Posttraumatic stress disorder

The choice to be a patient

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I have just been on two course-days about dissociation, and was happy when I discovered a news-letter from ESTD (I am a member now). There I found the following post about how hard it is to become a patient dealing with abuse. I have so much respect for people who want to live a better life after abuse, since this is no easy task. I hope this can be a reminder of just that

Nina

By Esther Veerman

THE CHOICE TO BE A PATIENT

Being a therapist for patients with chronic childhood abuse and neglect needs a conscious choice. Not a lot of colleagues will do the same, and sometimes it is quite a lonely voyage that one starts to make. Becoming a patient with a history of chronic childhood abuse and neglect demands a conscious choice as well. It is not logical to start exploring the traumatic past, once a survivor has learned to avoid the memories of the same. And in the field of psychiatry, it is not easy to find the help a survivor so desperately needs. Often it takes many attempts to find good help over the years. And of course, courage to keep looking after a lot of disappointments. For me, it meant that I had to decide to take on the role of a patient, despite my aversion to this role. Of course, I rather wanted to be a helper instead of the one needing help. Maybe I can explain some of my struggle in this, in order to help the helpers understand some of the dilemmas going on in (future) patients.

Being a patient of severe childhood trauma is a choice I had to make 20 years ago. I was young, still busy studying theology, Give upand wanted a normal, happy life. Weird things happened to me every once and awhile. During a lecture on psychology, when a movie was shown, I started to feel really sick. I had immense chest pain and feared I would die. Nothing was the matter with me, and I did not remember what the movie was about. And sometimes a horrid thought would come into my mind that, when I would have children, I could hurt them. Once I realized this thought and fear, I decided to seek for help. I would never want to have a child if I could harm it.

It took a lot of courage for me to look for psychological help. I did not know what was the matter with me. Sometimes I stumbled upon little words: there is something with my father. But I did not understand the content of these whispers. One of my mentors listened to these words and asked me the reason why I spoke them. I was too scared to remember, and so he sent me for the first time to a psychologist. Within two or three sessions, in which I was not able to tell about the images and fears in my head, the psychologist decided to bring my father into therapy and ask for reconciliation. For me, this was a message to (again) keep my mouth shut. For some time, I succeeded in doing this. My system collapsed when I gave birth to my son. During and after the delivery of the baby I re- experienced rape intensely. I fell into a dissociative psychosis in which I experienced incinerated hands and bodies, who raped me constantly. I tried to stay at home, take care of my son, even breastfeed him, until it seemed I had no choice but to listen to the doctor and get hospitalized into psychiatry. It was a complete nightmare to be hospitalized. I was extremely anxious, did not understand my own behaviour at all, but the psychiatrist said I have a hysterical personality. I went home and got hospitalized for a second time. The next psychiatrist thought I had PTSD, but could not believe that the symptoms I portrayed belonged to trauma. I could collapse for example, in a split second. It happened at the table when all the patients had dinner, or worse, in the shower. One time I collapsed in the hallway of the psychiatric ward, and later I heard, that the psychiatrist stepped over me, and said: she is just overreacting.

Years later, when I was hospitalized in a psychiatric hospital, I was shocked and felt humiliated by the bad conditions we had to live in as patients. I learned to check out the refrigerator before eating, to look at the dates of the meat and cheese that was in there for the patients. A lot of the food was out of date date. And when a lamp, or tiles in the bathroom were broken, they were not fixed. We had to live with ten patients on a very small ward, and the staff would sit in an office with the door closed. If something bad happened, like aggression between patients, most of it was not seen by the nurses. Sometimes patients hated each other, mostly because they were scared or aggressive in themselves. For example: a patient hated me kbecause I had screamed out of fear, and she thought I had reacted to her. So when I went to the bathroom, she would come in and vomit, so that I could not wash my hands in the sink. Another patient who was known to be highly aggressive, would throw chairs at me as I wanted to pass by. Nothing was done about this. Two times, I was locked away by “accident”. On one occasion I had permission to draw and sat in a room all by myself. I got re-experiences and hided in a corner of the room. A nurse came in the room, thought it was empty and locked the room. They did not miss me for hours. Another time, I had an appointment to talk with a nurse, she went away to answer the telephone and I again, hided in a corner, because I was so scared. After a long time, another nurse came by and locked the room. She did not come back for talking to me, she did not remember I wanted to speak with her. Another time, when I was hospitalized with serious suicidal feelings, I got away, and went back to the ward, very suicidal, and laid down under my bed, and for one day and one evening, nobody had missed me, or looked for me. I had not eaten and drunk and nobody had thought about speaking to me. 

