What can veterans teach us?


If you read much about matters of politics and the military, you are well aware of the significant problem of PTSD in returning veterans of Iraq and Afghanistan. While only 20-30% meet criteria for PTSD, all have been forever impacted. Rightly so, the military and traumatology researchers are expending oodles of money and time trying to understand (a) ways to reduce trauma symptoms and (b) improve resilience. Thankfully, we are seeing some helpful interventions being developed. However, there is much work to be done in perfecting treatments (finding ways other than just medicating vets into a stupor), ensuring that practitioners are competent, and improving societal acceptance of PTSD as a real disorder and not just something someone can just decide not to have.

And yet, these wounded and changed warriors have something to teach us about how we see ourselves and our world. Sometimes, it takes a life-changing experience to recognize serious blind spots. Even if you haven’t served in a combat setting, you can understand a bit if you’ve gone on a mission trip and returned with a different perspective and a sense you could no longer go about life the same way.

This article is a worthy read to consider what we can learn from those who were willing to sacrifice their lives, their futures for our safety. If you are indeed thankful for a vet’s service, take a minute to read it.

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Resilience in the face of trauma: Can it be learned?


The last plenary session at the ISTSS conference today covered the topic of resilience. I’ll give a few highlights of the Charney and Southwick presentation that might be of interest to you along with some of my own thoughts and questions.

The presentation centered on findings from their research regarding factors supporting resilience in POWs during the Vietnam war. Here are some of these factors that support overcoming and growing through traumatic experiences:

  • Optimism. Or, more pointedly, realistic optimism. Charney described it as trait optimism. This kind of optimism is not pollyanna but the combination of realistic assessment plus the faith/belief that one will persevere
  • Cognitive flexibility. The capacity to re-assess the traumatic events  and come to a different meaning. For example, instead of viewing torture as something that can’t be stopped, viewing it as something that makes the person stronger over time. KEY: the ability to reframe failures
  • A strong personal morality maintained.
  • Purpose in life. The researchers noted that those who attended more religious services were more likely to be resilient. They wondered if this was the result of the social support and identity or the sense of being created for a greater purpose. HOWEVER, they also noted that those more likely to believe that the trauma was a direct result of God’s punishment had much lower hope and resilience. 
  • Role models. Resilient individuals have a role models to encourage strength. The POWs often found each other to be a source of inner strength to bear up under torture. 
  • Ability to face fears; acceptance, yet 
  • Active coping responses. Responses such as minimizing memories of trauma, positive focus on personal strengths
  • Attending to physical well-being
  • A strong social network actively sought out. Inter 
  • Experiences of stress inoculation. Having minor to moderate stressors but with the capacity to cope (success with lower stressors)

Is resilience born or learned?

There is some evidence of genetic components. Personality traits seem to play a significant role. In addition, neurochemical processes play a strong role. Fear and reward circuitries in the brain play a significant role. One such neurochemical, Neuropeptide Y seems to be a naturally occurring anti anxiety neurotransmitter. Apparently, there are some promising studies underway using a nasal version of Neuropeptide Y to decrease anxiety in mice. 

However, there is some evidence that cognitive re-framing work in counseling helps improve resilience. In addition, physical activity, better sleep, improved social support, the practice of mindfulness, the presence of a caring adult and reflecting on positive self appraisal can improve resilience. 

So, if you are struggling to cope with recent or historic traumatic experiences, I strongly encourage you to consider not so much what you lost in the trauma but how God has given you power to survive despite the experiences. In addition, accepting the losses experienced during trauma is necessary even as you continue to take note of the gifts God has given you in spite of those losses. And when you can’t do that, get sleep, eat a high protein diet, and exercise. 

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Philly Friends: Check out the ISTSS Conference


Starting tomorrow, the International Society for Traumatic Stress Studies is having their annual meeting at the Marriott in downtown Philadelphia. Anyone interested in hearing the leading researchers and clinicians on the topic of PTSD and trauma (whether domestic or international, treatment of veterans or sexual abuse) should plan to drop by. There are 1300 plus registrants but room for more. 

If you come, check out Biblical’s Global Trauma Recovery Institute exhibit. I will be at the table on Friday and Saturday. 

