. But as the months passed, the situation began to look bleak. Nathan’s rare AB negative blood type greatly decreased his chances of finding a donor match.

Complicating matters further, Nathan was ineligible for the program; he required a liver from a deceased donor rather than from someone who was living. In his case, a pediatric donor would increase the odds of success, meaning that another child would have to die for Nathan to live.

And yet, despite insurmountable odds, thanks to the decision of one family, a liver was donated and Nathan survived.

Raelynn Maloney, a clinical psychologist and co-author of the book Caring for Donor Families: Before, During and After, says that the donor waiting period can be extremely stressful for families.

“Many traumas can occur during the ‘waiting period’; seeing a loved one suffer from illness without a clear outcome in sight, financial stress as families juggle care demands with work schedules, and, of course, the fear of running out of time.”

For the Brents, though, the psychological impact of their son’s traumatic journey started to surface only after the transplant was completed. Bill explains:

“Even though you are devastated when you receive the news that your child has a life-threatening illness, your need to remain focused on the outcome and to stay positive takes over. What has been shocking is the magnitude of post-transplant emotions that we’ve had to face. You’ve received a miracle, and yet, somehow, you are gripped with guilt and sorrow for the donor’s family, and an anxiety about the future that is so strong, it hinders your ability to feel good about life.”

For the couple, while they shared the same concerns for Nathan, their struggles with anxiety manifested in different ways. While Lindsay tended to ruminate and panic about the risks to Nathan post-transplant, such as illness, injury, and organ rejection, Bill reported an increase in social anxiety and was gripped with survivor’s guilt and depression. He says:

“It is very difficult for me to accept that my son needed someone to die for him to live. The donor family is in our thoughts constantly, and words cannot describe how thankful we are to them. They are our heroes.”

Maloney explains that recipient families can have a delayed reaction to the distress they experience while their loved one is on the donor list, and they are often unprepared for the rush of emotions that come after transplant.

While remaining focused on a solution, recipient families often do not allow themselves the space to grieve setbacks as they occur. Rather, they strive to maintain hopefulness while supressing the pain of the situation.

Maloney emphasizes that it may only be during recovery, when these families finally have a chance to process what they have gone through, that the traumatic grief hits.

The Brents recognized that, post-transplant, there was much more time to reflect on the enormity of what they had been through. Although grateful for Nathan’s outcome and the support of their family and friends, the Brents still faced ongoing emotional issues, all while trying to build normalcy back into their lives. Lindsay explains:

“Since Nathan has received his new liver, we no longer have access to the transplant support team that was available to us before the surgery. The medical team has moved on, the social support from the families at the hospital has been less frequent since we have returned home. In a way, Bill and I feel like we’ve lost family members, people that up until the transplant were a part of our innermost circle. In some ways, we feel left to navigate this post-transplant terrain on our own.”

Maloney acknowledges that there is an illusion held by the public that, after a transplant, all is well and life returns to normal. In reality, this is a time when transplant recipients and their families may need even more support as they try to reconcile the trauma of the illness with a hopeful and optimistic view of the future.

Now at home, Nathan continues to improve. Bill and Lindsay look forward to the time when this difficult journey will be surpassed by many happier, hopeful moments.

–Kimberley Moore, Contributing Writer, The Trauma and Mental Health Report.

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

This article was originally published on Psychology Today

Inadequate Training Increases Risk of Compassion Fatigue

March 15, 201870Burnout, Caregiving, Featured news, Health, Stress, Trauma, Work March, 18

Source: Pennsylvania National Guard at flickr, Creative Commons

Every afternoon, personal support worker Susan (name changed) struggled with administering medication to a particular elderly patient in the dementia ward where she worked. On one such occasion, fed up with the patient’s behaviour, Susan became so frustrated that she mumbled a profanity, reached over, and pinched the patient’s arm. With a sharp cry of pain, the patient quickly accepted the medication and Susan was able to move on.

Stories of malpractice or poor patient care like this are not as uncommon as one might imagine. Evident from media reports of negligence in hospital settings, such cases can ignite an outcry in the community and prompt questions about individuals’ suitability for caretaking roles. How could someone with a career revolving around caring for others lack empathy?