Every time I came home, after hospitalization, I was worse than before. As I described before, for me it felt humiliating to be hospitalized. It was almost impossible to keep my dignity in those periods of time. Sometimes I did not even feel human anymore. We had to ask for everything, the medicine (we had to stay in a line to receive them), the food, going out and getting back to the ward. It felt really degrading when all the power was taken off from me. One can say, maybe I was not able to take care of myself anymore. But many times, I felt that what I wanted to say was not heard at all. Of course, in those periods of time I could not express myself so well. That is true. But when people are not willing to listen, talking becomes extremely difficult. Maybe it is dangerous to say, but I think psychiatry felt for me like the environment I lived in as a child. Neglect, silence and disrespect.

But I never stopped fighting, all those desperate years. I realized that I would not survive much longer (I was highly suicidal over the years) and I tried one more attempt at getting the right help. I looked on the internet and found information about trauma therapy and dissociation. I emailed for second opinion and received this. It turned out I suffered from DID. The trauma therapist I spoke to, asked me to register myself for trauma therapy. For 6 years now I’ve been in trauma-therapy. I feel I am taken seriously now, in my desperate search for healing and the question I have asked for all of those years: help me through the nightmares and re-experiences.

deepfear1af881a91b94cc8cReading this, one can think that I had no choice but to be a patient. On the one hand, this is true. My life was falling apart and I would not have lived, if I had not been hospitalized and taken care of. On the other hand I had to decide to want to learn how I could get away from what haunted me. I have always wanted this. Already during the first hospitalizations I begged to be heard and for guidance to get out of trauma land. This was not honoured at all. Therapists and psychiatrists thought what was right for me. Many times they said that I had to stabilize, but it meant literally loads of sedative medication, and nobody asked me what had happened to me in my childhood. I was allowed to write my own treatment plan, but it was never honoured what I asked for in those plans. I felt more and more humiliated and thought I was really stupid.

After all these long and devastating years with more traumatizing events, the trauma therapy I am receiving (now for 6 years) now makes sense to me. For the first time a therapist explained to me what was going on in my head, with the distinction between Apparently Normal Parts of the Personality and Emotional Parts of the Personality, and their functions, inner dynamics and systems. I learned to distinguish parts within my head and body, who carried daily life (being a Mom, a Partner, one part who was always busy with music, one 8 year old, that had never grown but handled things in daily life; and scared little children in side of me, some freezing, others running away, some parts who seemed to copy the perpetrators etc. and some occupied with sexuality). Together we started to explore what was living inside of me. I did not dare speak anymore, because so many times I heard that what I told was not valid, or that a therapist would not believe me and from my childhood on, to shut up. So, I hardly could find words to describe all that was inside of me for all those years.

This asked a lot of patience from the therapist. Patience and boredom perhaps. This required from me a high standard of courage. To try once more, once more, to speak the words that frightened me the most. In one of the first sessions the therapist asked me: “Esther, do you want to change?” I said: “Oh yes, I do want to change, I just do not know how.” For me, this question of the therapist was very important. I realized, when I wanted to overcome all those years of trauma, I would have to be able to change, and not stick to my Disorder. Of course, I was intensely scared to do so, but I chose not to stay the same anxious twisted person I was. At that time, I had absolutely no clue of my future. I so much lived in trauma time, that everyday life was a challenge in itself, let alone that I had an understanding of the future. From the first session on with this therapist, I mirrored the perpetrators in his face. I told my therapist over and over again he was authoritative, and I was extremely scared of him. After a period of time, he asked me, if I thought he was my father? When I realized he was right about this,I calmed down a bit. In the years that followed I realized more and more, how much I projected on my therapist. I tried to accept inside of me, that the inner parts of me where doing this. I came to an understanding that the reliving of the trauma was necessary to overcome the same. This way I sat in therapy with my hands over my face for five years. Many exercises with looking around, and trying to look in the eyes of the therapist were necessary to overcome this huge stumble block.

