Posts Tagged ‘child abuse’


Timelines and Trigger Mapping in Healing PTSD

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In the “old” days of psychotherapy, when I began in the 80s, abreaction or emotional release of traumatic memories was considered a goal of therapy. This idea of therapy was also made popular in powerful movies such as Goodwill Hunting.

Abreaction will happen when it happens, and it will facilitate healing. But it is not enough.

We have to live with the day-to-day realities of our history as they manifest in the present moment. With that in mind, I wanted to share two of the most helpful activities in or out of therapy for people who suffer PTSD.

The first activity is to create a timeline of events. When our PTSD results in dissociation our sense of time can get distorted. In fact, many would say that PTSD itself distorts the part of the brain responsible for the sense of time passing.

In any case, most people I see have a very poor sense of the timeline of what happened to them. Also most people I see have had more than one type of trauma. Some peoples’ lives have been one traumatic event after another. Creating a visual timeline can help us understand and digest what we have actually been through.

 Chances are, when you begin, you will not put down every event. Our brains are associative, so if you are looking at, say, accidents, you will put down accidents. But, you may forget about abuse, or you may remember one type of abuse but not another. I consider the timeline a working document in therapy, whether on paper, or just as an understanding between my client and myself.

When you record an event, you have an opportunity to look at your age at the time. A good timeline should include: event, type of event, age and any other relevant details (such as physical injury).   The timeline provides a chance to re-associate the aspects of yourself connected to your own history and is a valuable tool for your therapist. (P.S. therapists can and do become dissociative too, so this tool can help ground both of you.)

The second important activity that will really start to empower you is trigger mapping. Everyone with PTSD has triggers! They may or may not be known to you. Knowing triggers can help you and your loved ones anticipate PTSD storms and head them off.

Here is how I describe trigger mapping in my book The Trauma Tool Kit:

I recommend writing down or drawing your triggers, getting them down on paper in some form or fashion. Some triggers you will know right away; some you will have to ferret out. Triggers fall into six categories: the five senses of taste, touch, smell, sight, and hearing, plus feeling states. Let’s start with the senses, because they are the easiest. You can divide your paper into different sections reflecting each of these senses. It will help jog your memory to go through each sense modality individually. Let’s say you are working in the smell category. Ask yourself what smells really bother you. All of us have smells we do and don’t like. Generally we all like floral scents and dislike the smell of feces, but I am not talking about ordinary aversions here; I am talking about radical reactions. Nobody likes the smell of poop, but if that smell sends you into a panic or frozen numbness and dissociation, it’s a trigger. Or maybe the scent of lavender makes you want to rip someone’s head off. That’s a little unusual; write it down. Take your time working through each category. Do not attempt to do all of this work in one day! If you are in therapy, it can feel safe and reassuring to do it with your therapist. Or it may not depending again on your triggers, but find some way to do it anyway. p. 184-185

The great thing about timelines and trigger mapping is that they create a bridge of healing between the present and the past. They empower and they inform, and they are tangible.  You can also add to them and edit them as you go. It is a great joy to be able to remove a trigger off the list!

One last thing, when you do them, do them with care and beauty. Take your time. Use beautiful colors and paper. Or if you just do them in your own head give yourself the benefit of a peaceful space and time to contemplate your own history and healing.

Blessings on your journey, Sue PB







Why Dylan Farrow’s Disclosure Matters

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“It is very tempting to take the side of the perpetrator…All the perpetrator asks is that the bystander do nothing. He appeals to the universal desire to see, hear, and speak no evil. The victim, on the contrary, asks the bystander to share the burden of pain. The victim demands action, engagement, and remembering.” 

                                                                                                ~ Judith Herman

 From 1989-1993 I worked in Massachusetts for the Child-At-Risk Hotline at Judge Baker Children’s Center, in the Longwood Medical Area.  We covered the entire state after hours for reports of suspected child abuse and neglect when the departments of investigation were closed for the day and on weekends.  I was a supervisor, which meant that every single suspected case of abuse or neglect was “run by” me.  With the screener’s help I determined whether it was a case that was false, probably true or so emergently true that we had to take action that very shift.

