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In order to understand why his obesity patients were dropping out of a successful weight loss program, Dr. Vincent Felitti dived into their medical records and interviews for clues. What he found launched a several year study that has enrolled more than 17,000 people. These patients were talking about incest, abuse and neglect, extreme adversity in their childhoods.
The Centers for Disease Control and Dr. Felitti with Kaiser Permanente launched a study to look at adverse childhood events and their effect on health and longevity over the lifespan.
What is an adverse childhood event? For the purposes of the study it is:
– sexual abuse
– physical abuse
– emotional abuse
– physical neglect
– emotional neglect
– a home where the mother was treated violently
– substance abuse in the home
– mental illness in the home
– parental separation or divorce
– one or more parents imprisoned
Count up the categories that apply to you. That gives you your ACE score. Anything above 4 predisposes people to substance abuse, dysfunction and health issues among other things. People with the highest scores died on average 20 years earlier than people with low ACE scores. (For more information about the mechanisms of these effects see my earlier blog posts on the HPA Axis.)
You can check out more information about the study here. Highly recommended reading for everyone: those of us who suffered difficult childhoods, caregivers, treaters and public policy setters.
This can feel overwhelming as we delve into the truth. The good news is that we are beginning to finally come to terms with the widespread effects of trauma and PTSD and the need to heal from it!
If you are partnered with someone who is struggling with PTSD or you both have PTSD, you know your life together is challenged in some very profound ways. Fights can be explosive, resulting in fireworks or endless stony silences. Misunderstandings can abound. The non-PTSD partner may start to develop secondary or vicarious trauma just being exposed to the intense PTSD in their loved one. Life can start to feel very unpredictable, like threading one’s way through a minefield. It can be easy to start walking on eggshells or conversely getting fed up and moving away from each other. Love and connection are harder to feel. PTSD challenges couples like nothing else. Waiting it out doesn’t work and neither do threats or force. What to do?
1) Educate yourself. PTSD is a whole body process that affects every aspect of the human being. It has predictable stages (see my book, The Trauma Tool Kit) and effects on the person and the partnership. You would educate yourself if your partner had a major medical illness, right? This is no different. Forewarned is forearmed, as the saying goes.
2) Set some clear boundaries around behavior in the relationship. Just because someone is suffering does not give them the right to be abusive. The anger/fear response is hardwired and amped up in full-blown PTSD. Often people with PTSD dissociate when they are angry and don’t even realize what they are doing. Sit down with your partner, ahead of time, and set rules for what is tolerable and allowed in the relationship and what is not. These can change over time depending on where each of you and your life circumstance. For instance, shouting might be OK if it is just the two of you, but if you have a child in the next room, shouting can become off-limits behavior. Violence or abusive behavior is never to be tolerated under any circumstances.
3) Learn to take time-outs, or, as we call them around here, amygdala resets. Your amygdala is the part of your brain that is the crisis response center. When it goes on red alert it highjacks the brain to deal with threats, whether real or perceived. With the amygdala in the red zone, people are very close to being out of control or they are out of control. Taking 20 minutes, the average reset time, to reboot the brain for both parties, will lend itself to a more peaceful and safe outcome. Either partner should be able to call time-out at any time. Be sure to make it a time out not an end to the discussion. Always come back together to resolve the issue at hand. If it is just too explosive get into couple’s therapy. Which reminds me…
4) Get into couple’s therapy! More research is showing that couple’s treatment can be very helpful in coping with PTSD. Individual therapy is great, but couple’s issues are complex and require their own special interventions. Not all therapists like to do or can do couples’ work well. Look for someone with previous education and training or with a degree in family work, who also is knowledgeable about trauma. Even a few sessions can make a tremendous difference. If you are worried about money (and who isn’t these days) know that there are many organizations that provide these services for low and no cost. If you are a veteran or married to one, you may be even more eligible. If money is still on your mind, remind yourself of how expensive divorces are, as long as you both shall live.
5) Study triggers together. Big rages and emotional swings are almost always brought on by triggers to PTSD. A trigger can be anything at all. I worked with a couple whose partner was an Iraq war veteran. He became severely triggered one afternoon by three events happening in close succession: he saw someone in the parking lot of the restaurant with camouflage clothing; he got a freeze headache, and he got closed in when more people joined his table. The clothing and feeling of being trapped are obvious triggers, the freeze headaches not so much. But it turned out he’d had a number of them in the desert, and it had become a trigger. The more triggers you figure out together, in the calm times, the easier it becomes to avoid setting the PTSD partner off, or resolving it more quickly if you do. This is an empowering step that often brings couples closer together. In this case, the couple avoided, what would have been in the past an angry meltdown on his part. His partner then could respond with concern and compassion.