When the sexual abuse was addressed, even more projection came into therapy. One of my biggest fears was that the reliving of the trauma would actually take place between the therapist and me. But instead of being silent about this, I chose to speak out, that I thought sex would take place between us, and I let my inner children react as if in the situation of rape, in the way they must have reacted in the situation they were in as children. I was convinced one day it would go wrong between the therapist and me, and I heard my inner voices come out and even ASK for sex. I knew, that my therapist had all the power to be able to abuse me (again), but he always took care of me and protected me, by staying consistent and calm. I had to get used to the feeling, that, although my therapist had more power, he would never use his power in a negative way, but only to help me forward.

wingsBecoming a patient was a difficult and courageous choice. I had to understand and realize that the problems I tried to avoid could not be solved on my own. I believe that I would have been helped from the very beginning to be grounded in my autonomy if I had met the right mental health professionals. In psychiatry I met so many people who seemed persons without the possibility to think for themselves, but I think this is not really true. A lot of problems that they create stem from their taking over the ability to think and decide what is best for a person called the patient. Like being a patient is a choice (one can chose to die, or to do something about it) and healing is the next choice to be made by a patient. But I believe here a therapist can be of tremendous help. A therapist can start to explore the possibilities and strengths of the patient and work together exploring the landscape of healing. Being a patient in itself can bring the key to healing. For the therapist the challenge is to find and guide the patient on this road.

Esther Veerman is founder of the Foundation Art out of Violence (www.artoutofviolence.com) She lives in the Netherlands, is a theologian and an artist.

Welcome, Mr Anxiety. Feel completely relaxed

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Have you ever been afraid of the dark?

You’re Not The Only One

Anxiety disorders refer to a high prevalence group of problems, which include excessive levels of fear and anxiety. Anxiety is a normal reaction to stress, threat, or danger and often serves us well. It enables us to deal with threatening situations by triggering the fight/flight response so that we can take evasive action. However, it is when this response is persistent, excessive and interferes with our functioning in daily life that it is referred to as an anxiety disorder; at this point a psychologist or counselling service may be required.

  • Excessive Worry/Generalised Anxiety: This is characterized by excessive anxiety and worry lasting 6 months or more. It is accompanied by central nervous problems including bodily tension, restlessness, irritability, fatigue, poor concentration and sleep disturbance. Worries usually relate to education, work, finances, safety, social issues and often minor issues such as being on time.
  • Social Phobia/Social Anxiety: Persistent fear of situations in which we are exposed to possible scrutiny of others, such as public speaking engagements, social gatherings or communication with the opposite sex. This form of anxiety elicits fear of intenseElettroshockfinalsolution_by_LucaRossato_flickr panic in such situations and avoidance of or escape from social environments
  • Panic Attacks: This form of anxiety can manifest in sudden, intense and unprovoked feelings of terror and dread often culminating in heart palpitations, dizziness, shortness of breath and an out of control or very frightening feeling. When we suffer this disorder we generally discover strong fears about when we might experience the next panic attack and often avoid places we feel we might have a panic attack or where escape may be difficult such as movie theatres, shopping malls or social gatherings.
  • Obsessions and compulsions which are characterized by persistent, uncontrollable and unwanted feeling, thoughts or images (obsessions) and/or routines or repeated behaviors(compulsions) in which individuals engage to try and prevent or rid themselves of anxiety provoked by the obsessions. Common themes through compulsions may include repeated actions such as; washing hands or cleaning the house excessively for fear of germs or checking something over repeatedly for
    PTSD
    PTSD

    errors. When we are caught in the cycle if obsession and ritual our lives are constrained and our time otherwise used for living is consumed.

  • Post Traumatic Stress: Witnessing or experiencing a traumatic event including severe physical or emotional trauma such as a natural disaster, serious accident or crime may expose us to the risk of post traumatic stress. Post Traumatic Stress can be characterized by thoughts, feelings and behaviour patterns that can become seriously affected by reminders of events, recurring nightmares and/or flashbacks, avoidance of trauma related stimuli and chronically elevated bodily arousal. These reactions mat arise weeks even years after the event.

