Tag Archives: Psychological trauma

Evil Hours (David Morris): A Must-Read for Mental Health Professionals


A bit ago, I blogged on David Morris’ new book, “The Evil Hours: A Biography of Post-Traumatic Stress Disorder” and his NPR interview. [You can read my previous post here.] Having just finished reading the text, I want to highlight a few more insights about the book.

Morris does an excellent job describing his experience of trauma and then expanding to the history of PTSD and its impact, both on those going to war and those who have experienced civilian traumas. For those who wonder why Vietnam vets struggle more than WWII vets, Morris helps reveal the falseness of that belief in the beginning of chapter 5.

But the most important chapters of the book are chapters 6 through 9 where he examines therapies designed for PTSD, how research protocols designed to help us know which treatments work best may harm, how drugs and alternative interventions (e.g., yoga) may help and how to think about posttraumatic growth.

Though these chapters are his experience, I would highly recommend every MHP to read these chapters. Skip the first chapters if you must (you should not!) but these are paramount if you are going to work with traumatized individuals. Here are just a few reasons why:

  • Following protocol for therapy can harm a patient. Don’t get me wrong, research IS necessary. But when a protocol is harming a patient, it is important to make sure that research goals do not become primary over the needs of the one who is in need.
  • Prolonged Exposure, the gold standard treatment, has a HUGE drop-out rate. Somewhere around 54%. That should give us great pause. Surgery hurts. PE is like surgery but repeated opening of a wound. The dropout rate should tell us that imaginal work can re-traumatize. There are other methods that may work just a well but do less damage in the process. I think about the changes in the last 10 years for breast cancer. We are discovering that not everyone needs bilateral breast removal to survive. Not everyone needs 30 days of radiation as radiation at the time of lumpectomy may work just as well for some patients. So, we must be less fixed in our minds on treatment protocols and be considering if the patient can improve with less radical treatment options.
  • Cognitive therapies are good but over-emphasize think right = feel right. Such work could ignore the moral complexity of life, especially for those who have moral injuries.
  • The person of the therapist is more important than the treatment modality. This is not to say that the modality is of no consequence. Rather, that good interventions live or die on the capacity of the therapist to be truly human with clients.
  • Recovery must be done in community. Gutting it out alone does not work.
  • Alternatives, like yoga, works for some far better than talking, but shouldn’t be sold as a cure-all.

…yoga stands out as a uniquely effective treatment, precisely because it insists that people shut up and start listening to their bodies. Yoga works to correct the central lie of Western philosophy, which goes all the way back to Descartes, who said that the body and the mind are distinct entities that exist independent of each other. (237)

However, Morris acknowledges that yoga is, “ridiculous”, even “moronic.” Though he is also quick to say, “In the Marine Corps, we had a saying: ‘If it’s stupid but it works, then it isn’t stupid.” (238). “Placebo, wishful thinking, whatever. I’ll take the help where I can get it.” (246, discussing the mixed evidence for EMDR). Yet, be wary of proponents of any one treatment as a cure. They prey on desperate people.

The bottom line is that there is no ‘magic bullet’ for PTSD, and claims to the contrary should be taken with more than a grain of sand. (240)

  • Growth happens but not apart from ongoing trauma symptoms and changes. Too often we expect recovery to mean the removal of symptoms. But, there is no going back. Identity changes, just as it would if you lost your spouse and then got remarried. Growth needs to be observed and underlined, but not assumed to eliminate strong, continuing reminders of trauma.

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Thoughts on Gary Haugen’s “The Locust Effect”


Over 2 billion people live on less than 2 dollars a day. If you doubled the population of the United States you would have the number of people who live on less than a dollar a day. As Gary Haugen points out, if you are reading The Locust Effect: Why the End of Poverty Requires the End of Violence (Oxford, 2013) or are reading this blog, you are not likely to be a member of the extreme poor. And if you aren’t a member of the extreme poor you probably wish you could do something to improve the lives of the most impoverished. The poor need clean water, food, housing, jobs, affordable healthcare, and education among other things.

But Haugen says all of those needs pale to a greater need: the need to stop the plague of “lawless violence.”