6) Make healing PTSD a joint task in your relationship. Strategize together. Discuss medical options. Open up lines of trust and communication. Often a spouse or partner is the only person to tell one’s story to with complete safety and trust. Don’t avoid the issues just because your partner wants to. Avoidance is part of the disease of PTSD. Don’t collude with it.
7) Join together in mental and physical fitness. Develop couple’s routines around calming down the mind and body on a daily basis. This could be through prayer, meditation, tai chi, yoga, or long walks. The evidence is pouring in daily about the beneficial effects of calming techniques on PTSD. You will both be better for it!
This great poster is from lifeworkscommunity.com . Check it out!
Here’s a little known fact about trauma: an experience of extreme stress or trauma always ruptures a sense of connection and secure attachment in the world.
What do I mean by that?
The world and our sense of safety and connection in it profoundly altered by the sense of disconnection. This makes healing from trauma a doubly hard endeavor.
Here are some examples of common traumas and the ruptured attachment:
Rape: strangers, your own judgment, even a whole gender (men, usually).
War: commanding officers, countries, your own country, people of other races
Child Abuse: authority figures, intimate relationships, justice system, sense of self
Natural Disaster: God, nature, government (if inadequate response)
Car Accidents: other drivers, own judgment, motor vehicles
Major Medical Illness: body, medical system (if inadequate), society (if not able to get insurance or help due to finances)
There are, of course, many other kinds of trauma and endless variations on disrupted attachment and connection depending on the experience involved.
All victims of traumas naturally experience a questioning of and sense of separation from self. Most end up having some sort of spiritual crisis in that their attachment to a higher power is called into question.
Without feeling secure in the world it’s easy to become lost and not know where to turn to for help when you need it the most. Therapists often underestimate the damage done by rupture of secure attachment in the midst of crisis, and patients often end up feeling angry, guilty and paralyzed.
It is important to not pathologize these responses but to see them as a normal conditioned response to trauma and extreme stress.
So, easy does it. When you are ready, sit down and think about areas of mistrust that result directly from your trauma. Be good to yourself today!
I found Street Yoga when I was writing The Trauma Tool Kit. They are an amazing group of people working hard to bring yoga and mindfulness to at-risk youth in need. If you are inspired please click on this link.
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Here is the definition of rape from the New Oxford American Dictionary:
Noun: the crime, typically committed by a man, of forcing another person to have sexual intercourse with him without their consent and against their will, esp. by the threat or use of violence against them: he denied two charges of attempted rape | he had committed at least two rapes.
Verb: (if a man) to force another person to have sexual intercourse with him without their consent and against their will, esp. by the threat or use of violence against them: the woman was raped at knifepoint.
Notice how that word “force” is used in both definitions of the word rape? Paul Ryan and those who wrote legislation with him apparently didn’t and somehow felt that they needed to redundantly modify rape with the word “forcible”. This is both insensitive and stupid.
Have you heard how water is powerfully wet? Or that mud is dirty? How about fatal murder or hot arson? You get my point. Aside from being poor English, this kind of language seeks to diminish women’s (and men’s) experience that rape is a form of violence that causes intense suffering over a long period of time. It suggests that there is a kindler, gentler rape that is somehow not forcible, perhaps even enjoyable as one Texan Republican gubernatorial nominee recently suggested.
By using the inflammatory words “legitimate rape” Republican nominee Todd Akin and others suggested to the American public that there is a form of rape that is OK. This is a powerful form of double speak, a sophisticated hypnotic suggestion to the audience that both suggests that rapes could maybe be OK in some circumstances while holding women responsible for proving the severity of rape to begin with and making them doubt themselves with the ridiculous suggestion that if they become pregnant it wasn’t a “real” rape.
In reality, rape is a terrible thing to come to terms with. The mind naturally wants to deny that it even happened. As I say in The Trauma Tool Kit: “the mind swerves away from trauma like a car careening around a deep, dark puddle…avoidance is nobody’s fault but is the very nature of trauma itself.”
Either through deep cynicism or ignorance those who minimize rape (for some reason they are mostly male Republican candidates for office) are siding with the part of the brain that does not want to acknowledge the severity of this trauma. They want to keep the public in denial. Some want to legitimize their own or others’ bad behavior.
