Tag Archives: mental health

July 30, 2013 · 11:11 am

How do trauma symptoms pass to the next generation?


As a clinician, I have had anecdotal experiences that the trauma experienced by a parent is passed on to a child who presents with many trauma symptoms despite not having experienced the initial trauma. We have witnessed what looks like this kind of transmission in places like Rwanda where children born after the genocide seem to experience many of the same symptoms of their parents.

Thus far, the data about generational transmission has been mixed. Looking at 2nd and 3rd generations of holocaust survivors, some research indicates that later generations can be affected; some research indicates no secondary traumatization. The problem with this research is that much is focused on the content of transmitted symptoms rather than the process. In the latest issue of Psychological Trauma (v. 5:4, 384-391), Lotem Giladi and Terece Bell have published a study looking at both content and process of trauma symptom transmission (“Protective Factors for Intergenerational Transmission of Trauma Among Second and Third Generation Holocaust Survivors”). The authors hope to have a clearer picture of risk and protector factors. As they say,

“The research question was not whether 2G and 3G experienced greater psychopathology than controls, but rather why some of them still carry some Holocaust-related psychological distress whereas others do not.” (384)

These researchers tested whether psychological concepts of differentiation of self (a Bowen concept indicating the ability to balance need for connectedness with family and need for being a separate self) and family communication (a previous study indicated that 2G holocaust survivors suppressed communication of negative emotion around their parents).

What did they find? 2G and 3G both showed greater levels of secondary trauma than controls (though all amounts of STS were in normal range) and surprisingly, the 3G group did not show less secondary trauma than did the 2G group. Indeed, greater differentiation of the self and better family communication among the generations of holocaust survivors positively correlated with  few secondary trauma symptoms.

So, how do trauma symptoms get transmitted to the next generation? We do not really know yet but one possible answer is that trauma tends to influence emotion regulation, anxiety regulation, and thus decreased self-soothing behaviors. This may get passed on to the next generation via suppressed negative feelings (children who do not want to make matters worse) and identification with the parent’s distress (and partially responsible for it).

For those readers who might wonder if their own trauma is causing secondary trauma in children, consider these things:

  • Most of the 2G and 3G holocaust survivor families are not terribly harmed. Most do well. So, it is not a given that your family is being harmed by your trauma symptoms
  • Open communication about the trauma symptoms and impact on family (without laying blame!) is likely helpful. Also communicate how coping with trauma symptoms can also teach a family some positive lessons as well (patience, gentleness, boundaries, etc.)

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June 18, 2013 · 9:57 am

Dr. Langberg on Dissociation (part II): DID, Principles and Cautions


Over at my other site, www.globaltraumarecovery.org, we now have part II of Dr. Langberg’s talk (March 2013) on dissociation. This video covers the concepts of Dissociative Identity Disorder (DID) and complex trauma. She ends with 10 principles and cautions for therapists working with clients who dissociate and/or who present with alternate personalities and identities.

Check out the video here. If you missed the first video or want to find other free resources, click around on that website.

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June 11, 2013 · 3:27 pm

Dissociation: What is it? What can be done?


For those of you who love or are helping PTSD or complex trauma victims, you may find this video link helpful. Dr. Diane Langberg (after an introduction by me) explores the experience and process of dissociation, or “leaving” the present. She discusses why it happens and what is going on when a person dissociates. At the end of the video, she explores a few helpful ideas for helping to ground the individual in the present.

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June 3, 2013 · 2:55 pm

Global Trauma Recovery Intensive: Day 1


20 students along with myself and Dr. Diane Langberg just finished a 3 day marathon together at Biblical’s Hatfield campus. This inaugural cohort has been studying together via our e-campus since January. We’ve read books, articles, watched slides shows, and discussed a wide variety of topics (e.g., the psychological, social, spiritual, biological impact of trauma, shame, culture, strengths-based listening skills, and faith and psychological intervention strategies). At this meeting, we continued to consider how to listen andGTRI - First Graduating Class respond to traumatized individuals in places other than our own.

