Long time, no post -- Hello Again!

It's been more than two years since my last post on this blog. So much has happened...

I'm at the tail end of a year and a half of Dialectical Behavioral Therapy. Other work I've done has helped save my life; DBT has literally given me the tools for living my life. I'll have a lot to say about DBT and about how anyone (with a mental health issue or not) could benefit by using the DBT skills in upcoming posts.

Look for other changes as well. My life isn't about trauma anymore -- not the trauma I experienced, and not about the fact that I survived it. I'm a thriving survivor, now, and I want to start having discussions about the ways that anyone can improve their relationships with themselves and others.

Finally, I've been invited to join in as a Health Central contributor. I'll have more details as I understand more about that.

If anyone is out there and still reading, I promise to make it worth your while in a very, very short time. And if you come here new from Health Central, be patient for just a bit and you will definitely be rewarded to the best of my ability.

When Trauma Damages Our Relationshps

During the fall of 2008, the relationship I was in ended by drowning in trauma. Each of us was facing life-changing, traumatic circumstances of our own. Neither of us was able to really help the other, and lacking the skills to do otherwise we added damaging each other to the list of traumas we each were reeling from.

I wish we had been able to read "Reconsidering the Anger in Your Relationship," an article I just received in my email in box from Psych Central, last year.

If you and your partner are dealing with trauma right now or in the more recent past, or you may ever have to deal with trauma in the future, take a moment to read and bookmark the article now. Following these steps, even imperfectly, may save you from adding a failed relationship to whatever list of traumas you're experiencing.

Image courtesy Life is a wonder via flickr.

Today's PTSD News Roundup

This is what happens when I find too many things worthy of writing about.

First, in the "No Shit, Sherlock Department," comes news from a Dartmouth web site that faculty at Dartmouth Medical School have discovered that, when people have both PTSD and substance abuse issues, it's a good idea to treat both at the same time.

According to the article, "PTSD is traditionally not addressed until up to a year after addiction treatment..."

Ok, I know that "common sense" is not always correct, and I realize the importance of studying therapies to see what will be most effective rather than jumping in and trying things that make sense.

But, I can't help but wonder if clinicians have been listening to their patients. You know, when we tell them that we use substances to self-medicate the symptoms of our PTSD. For the life of me, I can't imagine that people seeking treatment for both PTSD and substance abuse disorders don't at least occasionally talk about the former.

Next up, we have a study which says that mental health patients, including people living with PTSD, may not be receiving the most beneficial treatments.

Science Daily reports on a study written up in Psychological Science in the Public Interest, a journal published by the Association for Psychological Science. According to that study, mental health clinicians haven't been trained in the most up to date and effective methods to treat their patients.

Money quote:

"For example, cognitive-behavioral therapy (CBT) has been shown to be the most effective treatment for PTSD and has the fewest side-effects, yet many psychologists do not use this method. Baker and colleagues cite one study in which only 30 percent of psychologists were trained to perform CBT for PTSD and only half of those psychologists elected to use it. That means that six of every seven sufferers were not getting the best care available from their clinicians. Furthermore, CBT shows both long-term and immediate benefits as a treatment for PTSD; whereas medications such as Paxil have shown 25 to 50 percent relapse rates."

The study's authors are urging reform of clinical psychology training programs and a new accreditation system to be sure that clinicians aren't trained in outdated treatment methods.

Amen to that.

Finally, a reminder to help our veterans. As reported in this blog last month, the VA is considering a change to regulations to make it easier for many servicememembers to receive PTSD treatment and other mental-health benefits related to the traumas they've faced in combat. The public comment period is over on October 23rd. Head on over to the comment site and, well, comment.

Image courtesy Paul Keleher via Flickr.

Note from the Management: Nothing Substantive Today

I get headaches about once every five years or so. Make that, "Headaches." One started last night, and even looking at the computer screen is mildly painful.

I'll be back at my post as soon as the knife is out of my cranium.

Until then, be well and take care of yourselves.

This Month's Knee-Jerk Reaction: Roman Polanski

Originally, this post was going to be titled "Bullshit Headline of the Day."

The headline in question, "Polanski's past suffering entitles him to sympathetic treatment," initially had me using language I won't repeat here.

I'm a survivor of abuse and violence. I also believe it is important to take responsibility for my triggers, my reactions, and the impact I have on others.

Polanski survived the Holocaust. He lost his wife and unborn child to one of the most horrific mass murders in US history. No one reading this post, and certainly not it's author, can begin to imagine the horror that has taken place in Roman Polanski's head and heart.

But when it comes to raping a 13-year-old-child, I don't give a damn what he suffered. I do care that he chose to act his pain out in a way that would permanently mark, and possibly scar, a child for life.

Then I read the article. Ah, humble pie.

"Do we measure such a horrific history against his later crime of sexual abuse? We cannot measure one against the other any more than we can juxtapose art as licence or abuse as excuse. Being abused can confuse the victim's moral boundaries. Polanski's offence is not nullified by his own immense suffering. Nor is his crime pardonable through his brilliant and sensitive art.

But his suffering, his life and his art send us a message. Violence and abuse create violence and abuse."

The rest of the article, by a Psychologist practicing in Melbourne, Australia, brings forward ideas that I believe as well: retribution does not bring healing. Revenge begets emptiness at best, but usually all it gives us is more revenge. Not all victims become perpetrators, but all too many perpetrators were once victims.