Opportunities for education, jobs, healthcare, quality food and water will evaporate or will not be accessed if poor do not have protection from violent forces–security, law enforcement, and a just judiciary.

The book challenges the reader to stay with the problem of poverty and violence as it travels across the globe to recount story after story of vulnerable men, women, and children whose governments fail to (a) protect them from sexual violence, bonded labor, property theft, and (b) defend them or seek justice after becoming prey. Frankly, it would be easy to either turn away from this problem since it is too large for anyone to solve or to just keep offering some form of help (food, water, job creation–all of which are needed and good!) without confronting the epidemic of violence.

Sexual Violence

There are many forms of violence a poor person can face. Their livelihood, home, and communities can be destroyed. But sexual violence doesn’t just take those things but also eviscerates the soul. Haugen recounts that in some locations as many as 68 percent of girls report experiences of sexual abuse. Some 6 to 11 million individuals are trapped in the sex trafficking industry. Some 1 billion women are known victims of sexual abuse. For most readers, this is not new news.

But consider for a minute that somewhere’s between 6 and 50 million people (Haugen tells us to read that as MEN) pay for sex each day. Remember that buying sex is likely supporting violence (pimps, prior sexual abuse, etc.). Look at the problem of sexual violence a different way–the percentage of men who have EVER paid for sex ranges from 15 percent to 85 percent (depending upon the country).

Sit with that number for a bit. You want to stop sexual violence? Yes, we need law enforcement willing to investigate and charge sex offenders. Yes, we need a judiciary system willing to provide justice through convictions and sentencing. But, if we really want to stop sexual violence, we have to deal with demand side of the equation.

Trauma the Multiplier of Violence and Poverty

Gary’s book addresses some of the colonial roots of violence in the developing world (i.e., government and law enforcement built for the ruling/colonial class, not for the local population). While I have not finished the book, I’m wondering about how he sees the impact of trauma on this whole problem. As most recognize, traumatized people tend towards learned helplessness and thus are much more vulnerable to future violent acts against them. And Haugen acknowledges this problem, if briefly (pp 105-106). He identifies the fact that “unrestrained violence” leads to traumatic reactions that will hinder the capacities to take advantage of available resources.

While all true, the problem of trauma is likely causing problems not just for the vulnerable poor but also effecting the entire system (police, judiciary, and government). Trauma often causes individuals to stop thinking of the future. Instead, individuals make impulsive, self-protective decisions that may hinder future opportunities (e.g., drug use stops triggers but harms future health). The same can be true of systems (bribery to survive now, but destructive to safety and stability.

The book ends with a number of ways to address the problem of global violence so make sure you read to the end. But I encourage you to think about ways to respond to BOTH trauma and faith deficits. Check out the work the Trauma Healing Institute as an example of grassroots, lay level response to these two problems.

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What is Global Trauma Recovery Institute all about? Check out this video


At the beginning of 2013, Biblical Seminary launched Global Trauma Recovery Institute to train recovery specialists here and around the world. We’re small but thus far we have taken 20 students through 120 hours of continuing education, another 15 have just begun, and we are now preparing some of those first students to travel to Rwanda to observe and participate in trauma recovery training with local caregivers. Those students we serve are from or located in three continents plus the United States. In addition, we have represented GTRI in trainings in South Africa and Rwanda this year as well as engaged Christian counselors in Romania during one of their trainings. Our hope for 2014 includes more of this kind of training as well as our first immersion trip with students. Think we are just focused on the international scene? No! The “abuse in the church” video on the right hand bar of this site was sponsored by GTRI as well.

Maybe you wonder what we do and how we handle cross cultural challenges. Check out this short 3 minute video below to see our (myself and Diane Langberg) heart for raising up capable recovery specialists here and around the world as they follow Jesus into the world.

Want to support? After viewing the video, please consider supporting us with prayer and even tax-deductible donations. If you do choose to donate, this link will bring you to a donation page. You can give to the seminary’s general fund (without their support, GTRI would NOT exist!) or you can give a specific gift to GTRI. Just note that in the comments section. Your gifts will enable us to serve more international students and to begin the formation of learning cohorts on other continents!