This is extreme dysfunction, folks. In order to heal society we need to call out every type of trauma for healing and expose it to the healthy light of day, not shove it back in the closet where it festers and stinks up the place. Every victim needs to be acknowledged and given access to healing. Every perpetrator needs to be brought to justice. If our candidates cannot speak truth and bring healing, then they do not deserve to hold a microphone, much less hold office.
Insomnia and PTSD go together like a mosquito bite and itching but with far worse results. Insomnia is not only a consequence of traumatic events but, left untreated, can result in such chronic medical conditions as mood disorders, chronic fatigue syndrome, and even fibromyalgia, a painful condition affecting joints and tissues throughout the body.
There are roughly 4 types of insomnia:
1) Early awakening
2) Inability to fall asleep
3) Repetitive waking throughout the sleep cycle (usually every 90 min)
4) Unsatisfactory sleep
There can be other physical or disease processes that interfere with sleep so the first step with insomnia is to get a medical exam to determine if there are any conditions, such as sleep apnea (poor breathing during sleep) that are resulting in awakening or unsatisfactory sleep (waking up tired).
With PTSD the two most common types of sleep disorder I’ve seen are the inability to fall asleep or waking approximately every 90 minutes. These are so common that if I have a patient walk in with those symptoms there is a high likelihood that they have suffered past traumatic events.
The answer is simple. REM (rapid eye movement) sleep occurs approximately every 90 minutes. In this stage of sleep the brain processes memories and emotions. That is what the brain is hardwired to do and why people normally wake up feeling refreshed.
But if the memories are too scary and overwhelming or if the conscious mind is not ready to assimilate the information a person will shut down the REM process by popping prematurely out of sleep. Similarly with sleep inhibition or the inability to fall asleep, the mind is unconsciously resisting the process of assimilation or digestion of overwhelming experiences.
For these reasons, sleep can start to feel like a very overwhelming experience and can snowball into its own traumatic situation. Insomnia breeds its own special kind of anxiety. A secondary trauma develops: the fear of not being able to sleep.
What to do?
Here are three steps to getting back to a restful night even while healing from trauma:
1) Unwind the fear about falling asleep. If you are awake use your time productively. Do some yoga postures and relaxation exercises. Or read something that is “good for you” like history, medical information or a religious text. The mind wants to shut down out of boredom after a while, just like in school. Do not read Stephen King or the latest murder mystery! Tell yourself that you will not be awake forever and allow yourself to be awake if you need to be. You can always nap tomorrow. The more anxious you are about being anxious the less chance sleep will come.
2) Develop excellent sleep hygiene. Sleep in a dark room without computers, tv’s etc. Turn off bright lights at least 2 hours before bed (yes that includes all media screens). Abstain from caffeine and sugar for 6 hours before bed. Develop a routine. Etc.
3) Most important: Start addressing your traumas! Your unconscious mind wants you to heal and will keep throwing up traumatic dreams and memories until you get the point and deal with them. Seriously. The best cure for insomnia is curing your PTSD. Find a great counselor or program and get to work!
The alternatives to not addressing insomnia are unbearable. Pills only work for so long. If you resolve the underlying issues be they physical or psychological you will be well on your road to healing and back to the land of Bedfordshire in no time.
The Trauma Tool Kit is now available in ebook digital format here:http://questbooks-ebookstore.net/Books/9780835640541/af7456b1-7638-4421-942d-9a735be208f5 It is good for androids, iphones, ipads, computers, Nooks and more. (I’ll let you know when it comes to Amazon).
If you didn’t win the last giveaway you have another chance. Enter below!
I have taken time to digest the terrible news out of Colorado, that innocent people in a movie theater could be surprised by such a vicious tornado of violence when they were least expecting it. Like many, I have read accounts of tremendous heroism and the anguish of those who lost loved ones. I know that many in that theater will suffer from the effects of post-traumatic stress in the coming months and years.
Years ago I went through a period of tremendous loss due to the awful effects of an individual’s sociopathic behavior on people I love. At that time I entered a period of tremendous confusion. I had so many emotions; I hardly knew where to begin. The best advice came from a sensitive soul, a healer, someone who was a stranger to me. He simply said, “Let your heart be broken.”
This terrible event leaves us all feeling more helpless and confused than we were before. Many of us want to offer help. How can we, with an event that is so private and so public at the same time?
I would offer the same words that were offered to me. Let your hearts be broken.
We have an important choice. We can open ourselves fully to the pain of this event, grieve, feel and become soft with compassion.
Or we can harden our hearts, look for someone to blame, egoically imagine how it would have gone down if we were there. Or even if we were there with a gun as I have seen many touting on the internet.
