Here’s video of Dr. Diane Langberg musing about what she has learned from listening to trauma over the years. (link here) She made this presentation as a part of a larger evening of trauma counseling training at Biblical Seminary, November 12, 2012.
Enjoy. More to come soon.
Likely, you are participating in the current national soul-searching after the latest tragic school shooting/mass murder. In our angst we ask, “Why God?” and “What can we do to try to stop this kind of senseless killing?”
It is the second question that is on my mind right now.
Political debates will abound about gun control measures or the right to bear arms. In my humble opinion it is time to move beyond that debate and address the treatment of those who are most at risk to engage in mass killings. I have no idea about the mental status of this most recent killer but that shouldn’t stop us from trying to figure out how to better care for such individuals.
Who is at risk? A complex matter
Violence risk assessments have morphed over the years from clinical judgment (turns out our intuition wasn’t very accurate!) to an actuarial approach looking at factors like: active psychotic symptoms, family problems, history of aggression/domestic violence and or criminal behavior, social withdrawal/skills deficits, and substance abuse. But of course, there are many who have positive indicators on several of these factors who are in no danger of becoming a mass murderer. Still others meet none of these risk factors and yet become killers. [Read Randy Otto’s short paper on violence risk assessment and discussion of the historical, clinical, and environmental factors of violence risk]
One possible (partial) solution
Right now mental health professionals and educators are required to report possible child abuse. In addition, we counselors have duties to warn and protect when our clients indicate they are an imminent (meaning, immediate) danger to self or other. Sadly, many adults in high risk categories are not likely to be in treatment (due to costs, treatment availability and refusal) and may have enough sense not to make threats to those who are obligated to report.
So, what might we do to help those who do come in contact with at-risk individuals? In some states, all civilians are required to report potential child abuse. What if we develop a reporting mechanism for civilians to report those who are making statements about violent acts?
To make this procedure work, there are some additional changes we would have to enact (some of which are not simple)
Some need a rescue
Soon after the Connecticut shooting, The Huffington Post ran an op ed blog post by a mother of a mentally ill young man. It went viral as it was “a gorgeously written piece” by a mother whose son’s behavior terrified her. She well described the isolation and inability to find proper treatment and care for a son she loved but could not control. Almost as soon as her piece went public, others outed the writer as a person with mental illness who publicly blogged about wishing to strangle her children (see above link for that story). Despite her lack of judgment in prior writings, the original piece reminds us that there are many families suffering without avenues to help the ones they love. If we are going to make progress in quelling mass violence, we had better start building better mechanisms to treat the mentally ill and to support their family members.
Filed under counseling science, Psychology, Uncategorized
Just a reminder to those of you who are counselors and therapists out there, starting in January, Dr. Langberg and I will be offering group and individual consultations to mental health professionals seeking help for their domestic and international trauma recovery cases. We will be running a once a month group consultation on Fridays beginning mid January (runs for 6 months) here in the Philadelphia region. If you have any interest in joining the group or having your own private consultation, please check out our website for application and consent forms: http://globaltraumarecovery.org/group-consultation/
Group consultations are a great way to get feedback on a difficult case, learn from peers, as well as easier on your pocketbook.†
†consultations can not be considered supervision as we have no authority over your practice.
For many of you this is the season of buying Christmas presents. For me, it is the season of paper grading time. I have 46 term papers due tonight. Thankfully, I do have a TA helping with grading for the first time in a VERY long time. So, that is my excuse for no new posting today. However, our faculty blog is reposting a version of my recent blog on Dr. Diane Langberg’s definition of Christian Psychology. Alone, her definition isn’t intended to be comprehensive (as she does not choose to define psychology). Probably would be better to title this a definition of Christian psychotherapeutic intervention. The focus in this definition is on the character of the therapist and the submission to the Spirit’s working in the life of the counselee. The point of the definition is to remind us that we can define the boundaries of psychology from a Christian perspective and yet fail to see the relational aspects of the work that we do.
If you missed it, this link will show you the original post here on November 26 and some helpful questions and comments.
Filed under christian psychology, counseling, counseling skills, Psychology
The faculty blog at Biblical Seminary has posted one of mine about mindfulness from a Christian perspective. Actually, it is a call to develop a theology of mindfulness–or what I prefer to call watchfulness. While you are there, check out some of the other postings by my colleagues.
English: Neurologist and writer Oliver Sacks at the 2009 Brooklyn Book Festival. (Photo credit: Wikipedia)
What does it mean if you hear things that no one else hears? Sees things that no one else sees? Does it mean you are having a spiritual experience? Or, do you have some form of psychotic disorder?Thanks to a student (HT Heather), I submit for your reading pleasure a NY Times essay by Oliver Sacks. Dr. Sacks suggests there may be some other possible reasons why you might hear or see or feel something that isn’t heard, seen, or felt by others. In fact, he points to research that a large portion of those who do have these experiences never tell others or doctors about them for fear of being labeled falsely with schizophrenia.
Ever had either hypnogogic or hypnopompic hallucinations (ones that happen just as you fall asleep or awaken)? Did is scare you? Can you imagine telling others about it? If you find these kinds of unusual experiences interesting, I encourage you to read any of Dr. Sacks’ books.