Morning Session: Romania

Our morning consisted of a live engagement (thank you Google Hangout!) with mental health practitioners in Romania. Dr. Ileana Radu and Stefana Racorean hosted the meeting. The Romanian contingent consisted of mental health therapists, psychiatrists, and Christian leaders. As part of their conference, they took time out to ask us questions about trauma, trauma recovery interventions, and integration of psychology and Christian faith practices. In return, we asked them about the mental health scene in Romania, the most common forms of trauma and intervention models in their practices. From our conversations, it appears that they experience a significant divide between secular mental health models or “bible only or prayer only” models.

The conversation bolstered our students understanding of Romanian culture and put a human face to what they had read about regarding torture trauma resulting from pre-revolution days in that country. In addition, students had the opportunity to discuss a couple of PTSD cases written up by mental health practitioners in the conference.

The entire conversation and connection (bridge, according to our new Romanian friends) was the result of Dr. Langberg’s inability to travel to Romania in April. She was to be their keynote speaker but due to the death of her mother, she was unable to attend. The conference was rescheduled and Dr. Langberg spoke via SKYPE and previously recorded DVDs.

Afternoon Session: North Philadelphia

Elizabeth Hernandez, executive director and founder of Place of Refuge, led our afternoon session by giGTRI - appendix photoving us a window into the trauma work going in North Philadelphia among the latino population. She shared with us some of the groundbreaking work they are doing with low-income population who have experienced many traumas. The class also engaged around the matter of syncretism (Catholic faith practices mixed with witchcraft and other superstitions) and how faith-based counseling services are delivered.

We ended the day with some brief use of video to “listen” to trauma stories in Eastern Europe and the US. After these engagements, we had our students explore writing their own laments as means to connect with God and concluded with a corporate lament. The purpose of lament is to confess (one’s own sin or the sins of others!), converse with God and others, question God about what we see that is not the way it is supposed to be, and by questioning acknowledge hope in God that he is in the process of redeeming and rescuing a broken world. Lament is not a tool to get better but to connect to each other and to talk to God about our suffering.

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April 17, 2013 · 9:14 am

The “End of Worry” in a dangerous world?


In light of the recent bombing in Boston, I thought I would use today’s post as a timely book note. Will van der Hart (Anglican vicar) and Rob Waller (Psychiatrist) have written a small but helpful book entitled, The End of Worry: Why We Worry and How to Stop (2011, Howard Books). What makes this book interesting is the fact that Will freely discusses his own struggle with worry, made more evident after the 2005 bombings in his city of London. While the bombings were the final straw to panic attacks, Will also explores some of the early roots of worry in his life.

If you struggle with worry, there are several reasons why this little book might be a comfort to you.

  1. The authors write as if they know worry and fear.
  2. It is not, as they say, “triumphalistic.” Meaning, they do not believe the right beliefs/prayers/faith will automatically solve the problem
  3. Worry is portrayed not only as a spiritual problem but also explored through lenses of psychology, biology, and habit formation.
  4. It is written to the worrier, not about the worrier
  5. Each chapter gives you opportunity to engage in a few key exercises
  6. They differentiate between solvable worry and floating worry (and the tyranny of the “what ifs…”)
  7. Their solutions are practical but do not pretend to be simplistic. In fact, they devote some space to the notion that you should “stop trying not to worry.” Sound radical?
  8. A number of their solutions are helpful for those who ruminate (OCD, scrupulosity)

The book sits firmly in the cognitive behavioral model of intervention. Therefore, much of it encourages readers to explore belief systems about self and world and to begin challenging faulty thinking and to work to replace with more appropriate cognitions, meditations, and self-talk. CBT is not the only therapeutic model but offers anxious people something to do.

If you would like to work through a book that describes the process of worry and perfectionism and then gives you some ideas to examine and change your own struggle, this might be the book for you.

*I received a free copy of this book without any obligation to write this post.

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April 12, 2013 · 4:34 pm

Suicide education and prevention in the church


Suicide is in the news these days. Military suicides are off the charts. Bullied teens are in the news this week along with a nationally known pastor’s son. Suicide is an important topic! We need to talk about why, for some, suicidal thoughts (fairly common across the population) become plans and actions. We need to explore what helps reduce suicide as a desirable option. We need to talk about how to care for those left after the horror of suicide.