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Does the DSM 5 define pedophilia as a sexual orientation?


In recent weeks I have read a couple of postings suggesting that the new version of the Diagnostic and Statistical Manual of Mental Disorders (DSM 5) has taken Pedophilia out of the realm of (psycho)pathology and made it equivalent to sexual orientation (e.g., gay, straight, bisexual, transgendered, etc.). These postings propose that the publisher, The American Psychiatric Association, has decided to normalize pedophilia–something that some believe is mere politics and a sign of further loosening of social mores. Usually, these writers point to the fact that the APA depathologized homosexuality in previous editions and now are going steps further to normalize pedophilia.

But, is this rumor true?

The facts from DSM 5

Pedophilia, or Pedophilic Disorder still exists and is considered a disorder in the family of paraphilias (patterns of abnormal sexual desire or activity). To be diagnosed with Pedophilia, one must meet 3 criteria (summarized)

  • Have sexual fantasies, urges, or behaviors for prepubescent children
  • Either urges cause marked distress, interpersonal difficulty OR the adult has acted on the urges with children
  • Must be at least 16 and seeking those who are at least 5 years younger

So, why the rumors?

Okay, so pedophilia is still a disorder. So, where is the confusion? After listing the criterion, the DSM offers some commentary to further describe the disorder. Here’s where some confusion may enter in as they describe the person who has intense pedophilic urges but who has not acted on them:

“However, if they report an absence of feelings of guilt, shame, or anxiety about these impulses and are not functionally limited by their paraphilic impulses (according to self-report, objective assessment, or both), and their self-reported and legally recorded histories indicate that they have never acted on their impulses, then these individuals have a pedophilic sexual orientation but not pedophilic disorder.” (p. 698)

Meaning?

Unfortunately, “pedophilic sexual orientation” is not defined. By the way, neither do they define any other sexual orientation. The point being that since sexual orientation is outside the purview of  a catalog of psychopathology, it need not be discussed. So, my read of the DSM 5 intent regarding pedophilic urges is this

  • Pedophilia is NOT equated with sexual orientation when the person is acting on the urges or is troubled by them, BUT
  • Those who have these attractions, yet feel no shame about them, function in society to protect children, and have not acted to harm children are not pedophiles but can be listed in a new nonpathology category: pedophilic sexual orientation. thereby, 
  • Opening the door for some to self-identify in a nonpathological manner

Is this cause for alarm?

Short answer. No, this nor the removal of homosexuality as pathology is not evidence of APA’s moral degradation.

Longer answer. this addition/change will create confusion. It does open the door for some crazy thinking and adding the “orientation” language is wrongheaded and may harm the good research being done about sexual orientation. Further, never underestimate the power of some to use this for evil intent.

Remember, the DSM is a catalog of psychopathology, not social pathology, moral pathology or the like. So, if it is possible (and there is evidence to support this) that gay and lesbian people do not experience psychopathology solely as result of their sexual feelings, then it would be right to remove homosexuality as a psychological disorder (no matter how you classify it in terms of morality).

There is another DSM feature that may be more of issue in this debate. As of now, diagnoses are locked into using the criterion, “causes marked distress” as a way of determining the floor for a pathology. Thus, you could possibly experience recurrent and persistent obsessional thoughts and images but not have them cause “marked distress…or significantly interfere with normal routine, social activities…” and therefore NOT be diagnosed with OCD. So, if it is possible to determine that a person with sexual feelings for little children is able to be not disturbed by them AND not act on them, then you wouldn’t give the diagnosis.

See the problem?  Here’s an analogy of sorts: if all 80 year old men have cancer cells in their prostate but never have any symptoms, seek no treatment, and die of other causes, should they be diagnosed with prostate cancer? Denying the existence of the cells doesn’t seem to be the answer even if no treatment is necessary.

To the point: Is there movement in redefining pedophilia?

Not in the mainstream.

