Posts Tagged ‘PTSD’


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.




Defending Dr. Drew

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My husband is an interventional cardiologist. Most of the people he sees are in manageable stages of cardiac disease. Some of his patients are quite sick and come in with advanced stages of illness. A few are dead and dying when they reach his cath lab. Miraculously, he can bring a few back to life, or ease their suffering greatly with stents and medications, saving them the trauma of open heart surgery.

Nobody is surprised when some of these people die. Sad. But not surprised. And certainly not outraged.

I’m a mental health professional, as is Dr. Drew Pinsky. In the media Dr. Drew has been blamed for the recent death of country singer Mindy McCready, who appeared on his show Rehab a few seasons ago. Like my husband, we both see people in various stages of illness. We’ve held people’s lives in our hands in our offices as surely as my husband has in his cath lab.

Dr. Drew, on his show Rehab, treats the sickest of the sick. He admits people to his hospital who have a terrible prognosis, many of whom have been told they are going to die if they don’t get treatment. They are in the end stages of addiction, a disease just as surely fatal as heart disease.

Yet, for some reason, when these patients die, the good doctor is blamed. Why? He is treating those who need intensive intervention and treatment in a psychiatric facility, just as my husband treats people in his hospital. These patients can get well with interventions for a period of time and then fail, just as cardiac patients can.

I can only chalk this reaction up to the ignorance and wishful thinking of the American people. Here is what I, as a lifelong mental health practitioner, would like the general public to know:

1) Addiction is a deadly disease, no less of a threat than cancer, heart disease, or a terrible accident.

2) It takes a highly skilled practitioner, one with hundreds if not thousands of hours of training, practice and supervision to help these people get better, and, yet, like other physicians, we still may lose our patients.

3) When we do lose our patients, we feel terrible. We work so much more intimately with our patients than, say, my husband does with his. We know their secrets, their character. We have laughed with them and possibly cried with them. It is impossible to be a good therapist without attaching to our clients and they to us.

4) Clinicians don’t just ever treat addictions. Addictions are always a symptom of a much bigger problem, and, frankly, that problem almost always involves boatloads of psychological trauma.

5) Working with traumatic stress is incredibly taxing for patient and practitioner. Frankly, not that many people want to do it. If you don’t believe me ask yourself when the last time is that you asked someone to tell you about their history of abuse and neglect and then listened all the way to the end of their story. Never? I rest my case.

6) Mental health clinicians are the pariahs of the medical community in the same way our patients are pariahs in the public’s eye. We treat “losers” so we must be losers is how so many of us are seen (if you wish you can substitute the word “crazy” for “loser”). Most of us are undervalued, underpaid and disempowered, but we soldier on because we believe in our work and enjoy helping people end their suffering.

7) My husband never lacks for the tools to do his work. His patients have the best equipment, the best care, and only leave the hospital when they are well enough to go home. Often they go home with assistance of some kind or another. This is rarely true in mental health work. Our patients do not have long enough stays to get better, have trouble accessing clinicians who know how to treat them, and are often discharged without enough support at home.

Even with the best support money can buy, some patients, like the country singer Mindy McCready, fail. Some people do well until they are put under undo stress and then they collapse. This was the case, as far as I can tell, with Ms. McCready. She’d already had several suicide attempts until the completed suicide of her boyfriend. She snapped.

How is this Dr. Drew’s fault? Now, I know there is some controversy about publicly airing shows on mental health treatment, and the questions are valid. Yet, as a professional whose work is always done in complete opacity, I’m happy that the general public gets to see some of what I and thousands of my colleagues give to our clients on a daily basis. I can’t participate in Take Your Daughter to Work Day, but we can sit down and watch an episode of Rehab.

I am sorry that Mindy lost her battle with depression and addiction. I am sad that Dr. Drew is getting blamed for losing a patient in the end stages of a terrible disease process. I hope we can all use this event to deepen our understanding of the terrible costs and demands of mental health and addictions instead of using it as a way to take a cheap shot at a profession that works in areas that no one else will touch.




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.

 




The Power of Persistence (or What you Resist, Persists)

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I don’t know how to say this to you any other way so I’m just going to say it:  There is no easy way to heal from psychological trauma.

There is no pill, no elixir, no magic wand, no therapist, no book, no workshop, no yoga class, no blogger that will give you a quick fix from your suffering.  I’m sorry; I truly am.

If you want to heal from PTSD you are going to have to work very hard for a long time. You are going to have to spend money (probably a lot of money relative to your income) to get help to overcome what you feel should have never happened to you. And then you will have to work some more.

In my book I compare the journey of healing PTSD to the journey that Frodo takes in The Lord of the Rings trilogy to cast the evil, all powerful ring back into it’s source: a dangerous volcano hidden inside of an even more dangerous enemy territory governed by an all seeing magical evil sorcerer.  Frodo has two choices.  He can either stay in his comfort zone in the bucolic shire of his childhood and live in denial until his land is ultimately overrun with evil mutant elves and destroyed while the ring has corrupted him (or someone else) completely.  Or, he can man up and take the journey, one that is most perilous and with no guarantee of success and try to destroy the thing forever.