[Note: Link on image is broken, click here to see the video]

GTRI Video Image1

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Revisiting trauma healing and recovery words


Some time ago I published a blog considering which words communicate a person’s process of recovery after a traumatic experience. The faculty blog over at http://www.biblical.edu has posted an edited (and better reading!) version of that blog. If you are intrigued by the way particular words shape the meaning and description of change, click here.

What words would you use to describe the process of recovery from a traumatic experience? Trauma healing? Trauma Recovery? Do these words convey an ongoing process or a completed task. Read more if you want to consider another word: integration–the concept of developing a new normal.

 

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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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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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Study Global Trauma Recovery Online!


Dr. Langberg and I are forming our next cohort interested in studying global trauma recovery principles and practice. If you have thought about getting such training, now might be a good time! Check out this link to our website where you can find descriptions/objectives of courses in the series as well as application materials (see links on the right of the hyper-linked page)

 

If you aren’t sure about doing the whole series, just try our introductory month-long course. You can get graduate credit gtc-logoor 40 hours of CEs for just $500. Here’s a few more details:

 

 

  • CEs are NBCC approved
  • Class runs November 9th to December 14th (time off for Thanksgiving)
  • Workload is about 10-12 hours per week (readings, discussion boards, brief response papers)
  • 4 required live 1 hour web conference to discuss material with the professors
  • Focus of the class is to explore psychosocial trauma in international settings

 

 

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When trauma isn’t “post”?


Over the last year or so I have been doing some thinking about those experiencing ongoing trauma. We talk of PTSD, Post-traumatic Stress Disorder, as a set of symptoms experienced after a traumatic event or time. But some people continue to live in ongoing trauma. I’m reading James Fergusson’s The World’s Most Dangerous Place: Inside the Outlaw State of Somalia. Early in the book, he talks of seeing “Sister Mary, a warm-hearted big-bosomed Ugandan in combat fatigues, dispensing medicines from a table in the ruins of the villa’s kitchen.” (p. 45). Sister Mary explains that there are two medical problems she sees. The one she treats most often is diarrhea. But, she says, the other problem she could not treat,

The people here are stressed, she explained. They are traumatized. They do not know where to turn.

You talk a lot in the West about PTSD-Post-Traumatic Stress Disorder…but for these people there is no “post”. The trauma never ends.

What can people do when trauma isn’t post? Do they have to wait until the traumatic experience is in the past in order to deal with it? What can we do for others who remain in precarious and life-threatening situations? A friend raised this question when working with a group of refugees in a UN temporary camp. Some of the suggestions that were given this friend

1. Helping refugees find some way to hang on to small measures of empowerment: set up classes for children, build huts for those who are just arriving, develop “positions” for adults to fill so the camp runs smoothly and has a modicum of safety.

2. Reinstate religious and cultural traditions where possible

3. Practice corporate lament along with other worship activities

4. Allow people to tell as much story as they wish, whether by voice or artistic rendering

Notice that these are finding ways to cope by (a) making the moment better and (b) bearing witness, even if they can do nothing about the crisis. When a person feels some level of ability to respond to a difficult situation, that person often experiences less trauma than those who are unable to express any agency. Further, when they feel that they matter to others (someone listened to whatever they had to say), they tend to have less long-lasting PTSD symptoms.

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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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Abuse in the Church: Pastoral Responsibilities, Ministry Opportunities


This afternoon I will be speaking to pastors, ministers, elders, and key ministry leaders of the Bible Fellowship Church denomination at their annual conference. Their website states they have over 65 churches and over 10,000 in worship on a given Sunday.

It is a wonderful opportunity to talk about a difficult subject: abuse in the church.

We would like to believe that it happens elsewhere. But the church is not free from those who would harm children. The church has never been free from matters of abuse. The Apostle Paul takes a church to task for putting up with what sounds like abuse and incest. Thankfully, the evangelical church is waking up to the need to educate leaders about sexual abuse and how to care for both victims and perpetrators.

If you are interested in seeing what I will be talking about, here’s the slide show: Abuse In the Church

NEED MORE RESOURCES?

If you are new to this blog, use the search engine to find many other posts about preventing and responding abuse in the church. Or, click the image to the right for a 5 plus hour DVD on this very topic. Or check out www.netgrace.org for excellent resources and help on dealing with abuse in Christian settings.

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