Archive for the ‘Violence’ Category


Gun Control vs Mental Health: How Do We Stop the Killing?

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Are mass murderers mentally ill or should we pursue gun control? This is a hot topic of debate. As a person who has a career spanning 40 years in mental health I would like to answer this question by answering some common statements that I’ve seen in the news the last few days.

“We don’t need gun control, we need better mental health services”. Wrong. We need both. If we have even one dangerously murderous potential mass murderer in our community we need to restrict their access to weapons. Isn’t this obvious, Republican Party?

“Most killers are not mentally ill.” What?! First of all I’d like to see a shred of statistical evidence to back that up. This is always said in forums with no citations. Even if there were stats for this amazing statement, can we consider where the known killers are? They are in prisons, American prisons, that famously do not provide adequate mental health services to inmates. No services equal no diagnoses, and no diagnoses equal no statistics. In the 1980s I did some research about serial killers (different than mass murderers but still…) and I found that an alarming number had temporal lobe lesions and/or diagnoses of Multiple Personality Disorder (what would now be Dissociative Identity Disorder).   We do not know jack daw about mass murderers. Most kill themselves, the rest end up in prison undertreated and definitely unresearched. As a therapist, when I read the descriptions of these folks they seem easily diagnosable to me. They are definitely not pinnacles of mental health and well being.

“Most mentally ill people do not kill other people.” Yes, that is a true statement. But that is not a reversible statement. See above. It is not logical to use this statement to establish anything. Even if mentally ill people don’t kill, they still deserve treatment. Most of us who have PTSD, for example, know that if a gun were in our hands in the wrong moment we could have killed ourselves or somebody else.  I believe a lot of couple murder/suicides happen this way, as terrible accidents that could have been prevented by not having a gun in the house.

“These people are not mentally ill, they are evil.” Really, folks it is 2015 not 1515. Should we sprinkle holy water on them? All sarcasm aside, to make this statement you have to assume that people are either born evil or choose to become evil. I do not subscribe to the belief that any human is born evil. Evil is a construct. Nobody is all good or all evil.   We are born babies, open to both good and evil actions . If a human grows up and identifies as evil, in other words, service to self above all others no matter what the cost they can wreak great havoc in the world. But if they are sanely evil, they do not usually end up dead, at least not for a while, they usually end up running corporations or governments (jk) (not really). Most of these mass murderers are young men who have barely started to live, and most end up dead at the end of their rampage. Where is the sanity in that? Calling these guys evil is lazy and glib and blinds us to solutions.

I recommend we all step back, take a deep breath and acknowledge to ourselves that each mass murderer is an individual with their own reasons for doing what they did. If we hope to prevent more such actions we need to seek to understand their behaviors and address the disconnection and untreated suffering that led to such a horrible event. And we need gun control.

 




Health Care Providers: How to Welcome and Respond to Trauma Disclosure

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TMIMy husband, a cardiologist, and I recently spoke to a group of physicians about how heart disease is caused by traumatic stress and also causes it. Afterwards, one family practice doc asked me, “I never know what to say when patients tell me their traumas.”

I realized that many doctors and therapists, for that matter, were trained in an era before abuse was acknowledged, before trauma and PTSD were common household words (in some places they still are not).

So I’ve compiled a short list of do’s and don’t’s when answering a client that discloses a disturbing history of trauma or a traumatic event.

Do:

~ Routinely administer a screening questionnaire for abuse in your intake forms. You can use the ACE questionnaire or website or come up with your own boxes to check off (e.g. history of physical abuse, sexual abuse, domestic violence, neglect, veteran etc.) Clients with a very high ACEs score will have more health problems as they age.

~ Answer with a sympathetic and simple affirming response such as:

“I’m sorry that happened to you.”
“ That is a terrible thing to have to go through.”
“You must really be suffering a lot (if the event is currently affecting the client).”

If your client’s disclosure is met with a stony or panicked silence they will leave feeling very guilty, damaged, enraged or all three. Abuse has a lot of shame associated with it. Please do not reinforce this by failing to respond appropriately.

~ Maintain eye contact with a soft gaze. Our clients often do not feel seen or like others really want to see them and their suffering. Eyes are “the windows of the soul” and the client really needs to see that you are with them in taking this great risk of disclosure. We know that people are present to us and with us when they look into our eyes.

~ Get yourself grounded in that moment. Take a deep breath and take a moment to really absorb what your client just said to you.