This is basically our choice as well. Is the journey so easy? If it were, everyone would make it.

Yes, I know it sucks.  But suck it up folks. That is the way it is.  I can only say this to you, not because I am cruel and heartless, but because this is a journey that I’ve taken.  I’ve done the dirt time, so to speak, in spades.

It is totally worth it.  The sooner you get over resistance to healing and begin, the better.  Healing PTSD takes a chunk of your life.  Not healing from PTSD takes your entire life (and possibly future lifetimes if you believe in that sort of thing).

Take a moment and review the pros and cons of healing:

 Pros                                                                 Cons

 Peace of mind                                                  Nightmares and flashbacks for the rest of your life, chronic anxiety

 

 The ability to love and be loved                  Failed relationships; people who are afraid of you; persistent loneliness

 

 Bodily health                                                  Heart disease, migraines, joint pain, digestive issues, diseases

 

 Wisdom                                                           Ignorance, bitterness, confusion

 

 Compassion for self and others                   Self-pity, entitlement, self-loathing, shame

 

 Money well spent in healing                        Money ill spent in addictions, diversions and distractions

 

Well, you get the picture. 

 So which will it be?  Healing PTSD does have an endpoint.  It brings gifts beyond compare but only if you finish the job.  You have no more time to lose. Put this at the top of your New Year’s Resolutions and you will ring in a much brighter 2014.

Blessings on your journey of healing!

 

Endurance is the most difficult of all the disciplines but it is to the one who endures that the final victory comes. ~ Buddha

 

 

 

 

 







Sandy Update 3: Top Five Reasons You’re Eligible to Apply for SBA Disaster Assistance | SBA.gov

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Sandy Update 3: Top Five Reasons You’re Eligible to Apply for SBA Disaster Assistance | SBA.gov

If you have property destruction from Sandy, please read this very important article.  You don’t have to be a business owner or to have insurance to apply for a low interest loan from the Small Business Administration.  You might also be able to apply even if you live in a Coastal Barrier Zone.  Most loans are made at four percent! The remainder are at six percent. Read the article for complete details.




PTSD and the Holiday Season

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Here’s the sad truth. PTSD often worsens during the holiday season. One would hope it was different, that holiday cheer, food, friends and good spirit would pop up like champagne on one of those commercials we see on TV where people are toasting each other, smiling and all looking fit, young and strong. But alas, it is not and here are some reasons why:

1) Holidays come with lots of triggers. We can be around too many people or too few. Even if we want to be with people, loneliness can be enhanced by the inability to connect in the midst of deep emotions such as fear, grief, or rage. There is no lonely like the lonely that comes in the midst of a group of friends or family.

2) We tend to eat foods that aggravate our nervous system. PTSD causes an inflammatory reaction in the body (see my HPA Axis posts). When we pile on the sugar, alcohol, fatty foods and just plain junk that pervades holiday fare our delicate and taxed nervous system can come under a lot of strain. Eating aggravates our anxiety, and anxiety aggravates our eating, repeating until New Year’s Resolutions come.

3) Feelings of self-loathing tend to emerge more strongly in holiday season. Perhaps we are trying to live up to an unattainable ideal of our religious faith or maybe proximity to family reminds us of our (and their) shortcomings. Whatever the reason, the phenomenon is real.

4) There is a lot of stimuli in the environment! Bright lights, flashing lights, loud music, smells, endless holiday music, crowded shopping environments all add to the load on the nervous system. Not to mention traveling on overcrowded airplanes and roads in dangerous weather. Not exactly a good environment for the hypervigilant and stressed.

If you think avoiding the holidays is easy, just watch the hilarious movie, Christmas with the Kranks. A lucky few might escape to Hawaii or a cruise but even then the holidays follow and are on our mind (if not our neighbors).

So, what to do? If you see a therapist and can afford it, scheduling extra sessions can be helpful. For those of us not lucky enough to have that resource, protection from the holiday barrage starts with our own awareness.

Pace yourself. Take some time every day to see what it is you do and don’t want to do. Say ‘no’ as often as you must. Stop worrying about hurting other people’s feelings, and focus on healing your own. Remind yourself that this, too, shall pass. For it will.

Better yet, dig down in yourself to find your own meaning of the holiday – whether it is about religion, vacation, or promoting your business, find the meaning that will be best for you.

Move into alignment with the season. In Chinese philosophy, winter is a time to move inside, to become dormant like the plants outside, resting so that our roots will be nourished and the plant flourish in the Spring. This is my favorite meaning of the winter holidays: renewal, self-nourishment, quiet companionship with those you love, sleep. Lots of sleep. 

So here is my wish for you in the holiday and end of year time: Know when you are triggered and move to take care of yourself as needed. Cultivate compassion in your heart for yourself and others. Rest. Eat well. (And read The Trauma Tool Kit as needed.)

Happy Holidays. 




Research is in: Meditation works!

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Meditation appears to produce enduring changes in emotional processing in the brain

The good folks at Mass General Hospital (MGH), Boston University and other research institutions have shown conclusively in a research setting, for the first time, that an 8-week meditation program affected brain function in a positive way even when the subjects were not meditating.  The amygdala (our crisis response center) was positively affected by their modest practice.  Highly recommended reading!(Click on the title to go right to the article.)