Grace, an Ontario care worker who witnessed Susan’s behavior firsthand, believes the demanding nature of the job took a physical and mental toll on her co-worker. Having worked for eight years at a residential center for dementia patients, Grace knows from experience just how mentally exhausting the work can be. In an interview with the Trauma and Mental Health Report, Grace explained:

“There’s so much to take care of with these particular patients. When it’s dinnertime, you have to make sure to clean the patient, take them to the dining room, prepare the area for them, feed them, etc. But the next thing you know, they may have soiled themselves or vomited and you have yet another thing to clean when you already have so much to do… There are times when you need to take dirty clothing or dishes from them and they refuse to give them to you or just start yelling at you.”

When faced with the same situation on a daily basis, Grace explains that it’s hard not to become exasperated:

“It can get annoying and even angering at times. It’s hard to control… I didn’t hear much from Susan when I first started working here, but then she began yelling at the patients. I do believe it’s because the stress finally got to her.”

Mental health professionals support Grace’s theory. Overworked employees who are plagued by such feelings of frustration are showing signs of Compassion Fatigue (CF).

Francoise Mathieu, CF specialist and founder of Compassion Fatigue Solutions in Kingston, Ontario, describes the condition on her organization’s website as a gradual emotional and physical exhaustion of helping professionals. While CF is sometimes used interchangeably with Vicarious Trauma (VT), there is a difference between the two. VT is a secondary form of post-traumatic stress disorder, where a worker becomes preoccupied with a specific event or patient problem. On the other hand, CF is an overall decline in the ability to empathize with others.

The American Institute of Stress also differentiates CF from ‘burnout’. With CF, the constant pressure to show compassion toward patients may wear on mental energy stores, leading workers to become emotionally blunted to people and events. Burnout is less dependent on this loss of compassion.

CF is not limited to mental health professionals. It has been shown to affect teachers, social workers, police officers, prison guards, and even lawyers who work with trauma victims. In Grace’s words:

“At first, the stories you hear and the things you see involving the patients really do follow you home. They used to make me feel depressed. Over time, that sensitivity does lessen. After being exposed to this type of thing day after day, you start to lose those feelings.”

According to CF expert Francois Mathieu, once workers begin to experience this emotional exhaustion, they may be prone to moodiness, irritability, difficulty concentrating, intrusive thoughts, feelings of hopelessness, and apathy in both workplace and personal relationships. Fran McHolm, Director of Continuing Education at the Nurses Christian Fellowship has written about how CF can lead to a decrease in general employee happiness, workplace satisfaction, and quality of patient care.

CF is not a rare condition. Results from a 2012 dissertation study by Shannon Abraham-Cook at Seton Hall University show that, out of 111 urban public school teachers in Newark, New Jersey, 90% were at high-risk for CF. In 2010, Crystal Hooper and colleagues from the AnMed Health Medical Center in South Carolina also found that 86% of emergency department nurses exhibited moderate to high levels of CF.

While CF is common in many workplaces, help for employees who are experiencing symptoms, is not readily available. In an interview with the Trauma and Mental Health Report, Isabella, an assistant teacher working with special needs children at a Toronto daycare, describes her experience:

“When we began training, the instructors only talked about how to care for the children and how to work with the different age groups. Management didn’t provide us with anything else. The only thing we can do when feeling overly stressed is go for a break.”

Grace adds that her center for dementia patients fails to directly address employee needs:

“Recently, they added cameras everywhere to prevent poor patient care, but it’s made things worse. Now we are forced to seem especially compassionate and the littlest mistake can lead to a suspension. The management doesn’t try to understand the worker’s view of things at all.”

Dan Swayze, vice president of the Center for Emergency Medicine of Western Pennsylvania, discusses several ways management can address employees’ personal needs pertaining to compassion fatigue. In an article in the Journal of Emergency Medical Services, Swayze writes about the importance of implementing policies and developing programs that can help ease the onset of CF. Teaching employees how to set professional boundaries with patients, conducting meetings to solve individual client issues as a team, and offering counselling services to stressed employees are just a few options administration can take.