It appears that there is an effort to better understand those who are being charged and convicted of child sex offenses. I see a growing research beginning to differentiate between three types of people who commit sex crimes: contact sex offenders (those who directly abuse actual children), internet offenders (those who use or send child pornography), and solicitation offenders (those who use technology to communicate with minors for sexual purposes).  The idea is that there may be differences between these three types and thus arguments for different punishments and treatments. It seems, thus far, that contact sex offenders have far more distortions in empathy for victims, cognitive distortions about self and children while the other two categories seem to have some features that might protect them from becoming contact offenders. NOTE: the data is small at this point and we can’t predict who will and who will not become contact offenders.

Go ahead and worry some

If one could really argue that child porn viewers are not statistically more likely to become offenders against actual children, you can easily imagine someone arguing that virtual child porn (i.e., digital created images of children having sex) harm no one and ought to be legal for the pedophilic orientation individuals. On recent report stated that at any given moment in time there are 750,000 individuals accessing and viewing child porn. And that is with it being a crime. Do we really want to open this door to normalization? No. We want to understand, empathize, restrict, and intervene.

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Filed under APA, News and politics, Psychology, Sex, sexual identity, sexuality, Uncategorized

Trauma Healing Equipping Week: February 2014


Biblical’s Global Trauma Recovery Institute is sponsoring the American Bible Society’s Trauma Healing Equipping seminar set for the Philadelphia area late February 2014. This is a week-long seminar that gives participants hands-on experience with the Healing Wounds of Trauma material. If you are local and would like to have experience with this Scripture engagement material (excellent for use in churches or lay counseling contexts) that explores both content and means to teach others, I highly recommend you check out this 2014-02 Equip PA Flier.

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Preventing & Responding to Abuse in Christian Contexts: Plenary Presentation


Check out the link to slides (below) from my talk today in Potchefstroom, South Africa. I spoke on the topic of preventing and responding to abuse in Christian contexts and how this work is THE work of the Gospel.

Responding to Abuse South Africa

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The Power of a Counselor’s Words: Guest post over at biblical.edu


I’ve been thinking and musing about the power we counselor’s wield with our words. To be honest, I do so without always being aware of the impact. It is so easy to say, “that’s abusive” to a victim with the idea that I am validating her experience without realizing I have just crushed another part of her life.

So, if you want to read some of these musings and a gentle corrective to those of us who call ourselves biblical counselors, click here to find the blog I posted for October 18, 2013.  [posted prior to leaving for South Africa]

 

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The Mission of Trauma Recovery: Making the Church a Safe Place for Victims


A few months ago I asked readers to give me ideas about how the church could better serve victims of trauma experiencing PTSD and other
related symptoms. I did so as I was thinking about the presentation I would make to conference attendees in Potchefstroom, South Africa on October 18, 2013. So, I post these slides (in advance) for those who can’t join me there or who were there, but want a copy.

The Mission of Trauma Recovery South Africa

Conference link

 

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Filed under Abuse, Africa, christian counseling, Christianity, Christianity: Leaders and Leadership, Post-Traumatic Stress Disorder, ptsd

Before you cast judgment on stranger for their parenting failure


One of my current students, Stan, passed on this excellent blog post about the looks we sometimes give “bad parents” when we see their unruly and out-of-control children. The author nails the reasons for the shaming looks and thoughts we have: PRIDE.

It is also good to consider that whenever we see a child melting down in the grocery store or a parent using less-than-ideal strategies, we don’t really know the whole story. In the post you will see this mother’s understandable excuse for her child’s behavior–pediatric brain cancer. Of course, not every parent has an unruly child with cancer. But let it be a reminder, you don’t know the whole story and haven’t walked in their shoes…

 

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Follow up on ministry to sex offenders


After I wrote the last post, I was pointed to this article in the Independent on Sunday about a program of caring for sex offenders through friendship groups. The organization, Circles UK, develops these groups around offenders in order to build relationship and accountability. The article says that over a 4.5 year period, none of the Circles offender re-offended where a control group of the same size committed 10 new offenses in the same period.

As you can easily imagine, most sex offenders lose their entire support system. Loneliness and isolation can only lead to temptations to connect through offenses. If anyone is interested in supporting offenders and reducing recidivism, check out the program. While it is UK-based, it shouldn’t be hard for a church to decide to follow the same pattern.

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Filed under Abuse, christian counseling, Christianity