On Trauma Counseling and Intra-generational PTSD

 

Am going to start including more on PTSD in this blog since many people seem to land here via that search term and I run across quite a few articles about it.

This affects you even if you have never encountered trauma or don’t think you know anyone who has.

One-off Trauma Debriefing

Psychologist Vaughn Bell, has written a piece for the Guardian, Minds traumatised by disaster heal themselves without therapy:Aid agencies that promote one-off counselling sessions after major traumas only prolong victims’ suffering and done a little follow up on his excellent Mind Hacks blog (in which he objects to the Guardian’s headline on his article as being somewhat misleading) Disaster response psychology needs to change

In his blog addendum he summarizes the article and corrects the headline:

Unfortunately, the article has been given a rather misleading headline (‘Minds traumatised by disaster heal themselves without therapy’) which suggests that mental health services are not needed. This is not the case and this is not what the article says.

What it does say is that the common idea of disaster response is that everyone affected by the tragedy will need help from mental health professionals when only a minority will.

It also says that aid agencies often use single-session counselling sessions which have been found to raise the risk of long-term mental health problems. This stems from a understandable desire to ‘do something’ but this motivation is not enough to actually help.

Disaster, war, violence and conflict, raise the number of mental health problems in the affected population. The appropriate response is to build or enhance high-quality, long-term, culturally relevant mental health services – not parachuting in counsellors to do single counselling sessions.

The World Health Organizations textbook Psychological First Aid:Guide for Field Workers [PDF] outlines best practices for assisting in trauma situations. They are against the “debriefing” methods:

WHO (2010) and Sphere (2011) describe psychological debriefing as promoting ventilation by asking a person to briefly but systematically recount their perceptions, thoughts and emotional reactions during a recent stressful event. This intervention is not recommended. This is distinct from routine operational debriefing of aid workers used by some organizations at the end of a mission or work task. (p. 3 footnote)

In the future we are all going to be “Field Workers” dealing with people experiencing trauma so that’s a good read to get some information. We’ve only just begun to recognize the effects of trauma. Additionally the likelihood of a relative or friend experiencing some kind of trauma is rather high. If that sounds a bit dire read on.

Intra-generational PTSD

Mother Jones had an article not too long ago on the effects of PTSD on the family. Is PTSD Contagious? It’s rampant among returning vets—and now their spouses and kids are starting to show the same symptoms.

If you have lived with anyone who has PTSD you know it has profound effects on relationships. You also know that some of the symptoms are “contagious”. For example if a person is constantly hyper-vigilant there is a tendency for others to start experiencing anxiety and having it manifest in similar hyper-vigilence. As well there is STSD-secondary traumatic stress disorder sometimes called Compassion Fatigue and/or Burnout, although I think both are serious misnomers and are too generic for specific STSD. Compassion fatigue and burnout are generally related to people who work with those who have PTSD or have been otherwise traumatized. STSD is not necessarily related to work and is more oriented to continuing relationships. Here’s a webpage about STSD in relation to veterans. Additionally there is a good page there on what is termed Secondary Wounding. Secondary Wounding occurs when people around don’t understand trauma and it’s effects. Mostly it’s due to people’s ignorance and wish to distance themselves from anything unpleasant. This is one reason we should all be “Field Workers” as I mentioned above.

There are certainly overlaps between all of these terms but I think there needs to be much better delineation in the psychological literature and much better explanations available to the public.

The effects of trauma are extended a number of ways. Dr. Joy DeGruy has begun research on the continuing effects that slavery has had on African-American populations. Here is one presentation of hers:

 

Post Traumatic Slave Syndrome can be categorized under both Historical trauma and Transgenerational trauma

This approach holds true, I believe, for other populations as well. Children of refugees and children of war for example. Or children of Holocaust victims and survivors. Or people who have been wrongly convicted or people who have been political prisoners or people who have been marginalized and scapegoated by their societies…it doesn’t end.

We cannot compartmentalize trauma to the directly affected victims only. This is a mistake many treatment modalities make. It affects everyone to some degree. Even if one is not a direct descendent nor had a family member involved in a traumatic situation (that’s getting ever more rare these days) we all interact with those who have experienced trauma so it is important that we become familiar with the effects of trauma and what we can do, in the first instance to mitigate that, and secondly to curtail the types of circumstances that brought about the trauma.

Attention Economy

 

"This article tries to vulgarise but fails. Too many assertions, too shallow, too generic. I am not sure what it achieves. I certainly not end up being more informed. True, the title is particularly appalling. Worthy of The Sun."