Some of us providers have our own trauma histories and the older we are the more likely that is. If we dissociate or ‘check out’ our client will definitely notice and probably assign the worst possible meaning to our behavior such as: “they don’t really care about me”; “they are just collecting their paycheck”; “they think I’m crazy”. Our traumatized clients already have those feelings, and they respond to any perceived confirmation of those thoughts with panic and/or rage. This panic/rage can be expressed outwardly in your office as difficult behavior or as self-harm when they go home.

~ Ask for more details – especially about how this is affecting the patient in their body right now. It is a universal truth that our clients will only tell us what we are ready to hear. They do not want to ‘injure’ us with sordid details and will often leave out important aspects of their traumas. Occasionally a client will disclose too much in a kind of verbal diarrhea manner; in those cases it is OK to gently contain the discussion and take the necessary action for that client to get help.

~ Assess for current safety and contact the correct agencies as a mandated reporter. You can never overreport elder abuse or child abuse. As a medical social work supervisor I am always surprised about how conflicted medical staff are about filing reports and how little the laws are understood and followed. The state is responsible for determining whether abuse is happening or not. Most medical providers are not trained to make those screening decisions. Hence the law that says you are a mandated reporter to file if abuse is suspected. And, yes, that means everyone on your team who has a contact with the patient. It is extremely common for abuse victims to divide up what they tell to different people. There is no way for agencies to file as a single entity. If a doctor, a nurse and a social worker talk to this person and get any kind of disclosure they ALL are legally obligated to file a report. Our clients almost never call disclosure hotlines themselves. Sometimes they don’t understand that what is happening is reportable. Child and adult lives depend on us doing our jobs. The states do a very good job of maintaining confidentiality about who said what.

~ Refer! to the appropriate provider. Have a list of trusted mental health providers in your office. Steer your client towards the Psychology Today referral website which is excellent and widely used by practitioners.

Do Not:

~ Panic. Forewarned is forearmed. Educate yourself about the types of abuse in your community and the populations you serve. If you are expecting to hear these types of disclosures (and why shouldn’t you?) your clients will have an easier time telling and you will have an easier time hearing. I have heard about some truly horrendous and damaging responses from both therapists and doctors who were not ready to hear an abuse disclosure. One damaging response can put off a patient’s healing for years or forever.

~ Promise to keep a dangerous secret. A lot of patients will ask us to keep what they tell us confidential before they want to disclose anything. Don’t paint yourself into a corner. When my patients ask me to keep their secrets, I always reply that it depends on what kind of secret they have and explain my role as a mandated reporter. That gives them more control on what they want to disclose.

~ Ignore a disclosure. Yes, I know you have less time to do more work than at any other time in your career. Working correctly with a disclosure does not have to take a great deal of time. Our patients are pretty savvy. They know we have busy schedules and lives, and they do too. The vast majority of people who disclose will not abuse the privilege. If they do, you can still be kind and containing at the same time. Or you can ask them to schedule a longer appointment soon for a full trauma assessment (something I hope to be coming soon to a medical and psychiatric clinic near you). Being busy is no excuse for being uncaring. It’s not business; it’s personal.

~ Forget to take care of yourself. Know your community population. If you are in low income, high crime area, your entire population may be filled with trauma. Taking a trauma informed approach to your practice could be the best thing you ever do for you and can avoid needless complaints and confrontations. Get therapy if you need it (and who doesn’t?). Do your own sympathetic downregulating exercises: yoga, tai chi, meditation, exercise, breathwork. The less you care for yourself and your own suffering, the less you will want to help anyone else.

There, that wasn’t so hard was it?! If you need more in-depth assistance I offer trauma-informed consultations for health care professionals, and I travel!

Be well!




School Shootings: An Open Letter to Parents

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Dear Parents,

  I feel your pain and horror.  I, too, am a parent and have two Juniors this year whose finals week was interrupted by the school shooting at Reynolds high school.  They have been so busy just trying to get through finals week that they haven’t even had time or energy to integrate what is happening in their own community.

 Nothing makes us more anxious than a threat to our children’s safety. Nothing makes us feel more powerless, saddened and enraged then when our schools safe walls are breached by murderous rage and terror.

 Some of us are vulnerable to traumatic stress and anxiety already. Events like this can feel overwhelming to cope with, and even moreso to help our kids to cope.  So what can we do?