Helping Kids Recover From Hurricane Sandy

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Children can be particularly vulnerable to distressing weather and events. Most parents have not been taught to look for signs that children are under stress, or even intense stress. This blog, by request, will give you some tips on helping your children recover from Sandy.

First know that your child is stressed. Some signs that children are stressed include:

– repetitive talk about the event 
– repetitive drawing of the event
– unusually irritable
– unusually withdrawn
– needy and clingy
– more forgetful than usual
– having trouble regulating emotions: laughing silly “highs” crash into sullen “lows”
– hair-pulling (trichotillomania)
– disturbed eating
– disturbed sleep

We forget what it is like to be a child. Under 14 years of age, children have some awareness that they cannot survive without adult assistance; this is especially true for very young children. Children watch their parents very carefully and take their cues from them about whether they should be upset or not. In addition children have losses in the storm that adults may trivialize or not realize the depth of the loss. For instance, a parent may not know that a stuffed animal was more like a best friend, or that a destroyed work of their art has taken away a precious sense of self. Because parents are suffering their own losses and in survival mode they may not feel like children are dealing with anything significant, but, of course, they are. 

Here are some ways to help your child heal in the aftermath:

1) Limit media exposure of the event. Adults tend to watch traumatic events obsessively but we know from 9/11 that this can create traumas in kids who may not understand that they are seeing the same event repeated rather than several different events. TV may make them think the world is ending

2) Set some “processing” time aside every day for your kids where they can express their feelings. Young children (3yrs-8yrs) might be encouraged to color, draw a picture, or engage in puppet play. 8-12 years olds might want more information about storms, or just to spend time playing games. (Experienced child therapists know that most kids need to be occupied with a game or activity in order to talk about their feelings.) Teenagers may be able to sit and talk if they are mature, and are invited to participate in a judgment free zone. Also, ball throwing and basketball hoop shooting are excellent ways to get kids to open up. During this time turn off your phone and your own agendas and create a lot of space to just listen or answer questions.

3) Try to keep a normal rhythm to the day, even if you are in a shelter. Have regular mealtimes, structured activities and a bed time.

4) Speaking of bedtime, be aware that sleep may be difficult at first. Kids may be having unpleasant dreams processing the storm. Be patient and non-judgmental about this, while helping maintain a schedule.

5) Monitor your own reactions. Calm yourself down as much as possible. Do not share horrible new stories with your kids or in earshot of them. They will be alarmed but will not tell you.

6) Understand that quiet kids may not be OK. Invite them to play with you or help you with simple chores. Reinforce any sharing with your attention and love.

7) Provide lots of hugs and affection. Take time for yourself and for them. You both need the contact!

8) If your child has a pronounced behavioral change reach out for professional help ASAP. Red Cross will have referrals for free and low-income therapy professionals.

9) Be active in reassuring your children that life will get better. Hold the optimism for them, even if you are feeling discouraged. This is kind and wise parenting.

10) Lastly, cultivate patience! Be patient with your kids and be patient with the city and be patient with yourself. Stop and breathe as needed. Practice self-care and stay aware of your own needs! Then you won’t resist the children’s needs when they are up.

Know that there are so many of us pulling for all of you and your kids. Be well and be safe!




Halloween: A Tough Season for Ritual Abuse Survivors

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Ritual Abuse. Yes, it’s real. Yes, I know there are many of you white knuckling your way through October. Hang on!

For an unfortunate but larger than you might think number of Americans, Halloween is a time that activates ritual abuse memories and/or programming.
I know nobody talks about this. Therapists have been running scared since the sham lawsuits and harassment of the last two decades by the now discredited False Memory Foundation.

But I’m here to tell you , it’s real. And I feel for all of you who have been hurt in this fashion.

Ritual Abuse (RA) survivors have a unique set of triggers. Because so many are abused in rituals around Halloween (Satanic and Witchcraft ceremonial time) these triggers can get very activating. In some cases, there may be programming to return to the cult for ceremony. These internally installed prompts may be conscious or, more likely, unconscious especially for those who are still under cult control and connection.

If you think you may be a ritual abuse survivor, you may want to check out this page of Ellen Lacter, Ph.D.’s comprehensive RA survivor website, endritualabuse.org. 

If you know you are, here are some reminders:

~ know that Halloween programming and compulsions will pass right after the “holiday”

~ surround yourself with safe friends

~ plan to make extra appointments with your therapist

~ go on a media fast until the end of the month

~ take extra good care of yourself and your “littles” this month

~ affirm your own inherent spirituality unrelated to any rituals

Know that there are many of us out here wishing you safety, healing and freedom. Take good care of yourself!







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!




Help! My Partner Has PTSD: Seven Strategies for Coping as a Couple

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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!







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!




INSOMNIA!

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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.

Why?

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.

Sweet dreams.










5 Ways to Manage Post-Disaster PTSD

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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!




© Lotus Heart Counseling, LLC • 530 NW 23rd Avenue, Suite 109 • Portland, OR  97210 • (503) 869-0314 • 

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