As trauma survivors, how do we balance the demands of personal responsibility against the damage done to us as former and/or current victims? How do we judge the actions of others who have also been victimized?

For example, I learned nothing of empathy until at least my 30's, and my "trauma mind" still regards issues like health care insurance reform as a very real battle of good vs. evil. I know how hard I continue to struggle to fit in to a society I don't always understand, and still frequently regard as a hostile place from which the next bad thing will attack at any moment.

How dare I condemn Roman Polanski, or third-world terrorists, or any other victim who perpetuates the cycle of violence because that is all they know?

At the same time, how do we as a society, and as individuals, walk the wide crack between sympathy for a damaged perpetrator and preventing the "creation" of more victims?

Like I said, "humble pie." Because while my knee-jerk reaction was viscerally satisfying (and gave me a wonderful opportunity to feel morally superior to another trauma survivor; one with money and fame, no less) the fact is that our society already reacts, over and over and over again, with both knees jerking rabidly.

And we all know how much good those reactions aren't doing any of us.

Swimming Through the Memories

Sorry for my delay in posting this week; it's amazing what having a close friend in the hospital with a heart attack does to one's schedule.

That said, Monday evening gave me a chance to face the memories from one of the more traumatic times in my life, because my friend was in the same, inner-city hospital that was my second home for eight weeks after my then-husband was in a 6 O'Clock newsworthy car accident years ago.

Despite the move in recent years to make hospitals -- well, more hospitable -- this place hasn't changed. The same greasy pizza place, the same old architecture of doom, and the same dismal, cramped, loud rooms and hallways sucked me in on Monday for a trip down Remembered Trauma Lane.

I'm happy, ecstatic in fact, to say that it was three hours before my PTSD reactions to the place made it necessary for me to leave.

I'm not so happy to have to say (in the spirit of complete honesty) that yesterday was filled with lots of staring at walls and a seeming inability to get my mind to track anything for any length of time.

But at this moment (the only one that counts) the song below is going through my head courtesy of a friend who posted it in her journal. And I remember all of the times I've been able to keep my head above water, if even just my nose, and remind myself that it's getting a little bit easier every day to keep swimming.

(Fair Warning: There's a few lines of political commentary in this with which you may or may not agree. But that's not what the song is about.)



Image courtesy Nunu Bear via Flickr.

Narrative Exposure Therapy and Child Victims of Violence

Narrative Exposure Therapy: Helping Child Victims of Violence

This could be interesting for trauma-care professionals and hold out hope for our wider society as well.

While searching for a topic for today's post, I came across this article which talks about how Narrative Exposure Therapy (NET) seems to be an effective short-term method for helping children who have been repeatedly traumatized.

The article focuses on the work of two psychologists who are helping children who have been repeatedly victimized by violence in places including some African and Asian countries. They claim that NET helps these children put the past in the past.


According to the article, NET is a very structured process:

"The first session starts with a shank of rope, some flowers and some stones. The child arrays the rope in a way he feels outlines the arc of his life, then places flowers along the rope when times were good, stones when times were bad.

And then the excavation begins. Nothing is left unexplored ... particularly within those experiences that cause the most trouble.

'We have them describe it fully, from an emotional and psychological context to a sensory context - what did it smell like? - everything,' [Psychologist Frank] Neuner said. 'What we need to be able to do, finally, is to retell this entire narrative, so that it's something that's occurring in the past.'

In up to eight sessions, the therapists pull and tug the child's story, assembling it in a manageable context and blocking its jarring intrusion into the present." ...

This intense process enables the child victims to tranform non-declarative or "hot" memories into declarative or "cold" memories, thus giving them a sense of perspective.

"'The difference would be feeling, right now, that you are being raped, compared with the recollection that at some time in the past you were raped,' [Psychologist Claudia] Catani said. 'This second part is still very difficult, but when we place it in the past, we can start to put some distance there and keep it from intruding in the present.'"

Children and Trauma -- A More Widespread Problem Than You Think

The two psychologists were in Montana on Sept. 22 for a talk at the National Native Children's Trauma Center. The Director of the Center, Mariyln Bruguier-Zimmerman, brought up a very important issue when she likened the effects of violence on children in other countries with the effects of alcohol, poverty and neglect.

"'What we're talking about is trauma at the foundational level for all these children,' she said."

Bruguier-Zimmerman is right, and not just about Native American children. As a former traumatized child myself, I'm very aware of what can and often does happen when children who have been traumatized are not given the help they need.

I'm also aware that there are too many people who only think of obvious forms of violence when they think about trauma. But poverty, for example, can make a person (especially a child) feel every bit as helpless and victimized as rape does. In the case of someone who is raped society (mostly) has sympathy; victims of poverty are (mostly) told to pull themselves up by their bootstraps when they frequently don't have any boots, and thus are doubly victimized.

Narrative Exposure Therapy to Help Poor Communities?

According to this article, Narrative Exposure Therapy is even helpful when the treatment is facilitated by a trained lay therapist. This seemingly extremely low-cost modality may well help us reach both child and adult victims of poverty, neglect and violence who can't afford traditional treatments and/or who are too suspicious of professional agencies to seek them out.

In other words, we may well have the means to begin training people to help each other deal with the effects of our society's dismal record on fiscal equality.

Image courtesy Peter Mantello via Flickr.