The truth is that this killer is a very shut down human being, someone who made a choice somewhere along the line to harden his heart. The end point of hardness of hearts is always violence on a greater or lesser scale. When we look away, shut down, become vengeful we only add more violence to the collective. This behavior, these thoughts, may be natural. But they cannot help. They cannot heal. They cannot prevent.
What requires courage, what is truly heroic, is softening into the event. Breathing, empathizing, feeling, releasing our collective feelings are the only true way I’ve ever seen people heal. And it is the only way to prevent future cycles of violence.
Our emotions are layered, interlinked. Health means we flow through them. To get stuck in one, such as anger, creates pathology and damage. If we really breathe into our horror we may find anger. If we really breathe into our anger we may find grief. If we really breathe into our grief we may find helplessness and sadness. If we really contemplate our sadness, helplessness, grief, anger and horror and let ourselves move through these fully, we will eventually and inevitably move out the other side into compassion.
We will realize that there is really nobody outside of this event. Not the victims, not the perpetrator and not the bystanders. We are all part of the collective human family. And what happens to one of us, at some level, happens to us all.
We can join it or separate ourselves from it. Do we have the courage to feel, to assist in healing? Do we have the strength to keep our hearts soft and open? This is not a task for the faint of heart. Acting in violence is always easier than tolerating intolerable feelings. There are many grown men who would rather hurt, maim or kill than feel their feelings.
So, I invite you again to let your heart be broken, broken wide open. Let yourself be one with those bleeding, grieving, those in confusion, not in a puerile kind of sentimentality, but in the heart of courage that can change the world. Once our hearts are fully open and engaged we will know exactly what we need to do without adding a single drop of violence to this terrible event.
I just had a lovely interview with Luke Hayes, of MyRecovery Disaster Resilience Radio. We discussed helpful ways to prevent and overcome post traumatic stress around natural disasters, that are increasing in frequency and intensity around the world.
1) Be prepared. Don’t think it can’t happen to you (denial). Have food and water items stocked. Know what kind of disasters could happen in your area. Make a plan for a quick evacuation. An ounce of preparation is worth a pound of loss later. We don’t think and plan well in the midst of crisis. So plan ahead!
2) Know where to find help. Form a community organization. Familiarize yourself with local assistance such as Red Cross, shelters etc. If your community does not have such assistance consider forming a group yourself. People have much less trauma when they feel looked after by their community.
3) Practice control over your mind and emotions now. The first technique I teach my patients about PTSD is a single pointed meditation. Focus on one object for 3-5 minutes at a time. Most of us have flabby mind muscles. This exercise strengthens our ability to focus in a crisis and its aftermath while staying calm. It is easier to keep the mind calm when we have practiced at it ahead of time.
4) If you have severe trauma after a disaster seek help. EMDR (Eye Movement Desensitization Response) is a powerful modality that involves eye movements that dissipates traumatic responses. It seems to work best on those who did not grow up with tremendous amounts of trauma. The results can be surprisingly fast and powerful.
5) Restore yourself and your body after the crisis has resolved. The body is profoundly affected and in some cases permanently altered by trauma. The endocrine system and central nervous systems may take weeks to months to heal fully affecting appetite, weight, autoimmune responses, mood swings, sleep patterns, libido and other aspects of human life. Most people tend to underestimate the results of trauma. Take the time you need to get help and heal yourself. It may take some time.
You are valuable. You are needed. You deserve to heal!
This is a somber and historic day. A powerful, wealthy, well connected and protected man as been brought to justice for preying on the most vulnerable of victims. These former victims have found the personal strength and community support to stand up and support their rights and protect the community from the darkest of predators.
We all know this has been happening. Some of us have been victims of pedophiles abusing positions of power and privilege. But, until today, they have walked free, rarely even brought to trial.
As a therapist I treated many victims of sexual predators. It may surprise you to learn that less than one quarter of my patients’ perpetrators were ever publicly accused, prosecuted or convicted. Most of the victims/survivors were still carrying the secret when they came to therapy. And there’s a good reason for this. Of the perpetrators that were convicted, most served a vastly inadequate sentence.
One of my patients was abused all of her life by her father until the courts could no longer ignore the mountain of physical evidence. He was convicted for sexual abuse after years of rape and served….wait for it….one year. Yup. One year. He went into jail when she was 12 and was released when she was 13. Needless to say she had a serious (but uncompleted) suicide attempt shortly afterward.
This is not unusual. When I worked in protective services in Massachusetts, it was well-known in the protection community that there were certain judges who would never prosecute pedophiles. They always released them with a warning or a light sentence while others were locked away for years by other judges. Why? I’ll leave you to figure that one out.