But here’s a question: Have you ever heard a sermon or a Sunday School lesson on the topic of suicide?

I can’t say that I have.

This week I was sent a survey about graduate theological education and suicide assessment and prevention training. Our counseling students get a bit of education on suicide assessment in a couple different courses. They read an article or two on the topic. Not really enough but our challenge is to know what to cut in order to fit more suicide material into the program.

The result is that most learn in the middle of a crisis. Not really the best plan.

If you are looking for materials, let me point you to a few:

1. National Action Alliance for Suicide Prevention.

2. CCEF. Use their search tool to find their resources in this packed website (some free, some cost a bit). Jeff Black’s article on understanding suicide is helpful. There are several blogs that are free.

3. Al Hsu’s book, “Grieving a Suicide.”

4. American Foundation For Suicide Prevention.

If you google suicide and christian, you will notice that the vast majority of material is about whether or not suicided individuals can still go to heaven. While this is an important question, it appears that we have spent more time on this topic than on that of prevention and intervention.

Maybe we can do a bit better than this? Let’s commit to talking about it rather than being afraid.

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April 4, 2013 · 8:56 pm

What PTSD might feel like


If you haven’t experienced PTSD from a traumatic experience, you might wonder what a traumatic reaction might feel like. What I give below is just a teeny window. Note that what I write about is NOT PTSD but shares some of the same features on a very small and temporary scale.

Imagine the following:

You are sleeping peacefully but at 3:30 am by a horrible metallic crash just outside your home. You recognize the sound as a car crash. What follows that sound is continued crashes, spinning tires, shifting gears, more smashing sounds, shifting gears, then your house rocks when the vehicle hits your porch. You grab your glasses and stumble to your feet, find your pants and start for the phone to dial 911. Without yet seeing what is happening, you imagine that someone is choosing to smash another vehicle in order to get revenge. In a flash you imagine someone very angry who may be dangerous. You try to dial 911 but its dark and you are not yet awake. On the 3rd try, you get it right and the operator comes on the line. She asks several questions (who are you, spell your name, where do you live, what is your nearest cross street, what is your telephone number, what is the emergency, is anyone hurt, etc.). You struggle to answer these questions because of the distress of the situation and the tightening knot in your stomach. You hang up and look out the window. The sound of the offending vehicle dies away. You look outside and see a smashed car crossways the road. It is dark so you cannot tell if anyone is in the vehicle, if anyone is hurt, if danger is outside. You feel paralyzed and sick to your stomach. Should you go outside and see? What if the violent person is still out there?

Soon, the police arrive and neighbors pour out of houses. You venture out to learn that a drunk driver lost control and smashed into a parked car. the driver ended up on your neighbor’s grass and the repeated smashes were the result of his attempt to get back onto the street. Each neighbor describes what they heard or saw. The police arrive and take their reports and photographs. As neighbors share stories and laugh (even the one whose car was destroyed), you feel your stomach relax and you return to you bed for what is left of the night.

The next day, you go to work a bit more tired than usual. You tell a colleague or two about the experience. You perform your duties without significant difficulty. BUT, at moments of silence, you keep hearing the noises of the smashes, spinning tires, more smashes. You feel your stomach tense. You feel embarrassed that you struggled to communicate to the 911 operator. You feel embarrassed about your hesitation to go outside. You feel somehow that you would have failed to protect your family if they were really in danger (due to paralysis). You remember 2 other times you didn’t respond well to a crisis. The next night, you find yourself wound up and unable to sleep.

Again, this little vignette does not make a PTSD diagnosis. Those who have experienced terrible traumas (e.g., sexual assault, witnessing sudden death or forced to participate in a killing) would likely feel this event is simplistic. They are right and yet, you might see how the body/mind may respond to a crisis or the perception of a crisis.