As a professional and as a parent, I recommend that you put on the metaphorical oxygen mask first.  Please take the time to do whatever you can to take care of yourself in the coming weeks.  If you feel your own anxiety spiraling out of control, please get some help from a qualified trauma therapist or perhaps some other provider that you feel comfortable with such as an acupuncturist, Reiki practitioner or yoga therapist.  If you feel that you need psychiatric medication, now would be a good time to get a consultation. Practicing mindfulness meditation could be helpful or whatever really helps you calm down and integrate.

 If you are like most Americans you are probably going to want to think your way out of this problem and come up with a snappy and satisfying solution (gun control, armed school guards,  mental health interventions etc).  I would encourage you NOT to jump to this just yet.  First we need to calm ourselves down and become really, REALLY present to ourselves and our families.

 Trauma, like grief, has its own pace and rhythm, and some of us are dealing with both.  Our kids may have known the victim(s) or even been the victim. We need to give healing its full due. If our kids see us stopping, processing and restoring ourselves from trauma, that gives them permission to do so as well.  There are many resources for healing out there, including my book, The Trauma Tool Kit: Healing PTSD From the Inside Out, which has a whole chapter on first-aid for trauma shock, the first stage of trauma.  Reading it will help you cope with the immediate aftermath of trauma. (You can find it in your local library and in all bookstores.)

 Your children are in shock and grief, too.  Like my kids, they may be in the middle of finishing up testing and not really be available for processing their feelings, or they may have a lot of time on their hands and be inwardly stewing over what has happened.  Lately the world seems to have exploded in violence.  Even if they are quiet, they have definitely noticed.

 Make yourself extra available to them.  Depending on age, gender and temperament our children will have varying needs and ways of moving through their own horror, anger and sadness.  Allow them to find their own mode of expression, which may be very different than yours.  But they do need to express in order to integrate.

 As a child and teen therapist, I know that there are very few children who can just sit down and talk about their feelings to their parents in an adult way.  It is best to find activities to do with your kids and let the conversation steer its way naturally to what is troubling them.  You can ask open ended questions and make positive statements such as, “I’m really interested in what you think/feel about this event.” “What are other people saying about what happened on Facebook?” etc.  Good activities can be throwing a ball, shooting hoops (I got really good at this doing inpatient work with boys), going for a walk together, driving somewhere, listening to music together (their choice),  playing a card or board or video game (not too intense so there is room for conversation).  You need to initiate these activities, especially for kids who tend to isolate when they are upset. 

 Allow your children, and especially teens, an uncensored discussion.  If you have rules about swearing or intensity (such as loudness or sarcastic tone), tell your child that you have suspended these rules, so they can say, freely, whatever is on their mind.  Our kids talk very differently to each other than they do in front of us.  If they need to blow off steam but feel inhibited in front of us, they will blow off steam elsewhere. 

 Sometimes stressful events like this show areas of relationships that are in need of work.  If you have been having trouble connecting with your child, this trauma will not automatically draw you closer. It may, in fact, do the opposite.  If so, consider seeking out professional help for yourself and/or the family.

 Put down your cell phone when you are home.  Stay home and make it clear that you are available when they need to talk, even if that need comes up around 10 or 11 pm as they are going to bed (as if often will). Monitor your own need to engage in avoidance activities and choose engagement.

  If you do not already have a self-care routine, now would be an excellent time to start one.  I am a big fan of progressive relaxation exercises and often prescribe them.  You could find some online or buy a CD and practice relaxing your whole body a couple of times a day, to reset your own nervous system.  Allow yourself more downtime than usual.

  Know these signs of acute stress and monitor them in your children.  If they persist past 2-4 weeks they may be cause for concern:

 

–       repetitive talk about the event

–       
repetitive drawing of the event

–       irritable

–       withdrawn


–       needy and clingy


–       more forgetful than usual


–       having trouble regulating emotions: laughing silly “highs” crash into sullen “lows

–       hair-pulling (trichotillomania)


–       disturbed eating

–       insomnia or frequent awakening in fear or tantrums

–       age-inappropriate behavior such as bed-wetting

–       rigid and perseverative play behavior (in younger children)

 

Lastly, know that no matter how upsetting this event is to your family and child, healing is possible. Human beings are incredibly resilient.  In the process of healing you and your family may wish to take some action in the world.  If this feels right to you, do it.  The wound of trauma often demands some response from us – when the time is right.

Blessings on your journey of healing, Sue




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