Tag Archives: trauma

May 5, 2009 · 5:54 am

Rwanda!


My on again off again trip is now on. I have tickets and yesterday I got my shots! Our small group of psychologists (4) will be leaving on June 22 and returning July 1. We will be going as the guests of the Right Rev. Alexis Bilindabagbo, Anglican Bishop of the Gahini diocese. You can learn a bit about him here.

We will be meeting with pastors, government officials, victims, and perpetrators of the 1994 genocide. Our goal is to immerse ourselves into the culture to learn how best to provide trauma training and counseling education at the graduate level for pastors and key leaders of the church right in Rwanda. While we know quite a bit about trauma and counseling training, we wish to avoid the mistakes of assuming we know best what this particular people need and what works within their cultural milieu.

I hope to be able to give you more details as the time approaches and to blog from Rwanda when I have Internet access.

FYI, each of us are paying our own way. Some donors at Biblical Seminary gave generously to underwrite a small portion of the trip. Further, the American Association of Christian Counselors is helping to sponsor this trip. So, if someone wants to give to the trip, I’m sure we can find a way to provide you a receipt for tax purposes :). Email me at pmonroe[at] biblical [dot]com and we’ll figure it out.

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August 14, 2008 · 5:28 am

Birth trauma? Maternal PTSD?


The August 5, 2008 Wall Street Journal ran a short article on a new postpartum illness akin to PTSD. The author, Rachel Zimmerman, reports that though”PTSD is commonly associated  with combat veterans and victims of violent crimes, but medical experts say it also can be brought on by a very painful or complicated labor and delivery in which a woman believes she or her baby might die.”

While Postpartum depression has received more attention of late (the paper reports the NIH statisticof 15% of mothers affected), there is some speculation that as many as 9% meet criteria for PTSD, and most of these who have given birth to children with serious and immediately life-threatening health issues. These find themselves re-experiencing the traumatic birth, avoidance of places that bring these flashbacks up, and persistent symptoms of increases arousal and hyper-vigilance. Per the article more states are now trying to screen and/or education new moms to this problem. NJ requires all mothers to be screened for depression prior to discharge.

As an adoptive father, I recall well the anxiety and hyper-vigilance of bringing home our first child when he was 4 days old. I didn’t sleep for days, or so it seemed. I worried about his breathing. I felt like I had lost my independence for the rest of my life (I was the stay-at-home dad at the time). It was an overwhelming time for us. And we were healthy, he was healthy, and we were not recovering from the trauma of even a normal birth.

So, I can well assume that if you add all of the normal birth trauma plus medical crises, helplessness, etc. that these experiences can result in symptoms like PTSD. I would suspect, however, that for most people these symptoms would dissipate quickly, especially if the medical crises passes in a day or two. So, we should be careful not to overreact to transitory symptoms and medicate everyone with a struggle. If it is PTSD, then the symptoms should persist for more than a month.

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Filed under Anxiety, Depression, Post-Traumatic Stress Disorder, Psychiatric Medications, Psychology

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July 11, 2008 · 5:00 am

How do you listen to people’s problems all day long?


This is a question we counselors get from time to time, especially when someone is embarrassed that they need a counselor or think they shouldn’t be having problems (or that they are weak for having them).

Today in staff meeting we watched a video on vicarious trauma. This term has been mis-identified with burnout and secondary trauma. In short it isn’t about our symptoms or having our own trauma but about the changes in us after taking in large amounts of other people’s pain.

Individually, hearing any one person’s problems isn’t much of a burden. But when you add all together it gets heavy at times. What do I mean? Well, we begin to see danger of abuse everywhere. We begin to think that all leaders are abusing power. Interestingly, one of the speakers on the video said that early career therapists tend to struggle more with fears and later career therapists struggle more with cynicism.

Most of the problem is the result of the loss of hope. And yes, therapists sometimes lose hope. That is why we have staff meeting so that we can remember that hope comes not from our ability to change the world but that we fallen creatures look to the power of the cross to change us and our clients.

I’m not sure what nonbelieving clients hope in and how they manage living with the weight of the brokenness in the world.

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March 17, 2008 · 1:02 pm

Science Monday: Perpetrators have PTSD? New connections between attachment and PTSD


Unfortunately, many people experience violent or near death experiences. Some of those folks go on to have symptoms fitting the diagnosis of Posttraumatic Stress Disorder (PTSD): intrusive memories/flashbacks cause them to reexperience the event coupled with attempts to numb themselves in some way and yet still finding themselves in a heightened state of vigilance all of the time.

Since the Vietnam War, we’ve learned a lot about this set of problems. The primary forms of treatment touted now are controlled and imaginal exposure to the traumatic event(s) coupled with relaxation, distraction, and cognitive reframes. And we continue to learn about the presence of PTSD in violent family dynamics as mentioned last Monday (3/10/08).

But here are two articles pointing to somethings I hadn’t thought much about:

1. Perpetrators of violent crimes sometimes experience PTSD from their crimes. A group of English researchers did a study of 105 prisoners who had committed intentional violent crimes. 46% experienced distressing intrusive memories (one aspect of PTSD) and 6% met criteria for PTSD. The more antisocial the criminal before the crime, the less likely they would actually experience distressing intrusive memories. So, those who are most uncaring don’t really struggle with these problems. Here’s a question: should you try to help perpetrators with their distressing, intrusive memories? Does having them lead them to be less likely to re-victimize? Or do they make them more distressed, more hypervigilant and therefore more likely to attack?