I read this comment on a link I posted on Facebook and I thought, does this person keep a list of generic comments that they can cut and paste into any article just so their name appears? It could fit into nearly any circumstance, doesn’t mention anything specific about the article and it even works as a self-reflexive criticism, that is it can be applied to itself.

Generic commentary. Mindless commentary.

I am noticing a lot more of this type of response as either reading comprehension is in decline or some impetus to comment, even if one has nothing of substance to say takes over. If I were to hashtag this Twitter-style I’d write #attentioneconomy

I Wish You Great Heartbreak

 

I have no mercy for a society that will crush people, and then penalize them for not being able to stand up under the weight.

~Malcolm X

Last night I watched an hour long documentary called War in the Mind. The full program is on the web so you can watch it too. It was about soldiers with PTSD and the consequences they face having participated in war. Some of the soldiers were young and newly returned, some were very old and still affected by the conflicts they participated in such as WWII, Korea, Vietnam and other places and at other times. I had an uncle who was in the Navy in the Pacific in WWII. For decades after he was a genteel alcoholic, and many years later he hung himself in his garage. No one really knew what PTSD was back then. Once you have an experience of any kind but particularly an experience of horror, you can never return to the world you thought you knew or to whoever you thought you were before. Experience is a one-way street.

This documentary stuck with me all day today. It kind of shook me up. Sometimes I enjoy being shook up or upset. Enjoy may not be the right word there…more like “do not turn away from” or accepting, although accepting is also not wholly correct since that which is causing the disruption is not something that is accepted passively and filed away. It is more accepting the fact of being shook up and the reactions that arise because of the content of the trigger. I find when I have the urge to turn away or compartmentalize “that stuff”, the content, into some corner that will allow me to be numb to it, then it is often at that time, if I allow it to continue, that a moment of recognition or connection is at hand. It is hard to be vulnerable to anything but especially to horror and other people’s pain.

These kinds of things were on my mind when I read a Twitter discussion about Islamophobia. The gist of it was Islamophobia was merely racist. That description “merely racist” is not meant to downplay the seriousness of racism, but to point out that there is more to it than that. There’s always more.

This was followed by an article in Mother Jones, America’s 10 Worst Prisons: Pelican Bay, which describes what is a monument to inhumanity where prisoners spend, literally, decades in solitary confinement. There are currently 1,500 in solitary there. Entombed alive for life. Think about that for a moment.

The reaction of people to these kinds of things is often unthinking. It goes something like “Well that’s OK because they are “enemies” or “criminals” or “illegal” or <insert dehumanizing label of your choice>”

There’s two main ways that these kinds of reductionisms are understood and dealt with. In the first instance the label is used simply to dismiss something or somebody we don’t want to deal with in any substantive way. That’s the most common. In the second instance it is a call to action. I have consciously been shifting myself into that mode over the years after being well-conditioned to using the dismissive mode. [We all are similarly conditioned.] When I find myself using labels, I consciously try to separate the behavior and the human being. I’ve used labels in a derogatory way. My set of labels include, “fascists”, “Americans”, “capitalists” and so forth. By adjusting some of my thinking, and some of my language, what I am discussing becomes fascist behavior and ideology, nationalism as an identity, capitalism as a system that influence people to act in exploitative ways, etc. It takes a lot more work to be more precise in this way but it also brings a certain amount of clarity to issues of social structure and behavior. One starts to see the bigger picture then.

So while the reductionism of labels can confine issues to small words it can also be used to see beyond them if one is willing to do the necessary work.

That was something of a digression but it underpins what I thought about after being exposed to those particular pieces of disruptive information.

On Twitter I wrote:

I don’t think Islamophobia is *only* about bigotry. There’s a whole lot of hegemony underneath it.

Also the notion of a threat of collective (Ummah) identity which intimidates those who highly value individualism above all else.

[Hegemony is] Not necessarily state sponsored. It is now more of a dominance at all costs by anyone (or generally a group)ie cultural, economic

PB [Pelican Bay] and other supermax prisons are an abomination. It’s like entombing people alive.

That doc I watched last night on soldiers with PTSD kind of shook me.

Mainly the part when some recounted looking at their "enemies" and realizing the people they killed were human.

Imagine looking at everyone dehumanized with labels like "enemy", "criminal", "illegal", etc as humans. Hearts would break.

I wish that great collective heartbreak on every person in the world.