 Children’s lives and well-being hung in the balance so we were very highly trained and conscientious in our work.  Over that period I estimate that I heard somewhere around 15,000 stories of child abuse.  I developed a very good BS detector.

 Like many I had heard vague allegations about Dylan Farrow when she was a child, but it was hard to know what to think and why the case had not been prosecuted.

This week’s publication of her letter to the New York Times has changed all that for me.  

Since it was published last week there has been a firestorm of responses and conversations popping up all over social media, some helpful and others not so much.

As a child abuse prevention professional and a treater of many adult victims of childhood trauma I would like to add my perspective.  I believe Dylan.  Her story is coherent, believable and internally consistent.

Let’s look at the list of secondary gains that each side gets from lying.  For Woody and Dylan there are reasons to lie and reasons to tell the truth.  There are also many reasons not to.

Dylan Lies:

 Pros:                                                                          Cons:

She gets attention in the press.                           She and her family is vilified in the media.

She gets people to feel sorry for her                   Her credibility is forever tarnished

                                                                                   in the eyes of friends, employers, etc.

She’s going for a book or movie deal?               Her accused is a Hollywood insider.

 

                                                                                  She could be sued for defamation.

 Maybe I lack imagination but I’m already out of reasons for her to lie about this.  Usually when people tell big lies there is a big positive payoff.  I don’t see it here. Do you?  The Cons are overwhelmingly negative and threaten to ruin her life.  Just to be a somebody in the press? There are easier ways.  OK, let’s look at the other side.

 Woody Lies:

 Pros                                                                           Cons

He keeps making movies                                     He gets a clean conscience (if he’s not

                                                                                    a sociopath)

He keeps all his money                                         He may need to pay a lot of money in a

                                                                                    lawsuit

 

People keep loving him and his work                 People will be revulsed by him and his work

 

He keeps his relationships                                     He loses friends and business contacts

The Romans used to ask an important question, Qui Bono?  Who benefits here?  Dylan suffers more by lying than she gains.  Woody suffers more by telling the truth by far.  Lying is in his best interest as it is in the case of most perpetrators.  Even if we look at just dollars and profit motive, Dylan stands to lose more than she gains by lying where the opposite is true with Woody.  It is incredibly hard to win lawsuits against perpetrators, especially when there was no original conviction.

But what about the argument her mother made her do it by “implanting” memories. Oh please!  Maybe (maybe!!! although I’ve never seen it in decades of practice) a seven year old could be persuaded.  But an adult knows better.  Mind control is possible, but it requires years of skilled training to do and the only experts in the world are black ops top secret level psy military people who do not publish manuals.  Occam’s razor suggests that this argument is full of giant holes.  Like smoke and fire, reports of abuse almost always coincide with actual abuse!

As for Woody, well we already know him as a man with exceedingly poor boundaries and someone who acts without considering the consequences for those around him by marrying his long-term partner, Mia’s teenaged daughter. Everyone who “testified” for him at the awards show (wasn’t that strange) talked about all the roles he had written for women, not anything about his character.  I had the sense that the women supposedly speaking on his behalf were really speaking on their own interests.  But having said that perps are exceedingly good at getting people to believe them. And the longer the friendship, the harder to see the perp inside the man.

If you look at the Herman quote above you will see why.  I have written in The Trauma Tool Kit how the mind wants to avoid material it sees as threatening to its own sense of security and comfort.  Contemplating that your best loved films were created by a monster creates a level of cognitive dissonance that most people cannot handle.

But, you see, we must.  Because this is one story among millions.  Every day there are victims who tell the truth and are shut out of their families because the perpetrator is believed.  Because the people they tell will not or cannot tolerate a change in perspective and a re-ordering of their own lives and view of reality.