And a 2015 study by researcher Patricia Potter and colleagues in the Journal of Continuing Education in Nursing argues for resilience training, a program designed to educate personnel about CF and its risk factors. Workers are taught how to employ relaxation techniques and build social support networks to cope with symptoms that arise from working with difficult populations. Staff members from a US medical center who participated in the training self-reported an increase in their empathy and overall emotional health.

Volunteer crisis hotline operator, Anabel, explains the benefits of these resources in her line of work:

“The staff at the distress center are really considerate of their volunteers. In the training they prepare you for compassion fatigue, encourage volunteers to take care of themselves, and to not take the calls home with you. They also make sure to be available to the volunteers 24/7 in case they need to debrief a call with someone. It really helps to know they’re there to talk to—often after a distressing call.”

Training and intervention programs can help safeguard against the development of compassion fatigue in care workers. But many people working in the field, like Grace and Isabella, have been thrown into care-taking roles with no consideration for the risks to their mental wellbeing. Both women have identified various ways of coping as a stopgap until they receive the assistance and support they need.

Isabella suggests taking full advantage of breaks every few hours:

“Whenever you feel overwhelmed, go for a break right away—even if it’s just to the washroom or for a coffee… When you leave and come back, you feel refreshed. I’m lucky that I live so close to my workplace that I can go home during lunch.”

Grace recommends taking a deep breath and focusing on any positive aspect of the job:

“I learn so much from the patients. Hearing their stories, you can end up getting really close to some of them. I try to listen to them when I can and when I see the positive effect that has on them, I feel very fulfilled.”

These coping mechanisms do not work for everyone, which is why early intervention is so important. While camera implementation has prevented some inappropriate conduct like Susan’s from continuing, it doesn’t address the root problem.

“There are times where I get angry,” Grace admits. “I can’t always entertain patients or be friendly. I try… but it’s so hard… I know a lot of people, like myself, are really sensitive, which is why we are so emotionally affected by this job. There’s no stress management or counselling here, but… these training programs could really help.”

For many helping professionals, compassion fatigue may be inevitable. Cases like Susan’s show that the wellbeing of individuals in caretaking roles directly influences the quality of care that patients will receive. Support in the form of training programs and other preventative measures can make a difference in the lives of these workers, and, improve patient care.

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

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

This article was originally published on Psychology Today

Mental-Health Stigma All Too Common in Iran

March 1, 201870Depression, Featured news, Health, Psychopathy, Stress, Trauma March, 18

Source: PakPolaris at Deviant Art, Creative Commons

A Minor Leap Down, an Iranian film featured at international film festivals in Berlin and Toronto, illustrates the struggle of a 30-year-old Iranian woman named Nahal, whose deteriorating mental health is undermined by her family.

When Nahal is told she’s had a miscarriage, instead of seeking support from her family—who have, in the past, refused to recognize her struggle with depression—she keeps the news to herself, leading to desperation.

Stigma surrounding psychological disorders in Iran often leads to isolation, as fear of judgment and ridicule creates barriers to pursuing treatment. Some reports show that 26.5 percent of Iranian women and 20.8 percent of Iranian men have mental-health difficulties.

In an interview with the Trauma and Mental Health Report (translated, Farsi to English), Hamed Rajabi, director of A Minor Leap Down, explains:

“This social system is only concerned with how people work and perform, and when that performance is lowered, their behavior is instantly condemned.”

Research by Ahmad Ali Noorbala and colleagues from Tehran University of Medical Sciences shows women in Iran have a greater incidence of mental disorders than women in Western cultures. One contributing factor may be that women in Iran are often confined to the home, leading to isolation and poor domestic conditions.

After the loss of her unborn child, Nahal spirals into deep depression, deciding not to remove dead fetal tissue from her womb. When she tries to address the issue with her mother and husband, she’s turned away.

Familial relationships and reputation are important aspects of Iranian culture. Mental illness in a family member is viewed as a familial flaw.

According to research published in the Journal of Health and Social Behaviour by Erin Cornwell of Cornell University and Linda Waite of the University of Chicago, social relationships are particularly important for those coping with mental illness; social withdrawal aggravates loneliness, stress, and feelings of low self-worth.