Filed under news, Psychiatric Medications, Psychology
Brain structures involved in dealing with fear and stress. (Photo credit: Wikipedia)
A good friend of mine pointed me to a recent Nature essay that describes the biological markers for PTSD and resilience–and provides some of the answer of why some seem to recover fairly quickly while others continue to struggle. Here’s a couple key quotes:
“Functional magnetic resonance imaging (fMRI), which tracks blood flow in the brain, has revealed that when people who have PTSD are reminded of the trauma, they tend to have an underactive prefrontal cortex and an overactive amygdala, another limbic brain region, which processes fear and emotion…”
“People who experience trauma but do not develop PTSD, on the other hand, show more activity in the prefrontal cortex.”
Of course, we need to understand that we are complex beings with complex histories and current social connections. We don’t only look at neural activity but with increasing understanding, we learn how experiences such as childhood trauma, poor social support influence brain activity.
Some worry that the discussion of biological features of PTSD will lead only to increasing chemical interventions (meds, surgeries, etc.). I do not believe this to be the case given that we are also learning about the ways that current relationships and psychotherapies are altering brain activity.
At the recent AACC conference Dr. Michael Lyles, a board member of AACC and practicing psychiatrist, stated the following,
A diagnosis is only a word on a page if it doesn’t serve a function.
What kind of function was he thinking about?
I’m a firm believer that our current DSM diagnostic system is at once both flawed and useful. It is flawed in that DSM diagnoses don’t address causes or do much to point to treatment. It is useful when used carefully to help differentiate between overlapping sets of symptoms–even as it needs considerable overhaul to do a better job. Take differentiating between Major Depression and hypothyroidism instigated depression. The two look identical. But using a multiaxial diagnosis, a person could rule out Major Depression if they were able to make a positive diagnosis of low/inactive thyroid function.
So, until we have a better nosological system (i.e., a replacement for the DSM), I will continue to use it. In years to come we will, however, recognize it for the blunt instrument that it is.
Right Diagnosis…Wrong Focus?
Consider the following case study (not a real person, devised from several stories) as an illustration for the problems we have moving from current diagnostic categories to proper treatment.
Tom is 27, married, father to one young daughter, working part-time as a youth pastor and going to seminary full-time. He comes to counseling on the encouragement of his primary care doctor. One month ago during final exams and an overly busy ministry schedule, Tom began experiencing rapid heartbeat, shortness of breath, feelings that he was losing his mind, and chronic fear of dying. After experiencing 4 panic attacks in rapid succession, he began worrying that something was terribly wrong and that he was about to die. His doctor first ruled out a physical origin for these symptoms, taught him breathing and distraction exercises to interrupt the buildup of panic, prescribed an anti-anxiety medication, and recommended he make an appointment with a therapist. During the first session, Tom details his history of stress, reports he has been able to forestall 2 more panic attacks but admits he still struggles with fears of dying, lacks assurance of salvation, and feels flooded with guilt that he worries so much. Upon further exploration, Tom believes the bible teaches him that he should not fear if he has “perfect love”. He has read all of the verses about anxiety and feels condemned for his struggle.
Tom meets criteria for Panic Disorder, without Agoraphobia. This is a highly treatable problem and within a few short sessions, Tom is likely to gain mastery over his body in that he will no longer evidence panic attacks. This, of course, is not the same as saying he will stop experiencing worry, guilt over his chronic worry, or start having assurance of his salvation. Logic, disputing worries, distractions, exploring and altering core beliefs may help reduce the symptoms that brought Tom to his doctor and counselor. A good Christian counselor may also be able to reconnect Tom to Scripture in ways that help him experience God’s care for him in spite of his fears (e.g., hearing the gentle voice of Luke 12 vs. a harsh rebuke).
But has the diagnosis been properly made? Yes. Tom met the criteria for an anxiety disorder. No. Tom’s counselor also helped him discover a deep layer of shame that may have been the source of his anxiety. Without the latter, the former is not altogether helpful.
So, should the diagnosis be an anxiety disorder or shame? Until we have shame as some form of a diagnosis, I’m okay with maintaining the anxiety disorder as a good description of external symptoms. But, Tom and others like him will need wise counselors who can dig a bit to discover diverse multiple shaping factors (e.g., biopsychosociospirtual) that lead to a common expression of symptoms.
What good is a diagnosis? I concur with Dr. Lyles: not much.
On the way to work this morning, I listened to a story on NPR’s Morning Edition about “pathological grooming.” Never heard of this disorder? It’s called biting your fingernails…or other similar things (hair pulling, face picking, nose wiping, etc.). Apparently, the forthcoming DSM 5 will lump it into an OCD diagnosis.
Here’s a couple of interesting tidbits from the 8 minute show.
So, what do you think? Do you think chronic nail-biting fit better within an anxiety disorder, an addictive disorder, a tic disorder or just merely a silly habit unrelated to any mental health category?
Filed under Anxiety, Psychology
Anna Badkhen asks, “How do you heal an entire country suffering from shell shock. She describes conditions in Afghanistan. You can see she asks a great question but labors, as we all do, to come up with an answer that makes sense in a place that is still unstable (and therefore still traumatizing) and that fits the cultural and economic realities of the region.
Check out this short essay,
PTSDland – By Anna Badkhen | Foreign Policy.
Filed under Abuse, counseling skills, Psychology, ptsd
Musings on Faith and Psychology 