Our culture is sick.  I agree with the neo-feminists who talk of the ‘rape culture’ in which we live.  All over the world from time out of mind women and children have been raped, dominated and treated like property. Men have relied on each other to maintain power, to satisfy their lusts and desires and do what they want. Just because they can.  For humanity to evolve, this has to end.  That means TELLING THE TRUTH, no matter how unpleasant or personally uncomfortable that makes us.  After all, it could be your daughter or son, neighbor, friend or cousin who is the next victim.

Only then will the real healing begin for individuals and society as whole.

As for me, I’m breaking up with Woody and all his films.  I wish Dylan a sense of wholeness, peace and healing for her future. She has suffered enough.

 

 

 




The Root of Violence: Solutions for a Beleaguered World

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When I was in high school and the world’s population was at about 4 billion, I saw a video about an experiment in rat overcrowding. The researchers showed very clearly that up until a certain population the rats were civil, harmonious and happy. When they became overcrowded, the rats turned on each other and a cycle of violence began. I remembered wondering where that tipping point was for humanity.

Today the world’s population stands at about 7 billion, ready to top 8 billion in the next decade. I cannot help but wonder if the world is getting too crowded to maintain civil societies. At least in the old models.

Fortunately, we are not rats. We are human beings with a plethora of ingenious human tools at our disposal, the foremost being a thinking, self-reflective brain. We can not only reshape our environment, we can also reshape our bodies, personalities and even our own brains.

Clearly, it is time to evolve.

What would it take to stop the violence?

Currently it is popular to blame religion for violence. But I don’t buy it. Historically, nationalism was blamed for wars. But we didn’t abolish nations, nor could we. Anymore than we can abolish religion. The search for God and religion seems to be hardwired into the very fabric of humanity. And that’s potentially a good thing. Innumerable hospitals, orphanages, and other charitable endeavors have been supported by large religious bodies.

Look, I’m a therapist. I’ve spent a lifetime peering into the hidden mechanisms of human consciousness. I’ve worked with victims and perpetrators of violence, religious, atheist, you name it.

And the root of violence is pretty simple. The recipe is this: take a human ego, prone to intense biological impulses like sex and aggression, add a dose of rejection, violence, or trauma and withhold empathy, attachment and kindness. Don’t forget to add the testosterone, or all that violence will turn inwards. This is the basic formula; there are of course endless ways to “spice” things up. Anything that disinhibits a human helps: drugs, a charismatic leader, any kind of reward real or imagined, spiritual or material. You get the picture.

When the world becomes an overall less kinder place to be, when governments exist to punish and control rather than support, when adults are too busy trying to survive than to connect, when children are subjected to all manner of abuse growing up, when basic needs are withheld (food, shelter, education), then we can be sure the rise of violence is around the corner.
My little piece of contribution centers around psychological trauma. Like the tipping point for rat populations, I believe that there is a tipping point for the number of citizens with untreated abuse and trauma issues that starts to unravel societies and the fabric of civilization gets weak, gauzy and prone to tears.

That is why I wrote The Trauma Tool Kit: Healing PTSD From the Inside Out. But one book is not enough to stem the tide.

If we want to turn this around we need the biggest investment in our humanity the world has ever seen.

Our healthcare system is broke.
Out educational system is broke.
Our national aggression is disproportionately funded.
PTSD is a national (and global) epidemic.
Our TV and media is a wasteland of violence, sex and empty, puerile stories aimed at the basest nature of humans.
Adults can’t find meaningful work or time to connect.
Children can’t get their emotional needs met so they are turning to early sex, drugs, computers and violent videogames.

Like the global climate crisis we are in, we are in a crisis of our own humanity.

We need to ask ourselves: what does it mean to be human? Are we living lifestyles that are in alignment with our values and ideals, or have we given up?