Biblio: Evans et al. (2007). Intrusive memories in perpetrators of violent crimes: Emotions and cognitions. Journal of Consulting and Clinical Psychology, 75, 134-144.  

2.  Why is it that attachment literature and adult PTSD from child abuse literatures have been separate? Stovall-McClough & Cloitre of NYU ask this very question and review the literatures from each area. Attachment literatures come out of developmental theories while PTSD research tends to be CBT based. But the two are quite connected. Consider the authors points:

  • “As many as 48-85% of survivors of childhood abuse show a lifetime prevalence of PTSD…”
  • “As many as 80% of maltreated children [are] classified as [having a disorganized attachment pattern]…”
  • “…the theoretical mechanisms underlying the expression of both PTSD and [attachment problems], although developed separately, are notably similar.” How so? Both see powerful events stored in the mind that shape one’s sense of self and the world. Powerful and negative events are avoided in an “effort to contain the intensity of emotions triggered by attachment injuries or traumatic events
  • “When traumatic events are kept locked away or otherwise chronically avoided, the result is often long-term struggles with PTSD symptoms and ongoing fragmentation of memory and fear-related belief systems.” 
  • Both unresolved attachment problems and PTSD lead to dissociative and intrusive self-focused thought patterns
  • Unresolved childhood attachment problems (as opposed to secure or dismissing attachment styles) may predict PTSD in adults
  • Avoidance strategies which help the individual manage distress from the abuse may, in fact, increase emotional distress and cognitive disorganization. This is sad in that those best able to divorce themselves from those early experiences (which may protect them as a child) may set themselves up for the most pervasive PTSD. I suspect that avoidance strategies hinder the person from being able to carefully evaluate themselves in a clear and helpful manner. Thus at a later point when they can no longer avoid, they have little sense of self to use to understand their place in the world.

Biblio: Stovall-McClough & Cloitre (2006). Unresolved attachment, PTSD, and dissociation in women with childhood abuse histories. Journal of Consulting Psychology, 74, 219-228.

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November 2, 2007 · 2:29 pm

Women, victimization, & fear


Sarah Lipp (HarvestUSA, Chattanooga, TN office) gave a presentation with the above title. Her focus: What is the experience of women victimized by men; How do such women relate to God as a male being? She started us out with a review of the kinds of victimization experienced (abuse of all kinds (including nagging for sex and/or punishment for not being willing to give more), dehumanization, oppression rooted in the inherent power in masculinity, distortion of the image of God that of females (being treated as only sexual or only trouble). She gave just a couple of stats from the CDC. 18% of women are raped in their lifetime. 51% have been abused. Of those raped, 83% are raped prior to age 25 and 54% before age 18.

So, how do we help?

1. Affirmation. Permission to feel upset and victimized. What happened was wrong. She needs permission to define what happened and own it (name it for what it is). Educate about the patterns and symptoms of past abuse as they impact her life now. Educate on how abuse effects the brain (especially the amygdala’s work in generalizing emotions from the past to present situations).  Yes, the brain is plastic and can be changed but it may be that triggers remain. Teach on PTSD symptoms (re-experiencing, avoidance tendencies, increased arousal). Teach that she is not alone but 40 million others also fit these criteria.
2. Explore how this impacts her experience of her earthly father and males in general (and as a result God). What reactions does she have when she thinks of words such as man/men, daddy, father, husband, etc. What did she learn about herself and men from her family, from her community, from her church, her culture? What has she come to believe? Sarah says that the danger for counselors is to try to fix it. Tell them to think differently. Have compassion
3. Healing gender images. One of the images God gives of himself is female. Sarah isn’t arguing for a feminine God. However, she lists Mt 23:37, Is 51:12, Psalm 131; Acts 9:31; 1 Cor. 1; Isaiah 66:13 as images of the feminine side of God. God images himself in male AND female. Therefore, Sarah argues for starting with (not stopping with) some of the female images of God to see that he cares for her desires and needs as well. God does give maternal pictures of himself and these may be good places to start. To do this, you may have to explore what images she has of women, mothers, feminine. Healthy relationships with same sex members will help here. Once here, you will also need to heal the masculine images of the world and of God. Male is redeemable. This may take a lifetime of relationships with men, 1 at a time.
4. Grief & Redemption. Now that she is not living in denial, she will begin to grieve dashed or unfulfilled desires.  Sitting with the realization of the loss of love and men and women are fallen. This moves us to the possibility of redemption and the transforming power of Christ in men.
5. Dealing with the here and now. How does she discern her past from present. Begin re-writing her story and rewriting facts and feelings from her present perspective. This re-writing actually does change the brain and reduce traumatic fear. Counselor and counselee co-construct a new narrative and speak back into flashbacks. Her re-written story speaks into those flashbacks and in doing so mentally pictures something different. She is free to walk away from that flashback.
6.  Coping with past in constructive ways. Address the destructive means. Yes, repentance necessary but be aware of the body’s impact (look up info on the Endorphin Compensation Hypothesis (ECH) as why many become addicts). Work to avoid seeing destructive patterns as only sin or only body.

Healing must also include faithfully embracing Christ and her vulnerability as a woman.

Suggested reading: Brenda Hunter’s, In the Company of Women; Louis Cozolino’s, The Neuroscience of human relationships.  

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