  • Experience of danger
  • Inability to get away from it
  • Horror response
  • re-experiencing intrusive memories
  • Hypervigilance
  • Attempts to shut down the intrusive memories and emotions

Notice in this situation, some of these PTSD symptoms are not present and not likely to form. the problem resolves quickly and, more importantly, the shared conversation with neighbors afterwards reduces much of the isolation that is often common in traumatizing experiences. And yet, notice that sounds of the accident keep coming back to the person. In addition, this person feels some level of guilt and shame about the response to the event. This feeling can increase isolation and negative ruminations about personal failures.

Given this situation and it’s randomness, the person is not likely to remain distressed. Symptoms such as these tend to fade quickly. If, instead, the scenario contained sexual violence by a loved one, confusing physical responses, threats to one’s life if you cried out, you can quickly see how the symptoms would not easily fade but would grow in intensity, frequency and duration.

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January 26, 2013 · 11:03 am

“Schizophrenic and Successful”? What are the factors in success?


This recent New York Times Opinion Page essay is written by Law Professor, Elyn Saks. She tells a bit about her diagnosis of Schizophrenia years ago and her fight against those who thought that she would not amount to much. While we shouldn’t assume that everyone who struggles with delusions and hallucinations will rise to Dr. Saks level of accomplishments, we should take note where we give in to hopelessness when someone we love receives such a similar diagnosis. Such hopelessness will surely hamper our loved one’s prognosis for recovery.

There are two important factors that predict both recovery from mental illness and future recurrence of symptoms.

  1. Acceptance of diagnosis and treatment compliance
  2. Absence of family and social stressors

These factors are found in nearly all forms of mental illness, but especially pertinent for depression, mania, and psychotic disorders. When a person accepts the existence of a problem and commits to a treatment strategy, they are likely to be more cognizant of the signs and symptoms re-appearing and therefore willing to seek additional help. When medications create irritating side effects, the committed person will either find ways to tolerate these irritations or work with their doctor to find alternative treatments.

The absence or minimization of family stress requires the family or community to not behave in ways that exacerbate the problem. The family must also accept the limitations and not act in ways that place unrealistic expectations on the patient. This of course requires a great deal of sacrifice–on top of existing grief and loss over relationships that will not be what they could be (e.g., caretaking a spouse with mania, supporting an adult child who needs a sheltered environment). This means releasing the demand for the patient to reciprocate empathy or have insight about their impact on the family. Still further, when we loved ones maintain a hopeful perspective–identifying a patient’s value, capacity, and possibility for a future–we offer that person the greatest chance for success.

For some, success may mean being able to hold down a steady cashier job. For others, success may mean staying out of the hospital. Still others may rise to Dr. Saks level of success in academia. If you have a family member who suffers with mental illness, work hard to see them beyond their illness and evaluate their current capacities (rather than by their best or worst day). Oh, and be sure to find someone to talk to. Your family member isn’t the only one who needs help coping with a difficult world!

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December 15, 2012 · 8:29 pm

Mandated reporting of violence risk?


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)

  • We would have to engage in a large public awareness campaign and to train law enforcement and even mental health professional to recognize risk factors
  • We would need to develop humane but required treatment protocols
  • We would need to stop cutting public funds for mental health (and increase quality of community mental health care providers), and
  • We would need to consider limiting some of the currents rights to decline treatment when a number of the risk factors are present (this is, of course, no small matter. In this country we have the right to be insane…as long as we don’t hurt others).

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.

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December 14, 2012 · 2:43 pm

Bessel van der Kolk on curiousity


Watching Bessel van der Kolk’s live CE presentation on trauma and attachment from the comforts of a counseling office (far better than sitting in a hotel room since we can get up and go to the bathroom and make snarky comments from time to time).

He is focusing on neuroscience and the role of the body in trauma and trauma recovery. Here are a couple of tasty quotes:

  • trauma isn’t about what happened but how it lives in you now
  • the most important part of trauma recovery is self-regulation
  • If you can’t be curious about yourself, you can’t get better (speaking of curiosity of one’s body, how it reacts to trauma triggers; the capacity to observe in the here rather than live in the past).

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