The answers are simple. Accomplishing them requires insight, wisdom and the will of the people.

1) Convert from a permanent wartime economy to a peace economy. Stop trying to control the world and get back to taking care of American citizens.
2) Reinstate the important status of mothers in the world by funding them to stay home with their children as needed. Working mothers is a redundant, and obnoxious term. We need to recognize that all mothers are, by definition, working.
3) Stop projecting our own internal demons onto other groups: immigrants, “terrorists”, “dirty hippies”, whatever. And affirm the dignity of all human beings, the vast majority of whom merely seek to be happy.
4) Reign in the vast greed industries and interests in Washington.
5) Recognize that only people are people. Corporations are sociopathic entities.
6) Fund a single payer healthcare system and come into the 21st century.
7) Throw out the educational dictates of the last 20 years and create sound educational ideas that really engage students and teachers in learning in the new millennium.
8) Turn off your TV. Or at least have enforced rules about usage .
9) Heal your traumas. Help yourself.
10) Recognize that your children, friends and neighbors may be struggling quietly and desperately in need of help. Help them.
11) Spend more time with your kids. Quality is not enough. Quantity is also required for healthy kids. Don’t let computers and TV parent.
12) Create community events for connection. Host a potluck once/month. Get involved. Talk to your neighbors. Get over your fear of the ‘other’.
13) MEDITATE. Rats can’t meditate, we can. If we all just calmed down and healed our own brains, it would be enough.

OK, then. We do have choices. It’s either us or no one. We can cower in fear waiting for the next attack, the next screw gone loose, or we can start changing our communities here and now.

I vote for now. I’ll go meditate on it, and then I will act.




Healing Together With An Infinite Mind

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HT_logo_HPI just returned from my favorite conference of the year, the Healing Together Conference put on by Infinite Mind.  Infinite Mind is a group of people with DID, which is Dissociative Identity Disorder.  You might know it better as Multiple Personality Disorder.

Why is this my favorite conference?  Many reasons.  This group of people who suffer from DID and those who support and/or treat them are the most dedicated, open and knowledgeable group I have been involved with.  There is no lying, no minimization, no disinformation.  Pain is acknowledged but not dwelt on. Jaime Pollock, the main organizer, is known for her organizational skills, her comedic timing and her immense sensitivity to the suffering of others.  She is completely open about her own journey, but never triggering.  There is an art room and a quiet grounding room with lots of pillows and blankets with student psychology interns available to help as needed.

Remember the movie Sybil?  Well, the real Sybil, Shirley Mason painted her way through her treatment.  There was a beautiful and moving exhibit of some of her paintings during the conference.  Despite the recent book questioning her diagnosis, most people who knew her, and most specialists believe, she was, in fact, DID.  The pictures in this article are some of hers.  Some facts about them: she often painted telephone poles, sail boats (to sail away from her pain?) and yellow, she said, was the color of her mother’s screaming.

Another famous multiple, Truddi Chase, wrote the runaway best seller When Rabbit Howls.  Her daughter, Kari, gave a very moving account of what it was to be the daughter of a multiple growing up.  It was very clear that a distant, mean father was much more of a liability to a growing child than a mother with DID.  Another interesting presentation was a mother-daughter pair from England discussing the same topic.  Carol, who only “discovered” her DID later in life brought some remarkable videos of herself in other personality states (called ‘alters’ or ‘parts’).  Her daughter with much patience and humor described a mother who often could not remember what she had said five minutes ago, but she was fun to play with!  They shared a very dramatic and, at times,  journey of healing which continues today.

On a more serious note, the mental health system in England and other places is severely lacking and there is much international work to be done on educating practitioners not only about the reality of DID, but how to work effectively on integrating painful memories.

Here are a few important facts to know about people with DID:

 1)   DID begins at an early age, usually before 7 but is often not diagnosed until later in life.

2)   DID is always the result of severe and prolonged trauma.  There has to be immense force involved to shatter a mind.