Anxiety treatment at Sydney Emotional Fitness also covers specific phobias, a related disorder to Panic. Specific Phobias involve marked, persistent and intense fears about certain objects or situations. Specific phobias may include things such as enclosed spaces, encountering certain animals or flying in airplanes. Exposure to the feared situation or object usually elicits a panic attack leading to a tendency to avoid the feared object.

For all information about Anxiety TreatmentPsychologist CounsellingAnger CounsellingGrief CounsellingAnger ManagementRelationship CounsellingStress Management and Depression Treatment in Sydney, or any of our services that may assist you in leading a more rewarding life please call us on 1300 790 550.

How we remeber, and how we forget: Trauma, denial and dissociation

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How We Remember and How We Forget: Trauma, Denial, and Dissociation

I “forgot” a good part of my life.  I “forgot” the 3-6 months I spent in foster care, the events that led up to it, and the intense grief of being returned to a biological family I felt no connection to.  I “forgot” being trafficked for sex by my own father.  I “forgot” being placed in a freezer, tied to a wall in the dark in the garage like an animal, and forced to hang myself.

For a long time, I “forgot” about appointments, bills, and things I had done and said within the last 24 hours.  Sometimes, I still do.

I know a lot about forgetting.

Since then, I’ve been working at remembering.  I know a lot about that too.

A diagram of a neuron.

We remember information, experiences, and ideas because there are robust neural pathways between them.  If I am trying to remember a person’s name, I will most likely start with a piece of information that seems like it will lead me there: the face, trivia about the person, our last conversation.  If I am really intent on remembering, I will continue to dredge up these bits of associated memory until I am able to locate it.  So, the more connections we have between something we want to remember and other things and the more robust those pathways, the easier memory becomes.

Neural pathways become faster and more efficient with use.  When we stop using a particular pathway on a regular basis, it becomes less robust, slowing us down when we try to use it.  We may not “forget” information so much as lose the connections that allow us to find it.

I suspect that denial and dissociation both affect memory because of how they impact the neural pathways between parts of a memory.

Both the cortex and the limbic system are involved in memory formation. The amygdala, in particular, plays an important role in emotional memories.

In the case of dissociation, I speculate that the lack of robust neural pathways occurs at the time of the event.  Sensory impressions, thoughts, and emotional reactions are recorded, but with very little connection between them.  Whether this is because the brain functions that create order and connectivity are suppressed during traumatic events or because the parts of the brain involved in forming memories during life-or-death situations are different and don’t form connections as well, I’m not sure.

But I am sure that it happens because of how my own memories arise for me.  A major part of working through the trauma I’ve experienced has been simply finding things and putting them together–connecting pictures to words, declarative knowledge to sensory impresssions, physical responses to my knowledge of feeling states.  I “remember” nearly everything significant that has happened to me, but when I first began to work with them these memories stood in no particular order and in no relation to one another.

How the events were recorded in my mind in the first place has something to do with this.

Now, I know that the general wisdom is that we suppress trauma because we are trying to protect ourselves from the knowledge of what happened until we are in a position to deal with it.

I don’t entirely believe that.  I don’t think the memories are difficult to locate for the sole reason of emotional self-protection.  Partly, yes, but not entirely.

At the time of the event, we shut down certain types of awareness for two reasons that really come down to physical survival: one, we do this in order to suppress an awareness of physical pain so that our reactions to pain don’t interfere with doing what we need to do to survive.  Two,  we do this because conscious thought is the slow-track to action, and if we engage in it we could be killed before we’ve even come to a decision.  Much better to think like a lizard and just run away.

It is this state of suppressed conscious awareness that limits our ability to form connections between parts of a memory.  If a traumatic event is extremely intense, or if we have a lot of experience with being traumatized, touching on one aspect of the memory can re-start the process of suppressing conscious awareness, and our brains remain unable to form connections.

That is what PTSD looks like.  Elements of a memory are triggered, but instead of this access to the memory allowing us to form robust connections between parts of the memory, the connection is instead formed to whatever processes are involved in dissociation.  The more this happens, the better we get at dissociating as the pathways involved in dissociation get more and more robust.

But we may never figure out why red sweaters scare the bejesus out of us, or what happened after we put one on.  We may never link the scratchy feeling of the sweater with the color, or with the queasy feeling in our stomachs.  Not because we are avoiding that connection, but because we are busy doing something else.  We aren’t trying to protect our psyche.  We are trying to protect our bodies, and our brains don’t know that they can stop.