Nahal’s silence about her mental illness also relates to a worry that she’ll be forced to resume antidepressant medication, which she took prior to pregnancy. Medications like these are seen as first-line treatment in Iran.

In A Minor Leap Down, filmmaker Rajabi addresses the over-prescription of psychotropic medication in Iran, explaining:

“Depression signifies that a part of our lives hurt—and taking pills won’t solve anything until we distinguish which part of our life is causing the problem.”

Although recognition of mental-health problems in Iran has arguably increased over the past few years, considerable stigma still exists.

Awareness can translate to an enhanced understanding of the complexity of mental-health problems in a culture that holds rigid attitudes about mental health and illness.

–Nonna Khakpour, Contributing Writer, The Trauma and Mental Health Report.

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

This article was originally published on Psychology Today

Stigma Surrounds HIV-Positive Children in China

February 15, 201800Bias, Featured news, Health, Law and Crime, Trauma February, 18

Source: quaerion at DeviantArt, Creative Commons

In 2014, a young boy (pseudonym ‘Kunkun’ for anonymity) was banished from his village in Sichuan, China after being diagnosed with AIDS. The villagers did not understand the disease, so feared for their safety. In a CNN article, resident He Jialing expressed his concerns for his daughter who went to school with Kunkun at the time:

“My daughter is around his age, and goes to a boarding school now. What happens if she gets bitten while playing with him here at home? That boy is too dangerous.”

There are roughly 740,000 active cases of HIV in China. Misinformation and intense stigma surrounding HIV and AIDS often result in tragic consequences for HIV-positive children. For example, infected children are frequently banned from their schools and abandoned by their loved ones.

Xu Wenqing, an HIV/AIDS specialist with UNICEF China, revealed to The World Post that HIV-positive children are often segregated from their peers in school:

“If their HIV status has been disclosed, it’s very common that parents of other children complain to the school and force the school to separate their children from HIV positive children.”

But a boarding school in China called the Green Harbor Red-Ribbon School was created in 2006 to house roughly 30 HIV-positive children between the ages of 6 and 19. The school is a refuge for those who have been ostracized by their communities because of their illness. Other organizations are intervening as well.

At an orphanage run by the non-government Fuyang AIDS Orphan Salvation Association, children receive food, housing, education, and the necessary medications to control the virus. The director, Zhang Ying, explained to Reuters that psychological improvements are seen in the children under their care:

“Our children have a healthier state of mind now. When I first started to get to know these children, they had low self-esteem and were afraid of being discriminated against by others. After these few years, by staging different kinds of activities for them, the children no longer feel inferior and are more confident about themselves.”

Although a source of refuge for children, boarding schools and orphanages are not a long-term solution. They cannot cope with the sheer number of children who have HIV. In the case of Green Harbor, the haven can only protect children to age 19, at which point they are expected to leave. Unfortunately, the stigma faced by HIV-positive adults is also problematic.

In 2010, a court in China ruled against a man who said that he was wrongfully denied a job after his prospective employer discovered he was HIV-positive. The judge’s ruling contradicted an earlier law that was meant to protect infected individuals from being discriminated against by employers. The law stated:

“No institution or individual shall discriminate against people living with HIV, AIDS patients and their relatives.”

Even with legal protection, those with HIV are still regularly banned from schools and jobs, perpetuating the ignorance and fear surrounding a positive status. And, although medical treatment of AIDS is becoming increasingly accessible in China, a 2009 United Nations report stated many infected people do not seek treatment due to lack of knowledge or to concern that their status will be exposed.

Lack of consistent medical care, or lack of any treatment for that matter, presents huge risks to those with HIV. Without medication, HIV can develop into AIDS and cause death. Nonadherence to medication can lead to the development of drug-resistant strains of HIV that may lower quality of life, since patients may require stronger medications with more serious side effects. All the more reason to reduce the stigma associated with positive-HIV status, and to support treatment for those battling the virus.