There are many predators in high places. Jerry Sandusky is only one, and only the beginning. In the past, these guys (and, yes, they are mostly guys) have been able to operate with only the slightest anxiety of ever being caught. Today all of that changes. Forever.
Predators, you have been put on notice. Your time is coming.
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I was fortunate to have Stephanie Potter of KBOO’s show Recovery Zone, in Portland, Oregon interview me yesterday about healing from stress and PTSD. The show is 30 minutes long and features three different callers with excellent questions. I had a blast doing it and am thankful for a chance to help people go deeper in their healing process. Click here, for a link to the downloadable interview.
This coming Thursday night I will be giving a workshop and book reading/signing at Quest Bookshop in mid-town Manhattan. We will be exploring yogic healing from traumatic stress. Expect to laugh, explore, engage and add more tools to your healing tool kit! You can find more information if you click here.
Maybe you have seen the discussion in the media lately around whether PTSD is a disorder or an injury. It is an injury.
Psychological trauma affects the entire body through the Hypothalamic-Pituitary-Adrenal (HPA) Axis. As we discussed before, (see The HPA Axis, Trauma and You), this axis governs the body’s entire endocrine (hormonal) system. This is not in control of the victim, any more than bleeding and swelling is for the victim of a beating. PTSD always involves injury to the body’s mechanisms. Always. This is one of the reasons the disorder is so painful and so hard to describe.
I have come to believe that all symptoms of PTSD are related to these disturbances or attempts to ‘heal’ the disturbances.
Let’s take an extreme symptom, cutting or self-mutilation. We know in neurology that pain in one part of the body cancels out pain in another part of the body. This is a joke with my acupuncturist. Some times a painful needle will be inserted and he’ll ask how my symptoms are. I’ll answer, “fine, now that all I can feel is your painful needle!”.
So, in a strange kind of way, cutting can be “adaptive” for forms of extreme trauma by managing through diversion and re-routing of pain signals, which then gives the victim a feeling of control.
Avoidance is another one of these symptoms. People with PTSD go to great lengths to avoid (or scare off, if it’s a person) reminders of their trauma, sometimes resulting in strange “phobias” or behaviors. That saying, “you always hurt the one you love” goes twice for PTSD sufferers when their partners inadvertently trigger them. We need to learn when our PTSD injury is manifesting and make ourselves safe in ways that don’t injure our relationships.
When medicine embraces the physiologic basis for PTSD, sufferers will finally gain the help that they need to heal from this profound HPA injury.
Last week my sweet kittie went missing. After a few very sad and anxious days, I realized that this event tapped into an outmoded deeply held belief that I did not realize I was holding. That belief is:
If I love something or someone too much, they will abandon or abuse me.
Sound familiar? It should. It is one of the most common beliefs of people raised in traumatic environments.
We all have core beliefs, about ourselves, about life, about love, about why we are suffering. These beliefs largely lay unconscious in our psyche, like a filter that colors everything we see. We don’t question these core beliefs because we do not know they are there!
People who live with PTSD have core beliefs that arise out of their traumas (and sometimes precede them). We do not choose these beliefs. In a sense they choose us. The purpose of mind, evolutionarily speaking, is to make sense out of a random set of stimuli, the environment we live in. Without mind, the world would be an inchoate mass of incoming information. Mind sorts, slots, and makes meaning of sensory input.
But it is also largely automatic and unconscious.
Our mind selects meaning similar to other messages we have been given by our families, our schools, our communities, our religions etc. Most of the time we are completely unaware of this process, just as you are unaware of your breathing right now. Think you’re aware? How many breaths have you taken in the last hour?
Right! Same with the mind. Our minds think and make meaning but we are largely unaware of the process.
So what does that mean for the person with PTSD? Well, traumatic stress ups the ante on thoughts. Our thoughts tend to be more highly charged, faster, more automatic and more intense when we are stressed. Sometimes they are helpful and help us survive. Other times not so much.
This thought that came to me: If I love something or someone too much, they will abandon or abuse me, it could have first arisen in my childhood, or maybe several lifetimes ago. But it has persisted, lurking in my mind like a malignant dustbunny. Once I became aware of the thought, I felt my body start to release. These thoughts, like shadows, melt away in the light of awareness. Do I still feel sad she is gone? Yes. But I no longer suffer from the underlying guilt and anxiety that went along with my unexamined core belief, which puts me in a much more functional position!
Now it’s your turn. What core beliefs do you have that may be holding you back from healing yourself?