Denial, on the other hand, can lead to a kind of deliberate forgetting.  Every time the memory is accessed, we shift our attention away from it.  (For why, see Unsolicited, Bad Advice.)  The connections are there, but we train ourselves not to use them.  With time, the connections become tenuous, weak, frail.  They may break altogether.  The memory then becomes suppressed.  It is there, but we no longer know how to find it.

In dissociation, there may not be enough connections to the memory or between parts of a memory to start with.  In denial, we can intentionally remove them.

In the case of childhood trauma, the family can aid in this.  Children remember events partly because others in the family rehearse what happened with them later on.  Those pleasant sessions of “Remember when…?” reinforce and strengthen neural pathways between the details of events.  They also help children construct comprehensible narratives of what may be more fragmented impressions.

When traumatic experiences occur in the family, members often actively avoid doing this.  The message implicitly or explicitly stated may be that it would be better to talk (and think) about other things.  Without those rehearsals, children lose the connectivity between traumatic events and the rest of their lives and may have trouble accessing them as adults.  Or they may be able to access them, but assume the memories were simply bad dreams or the products of a fertile imagination.  The memories may not seem like memories because no one else seems to have them.

In cases of family abuse, both mechanisms involved in “forgetting” can work to “repress” a memory.  Elements of memory start out disconnected and isolated because of the functioning of the brain in the midst of trauma, and the connections that are there can become disused, slow, and inefficient because of denial within the family that means those pathways are deliberately avoided.

No wonder I feel like I’m giving my brain an extreme home make-over–cleaning, organizing, and re-designing.

Further reading:

The Brain Athlete. (2012)  Brain Plasticity Forms Who We Are.  Retrieved from: http://www.brainathlete.com/brain-plasticity-forms/

—-Neocortext and Not Hippocampus May Form Memories.  Retrieved from: http://www.brainathlete.com/neocortex-hippocampus-form-memories/

How to Forget Unwanted Memories.  (2012, October 20).  Medical News Today.  Retrieved from: http://www.medicalnewstoday.com/articles/251655.php

Plasticity and Neural Networks.  Canadian Institutes of Health Research.  Retrieved from: http://thebrain.mcgill.ca/flash/d/d_07/d_07_cl/d_07_cl_tra/d_07_cl_tra.html

Posttraumatic Stress Disorder Factsheet.  (2011, October 17).  National Institutes of Mental Health.  Retrieved from: http://www.nimh.nih.gov/health/publications/post-traumatic-stress-disorder-research-fact-sheet/index.shtml

 

Dissociation: Army of me

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I have written some posts on dissociation, and even if people might feel this song has nothing to do with it, it still highlights one fact about dissociation: Dissociation means that we have different parts with their own unique abilities, weaknesses and strengths. Aguilera sings about the strong ones, and together they make an army. You have the wise, strong and the fighter. The point is also that when you are one of them, the others are in the background. A “fighter” would be in that mode, ready for attack with all that means in form of thoughts, feelings and actions. When you go from one mode to another, you “switch”. We all do it, so it`s not as otherworldly as the word dissociation suggests.

Enjoy the song, your time and yourself.
 

wise

Lyrics to the song. Notice the “parts” she sings about in the chorus.

I’ve been standing where you left me
Praying that you’d come and get me
But now I’ve found my second wind
Now I found my second skin
Well I know what you were thinking
You thought you’d watch me fade away
When you broke me into pieces
But I gave each piece a name

{Chorus}
One of me is wiser
One of me is stronger
One of me is a fighter
And there’s a thousand faces of me
And we’re gonna rise up
For every time you broke me
Well you’re gonna face an army
Army of me

{Christina Aguilera}
Welcome to my revolution
All your walls are breaking down
It’s time you had a taste of losing
Time the table’s turned around

I see a glimpse of recognition
But it’s too late, yes it’s too late
And what you though was your best decision
Just became your worst mistake

{Chorus}

So how does it feel
To know that I beat you?
That I can defeat you ?
Oh. how does it feel ?

It sure feels sweeter to me

Army of me

Be fearless! We need every part of us
Be fearless! We need every part of us