In an effort to combat these problems, China’s first lady Peng Liyuan appeared in public advertisements holding hands and playing with HIV-positive children at the Red-Ribbon School. Plus, in 2010, a law limiting HIV-positive individuals’ entrance into and movement within China was lifted, but more needs to be done.

People with HIV in China are still ostracized, and laws meant to protect them from discrimination are circumvented. Until awareness and access to disease education improve, cases of people being denied schooling and jobs due to HIV status are likely to continue. Furthermore, children who do not live in a protected environment or who are too old for an orphanage will be left fending for themselves.

–Abbiramy Sharvendiran, Contributing Writer, The Trauma and Mental Health Report.

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

This article was originally published on Psychology Today

Firefighters Fight Stress as First Responders

February 1, 201890Burnout, Featured news, Post-Traumatic Stress Disorder, Stress, Trauma, Work February, 18

We tend to think of firefighters saving lives as fires tear through homes or forest land. What many people don’t know is that firefighters are also first responders, arriving at crisis scenes even before paramedics or police officers.

Working in stressful and traumatic situations can take a toll on their mental health. Post Traumatic Stress Disorder (PTSD) and suicide rates are much higher in first responders than in most other professions. Canadian first responders experience twice the rate of PTSD compared to civilians.

Ongoing exposure to stress means that access to support is critical. But cultural and administrative barriers get in the way. Because firefighters are regarded as tough and invulnerable, many feel embarrassed to ask for help, and available programs can be difficult to navigate.

Brian (name changed for anonymity), a 30-year veteran of the fire service and a District Chief in Ontario, Canada has experienced the stressful effects of the job firsthand, and has witnessed the toll it takes on colleagues and family:

“You’re just supposed to deal with the effects of the job. The stigma is that, if you can’t handle it, you’re weak. This idea has been built into the profession.”

When Brian entered his new role as District Chief, he received very little training on how to support the well-being of those working under him. He received only a phone number to an Employee Assistance Program (EAP) to distribute to team members if they had an exceptionally stressful day. The call is left up to individual firefighters rather than to an outreach program that communicates to them directly.

Although Brian believes that firefighters can benefit from the EAP, he knows that stigma exists around making the call. So, the resource doesn’t get used.

“There have always been employee assistance programs. In all my thirty years, I’ve only seen the EAP used once or twice. For the program to work, the agency needs to call the firefighters, because firefighters don’t reach out.”

To fight this stigma, the province of Ontario has launched several initiatives, including a new radio and digital campaign created to raise awareness and reduce the hesitancy of first responders to seek support. A free online toolkit has also been developed that addresses how to cope with PTSD.

Social support is another essential component of first responders’ wellbeing. In a study published in the Journal of Occupational Health Psychology, Jasmine Huynh of Flinders University and colleagues found that support from family and friends was critical for protecting workers from burnout and for them to cope with the demands of frontline responsibilities.

Brian and his wife Sandra (name changed for anonymity) find support in each other and also through other firefighters and their families. Sandra explains that they often use humour to address the stress:

“When you go into the fire hall, there’s a lot of humour. I think we use humour to deal with the pressure, to keep going. That’s our coping mechanism. It’s also how we manage the stress as a family.”

While some programs exist to help firefighters work through their own issues, there is very little support for families of first responders. Having a loved one who is a firefighter can take a toll on the whole household.

In a study by social work professor Cheryl Regehr and a group of researchers at the University of Toronto, the authors explored how firefighters’ wives coped with the mental distress caused by their husbands’ emotionally taxing jobs. Wives handled partner stress by emotionally distancing themselves when necessary.

After thirty years, Sandra has learned to better read Brian’s emotional states, allowing her to recognize when he needs some space after a bad shift. She explains:

“If he comes home and is quiet, and not himself, I know that something is wrong. But I just let it go and let time pass, and then, eventually, I ask him about it. I can tell when it has been a rough shift. If he wants to be alone, I let him be.”

In an attempt to shield his children from the dangers of his job, Brian doesn’t discuss work much at home:

“When I was initially on the job, I talked to Sandra a lot about it, but when the kids came, I stopped. You don’t want to bring the experiences home; you don’t want the kids to worry. It’s bad enough that Sandra worries.”