3)   Most people with DID are law-abiding and peaceful people who suffer from extreme internal torment.

4)   Many people with DID grow up to be loving (if somewhat dysfunctional) parents.

5)   Children of parents with DID can thrive, especially with support from the community.

6)   People with DID hold jobs in all sectors of society.  They are preschool teachers, lawyers, police officers, writers, hospice workers, etc.

7)   You cannot tell if someone has DID by looking at them.

8)   With appropriate treatment people can integrate fully and heal from DID and their traumatic histories that were the cause of their problems.

9)   People with DID almost always have problems with losing time.  Often people think they are pathological liars because different alters give different information. Over time they learn how to compensate for these difficulties.

10)  DID is fairly prevalent.  It is estimated that  1 out of 100 people in the USA suffer from DID, and it is found in every country.

 I had the privilege of giving trauma informed yoga classes in the morning and presenting two workshops: one on Yogic Modalities For Healing From PTSD and one on The Effects of Abuse and Trauma on Developing Children. The audiences were engaged, and responsive.  

 If you are a therapist, a physician, someone suffering from DID or you know someone with DID I would highly recommend this yearly conference as a place to learn, to laugh and to commiserate with a group of compassionate and knowledgeable people. It is held in Orlando, Florida every year in late winter.  I feel very grateful to be involved with this amazing group.

 




Find Your ACE Score

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Last year I posted about the largest study you’ve never heard of : the Adverse Childhood Events Study.  ACE has shown by using over 17000 participants data over several years that the more adverse childhood event categories you’ve been exposed to, the higher your chance of illness, obesity, mental problems, and socioeconomic ills.  You do not have to have full blown PTSD to be exposed to these risks.   People with the highest scores died, on average, 20 years sooner than people with the lowest scores.  The good news is that getting treatment and adopting healthy lifestyle behaviors can mitigate your risk.

What is your risk?  Take the questionnaire below:

 

Finding Your ACE Score While you were growing up, during your first 18 years of life:

1. Did a parent or other adult in the household often or very often… Swear at you, insult you, put you down, or humiliate you?

or

Act in a way that made you afraid that you might be physically hurt?
Yes No If yes enter 1

2. Did a parent or other adult in the household often or very often… Push, grab, slap, or throw something at you?

or
Ever hit you so hard that you had marks or were injured?

Yes No If yes enter 1

3. Did an adult or person at least 5 years older than you ever…
Touch or fondle you or have you touch their body in a sexual way?

or

Attempt or actually have oral, anal, or vaginal intercourse with you?
Yes No If yes enter 1

4. Did you often or very often feel that …
No one in your family loved you or thought you were important or special?

or

________

________

________

Your family didn’t look out for each other, feel close to each other, or support each other? Yes No If yes enter 1 ________

5. Did you often or very often feel that …
You didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you?

or

Your parents were too drunk or high to take care of you or take you to the doctor if you needed it?

Yes No If yes enter 1 ________

6. Were your parents ever separated or divorced?
Yes No If yes enter 1 ________

7. Was your mother or stepmother:
Often or very often pushed, grabbed, slapped, or had something thrown at her?

or
Sometimes, often, or very often kicked, bitten, hit with a fist, or hit with something hard?

or
Ever repeatedly hit at least a few minutes or threatened with a gun or knife?

Yes No If yes enter 1 ________

8. Did you live with anyone who was a problem drinker or alcoholic or who used street drugs? Yes No If yes enter 1 ________

9. Was a household member depressed or mentally ill, or did a household member attempt suicide?

Yes No If yes enter 1 _______

10. Did a household member go to prison? Yes No If yes enter 1 _______

Now add up your Yes scores:  ___________

For more information go to www.acestudy.org.

 




ACE (Adverse Childhood Events): The Most Important Trauma Study You’ve Never Heard About

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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!




Trauma and Attachment

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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!




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