Despite being proud of her husband, Sandra can’t help but feel constant fear in the back of her mind:

“I think about Brian’s safety all the time. The fear is always there. When he was first on the job, I tried not to think about it. I didn’t watch the news, and if I did, I prayed it wasn’t his fire truck at an emergency.”

To her relief, it has always been someone else’s fire truck. But that someone usually has a family at home, also worrying.

Brian and Sandra agree that more needs to be done to support frontline workers and families. At least initiatives like the media campaign and online toolkit serve as a starting point for an open dialogue surrounding the stigma of seeking help.

At the end of the day, Brian’s job is just that: a job. He says:

“People want to call us heroes. Most of the time, I don’t classify us as heroes. We do what we’re trained to do, and if we do it well, we all come home.”

–Alyssa Carvajal, Contributing Writer, The Trauma and Mental Health Report.

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

This article was originally published on Psychology Today

Rape Victims’ Reactions Misunderstood by Law Enforcement

January 11, 201840Depression, Featured news, Law and Crime, Neuroscience, Post-Traumatic Stress Disorder, Trauma January, 18

Source: Richard George Davis, used with permission

In 2008, 18-year-old Marie reported being raped at knifepoint in her apartment. Confronted by the police with allegations that she was lying, she conceded under pressure that the rape may have been a dream. Then, after being aggressively interrogated about her story, she finally admitted to making it up. She was subsequently charged with false reporting.

The report, however, was not false. In June 2012, Marc O’Leary pleaded guilty to 28 counts of rape and was sentenced to 327½ years in prison, including 28½ years for the rape of Marie.

Rape is unlike most other criminal offences. The credibility of the victim is often on trial as much as the guilt of the assailant, despite the fact that false rape accusations are rare (only an estimated 2-8% of cases are fabricated).

Sergeant Gregg Rinta, a sex crimes supervisor at the Snohomish County Sheriff’s Office in Washington, deemed that what happened to Marie was “nothing short of the victim being coerced into admitting that she had lied about the rape.” Rinta recounted in an external report of the department’s handling of the case how Marie was subjected to “bullying and hounding”, as well as threats of jail time and withdrawal of housing assistance.

Steve Rider, the commander of Marie’s criminal investigation, considers her case a failure. In an interview conducted by ProPublica and The Marshall Project, he explained:

“Knowing that she went through that brutal attack—and then we told her she lied? That’s awful. We all got into this job to help people, not to hurt them”

The seed of doubt was planted when the police received a phone call from Marie’s former foster mother Peggy and another foster mother, Shannon. One of their biggest issues was that Marie was calm while describing the attack, rather than upset. Shannon stated:

“She called and said, ‘I’ve been raped. there was just no emotion. It was like she was telling me that she’d made a sandwich.”

Peggy remembers:

“I felt like she was telling me the script of a Law & Order story. She seemed so detached and removed emotionally.”

Hearing these accounts from those closest to Marie led the police to distrust her story, and the situation unfolded from there. In rape cases, a judgment of legitimacy often focuses on the victim’s reaction during and following the event instead of on the assailant’s behaviour.

Clinical psychologist Dr. Rebecca Campbell spoke about the neurobiology of sexual assault in a talk to the National Institute of Justice. She explained that victims are flooded with high levels of opiates during a rape—chemicals in the body intended to block physical and emotional pain, but which can also dull the victims’ feelings:

“The affect that a victim might be communicating during the assault and afterward may be very flat, incredibly monotone—like seeing no emotional reaction, which can seem counterintuitive to both the victim and other people.”

This misperception contributes to sexual assault cases not going to trial. Of rape cases that are reported, 84% are never referred to prosecutors or charged; 7% are charged but later dropped; 7% get a plea bargain; 1% are acquitted; and only 1% are ever convicted.

Dr. Campbell identifies part of this problem as the police misunderstanding victims’ reactions as they recount their trauma. Based on this confusion, police officers make assumptions about the legitimacy of what they hear and often discourage victims from seeking justice. Officers may even secondarily victimize them.

Secondary victimization is defined by Dr. Campbell as “the attitudes, beliefs and behaviors of social system personnel that victims experience as victim blaming and insensitive. It exacerbates their trauma, and it makes them feel like what they’re experiencing is a second rape.”

On average, 90% of victims are subject to at least one secondary victimization in their first encounter with the justice system. Victimization includes discouraging victims from pursuing the case, telling them it’s not serious enough, and asking about their appearance or any actions that may have provoked the assault.

These incidents have a profound effect on victims, as conveyed by Dr. Campbell, with many reporting feeling depressed, blamed, and violated. In fact, 80% feel unwilling to seek further help. As a result, many rape victims withdraw their complaint. To make matters worse, only 68% of rape cases are reported in the first place.

Sharing information on the neurobiology of trauma could be a powerful tool in educating police officers who don’t understand victims’ reactions. Evidence of the neurobiological changes that lead to flat affect or what appear to be huge emotional swings after an assault may help police better serve this population.

Furthermore, normalizing a range of reactions from rape victims, rather than accepting preconceived notions, may lead to a safer and more effective environment for reporting sexual assault. Knowledge about trauma can also serve to inform public discourse about sexual assault, as well as help victims to see their own reactions with compassion.

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

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

This article was originally published on Psychology Today

Rape Victims' Reactions Misunderstood by Law Enforcement

January 11, 201800Depression, Featured news, Law and Crime, Neuroscience, Post-Traumatic Stress Disorder, Trauma January, 18

Source: Richard George Davis, used with permission

The report, however, was not false. In June 2012, Marc O’Leary pleaded guilty to 28 counts of rape and was sentenced to 327½ years in prison, including 28½ years for the rape of Marie.

Rape is unlike most other criminal offenses. The credibility of the victim is often on trial as much as the guilt of the assailant, despite the fact that false rape accusations are rare (only an estimated 2 to 8 percent of cases are fabricated).

Sergeant Gregg Rinta, a sex crimes supervisor at the Snohomish County Sheriff’s Office in Washington, deemed that what happened to Marie was “nothing short of the victim being coerced into admitting that she had lied about the rape.” Rinta recounted in an external report of the department’s handling of the case how Marie was subjected to “bullying and hounding,” as well as threats of jail time and withdrawal of housing assistance.

Steve Rider, the commander of Marie’s criminal investigation, considers her case a failure. In an interview conducted by ProPublica and The Marshall Project, he explained:

“Knowing that she went through that brutal attack—and then we told her she lied? That’s awful. We all got into this job to help people, not to hurt them.”

“She called and said, ‘I’ve been raped.’ there was just no emotion. It was like she was telling me that she’d made a sandwich.”

Peggy remembers:

“I felt like she was telling me the script of a Law & Order story. She seemed so detached and removed emotionally.”

This misperception contributes to sexual assault cases not going to trial. Of rape cases that are reported, 84 percent are never referred to prosecutors or charged; 7 percent are charged but later dropped; 7 percent get a plea bargain; 1 percent are acquitted; and only 1 percent are ever convicted.

Dr. Campbell identifies part of this problem is the police misunderstanding victims’ reactions as they recount their trauma. Based on this confusion, police officers make assumptions about the legitimacy of what they hear and often discourage victims from seeking justice. Officers may even secondarily victimize them.

Secondary victimization is defined by Dr. Campbell as “the attitudes, beliefs, and behaviors of social system personnel that victims experience as victim blaming and insensitive. It exacerbates their trauma, and it makes them feel like what they’re experiencing is a second rape.”

On average, 90 percent of victims are subject to at least one secondary victimization in their first encounter with the justice system. Victimization includes discouraging victims from pursuing the case, telling them it’s not serious enough, and asking about their appearance or any actions that may have provoked the assault.

These incidents have a profound effect on victims, as conveyed by Dr. Campbell, with many report feeling depressed, blamed, and violated. In fact, 80 percent feel unwilling to seek further help. As a result, many rape victims withdraw their complaint. To make matters worse, only 68 percent of rape cases are reported in the first place.

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

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

This article was originally published on Psychology Today

Category: Trauma