Is mental illness an excuse for poor behavior? I came across this podcast episode and thought I would write my blog about this. Mental illness is more prevalent than it ever has been in our country. After listening to this podcast, I wanted to conduct a little research of my own, so I asked some of my friends, family, and co-workers the same question: Is mental illness an excuse for poor behavior? A frequent answer I got was “Lately I see it as trying to justify actions”. I found this pretty interesting. I actually see this as being somewhat true as well. I am not sure of everyone else’s opinion, but I think the media tries blaming mental illness before anything is factually true. A shooting happens and within minutes headlines on media outlets are “suspect was mentally ill”. To me this is taking away from the fact that the shooter did something horrendous. Yes, mental illness is a huge issue, but the context needs to be monitored on how the word is used. It is not a way to justify actions. In the podcast the podcasters use the example of a mentally ill driver has a seizure while driving crashing into another vehicle. Does the person suffering from the seizure have to pay for the damages? In the podcast, the girl says yes, and the male podcaster seems taken back like the answer should have been no. This is exactly why some might think mental illness is being used as an excuse for poor behavior. This by no means is me trying to be mean, but isn’t it the person with mental illness responsibility to make sure they are taking their medications and going to their doctors? The person who was just stopped at a red light should not be responsible for the damages to his car, am I right? We need to focus on health and responsibility when talking about mental health. Mental health is not something we can use to justify poor behavior. The person with mental illness needs to take responsibility. Avoiding responsibility will just make poor behavior become normal because they can get away with more if this is the case.
Delving into the dark catacombs of the human condition lends itself to the exploration of some of the most abominable crimes. Since the late 1880s, modern society began to grapple with the empirical construct of serial murder, demanding attention and insight in explaining its etiology in the criminological framework. A rudimentary understanding of serial killers has inexorably gained momentum and social significance because their attendant crimes both perplex and fascinate those in their periphery. Such illuminating examples constitute the heinous crimes of Jack the Ripper and Ted Bundy, who predated on multiple women and left a trail of horror behind. One may ask: Are there similarities in some of the underlying causes and manifestations of their crimes? Such a juxtaposition raises the specter of whether their crimes share commonalities involving the designation of a sex crime.
Attention to the predatory violence inflicted on the hapless victims of the Ripper and Bundy reflects an insatiable desire to engage in sexualized violence, perhaps stemming from immense feelings of emasculation, giving rise to a eunuch. In describing a sex crime, Caputi (1982) emphasizes a sexualized violence associated with the crime, whereby the target of the attack, the motivation, and the manner of violence are collectively relegated into the realm of “sexual,” within the cultural fabric. Thus, an ideology emerges to reveal a sex crime, conferring realistic and metaphoric significance (Caputi). In a quest for attention and infamy, Jack the Ripper sought women in the slums of London, leaving their morbid bodies on display, eviscerated and mutilated. Similarly, Ted Bundy would lure women into his deadly lair, killing them with no compunction, and dumping their bodies in remote areas to be scattered by ferocious animals. Told anew, these tragedies invoke a ritual, reflecting the perpetuation of entrenched cultural values. In this vein, the murderous ritual functions to align with the cultural universals of male dominance and patriarchy, should they be challenged.
Conceivably, this ritual allows those who manifest sexual violence to enact their dominance over women, and thus, dichotomizing the sexes into the structure of predator and prey (Caputi, 1982). This chasm, serving often as a linchpin for gender inequality, undergirds the rationalizations of a sex crime. Against this backdrop, it is instructive to understand the psychological underpinnings of the sex crimes committed by Bundy and the Ripper. In analyzing them, common themes emerge. Much blame is imputed to their mothers for their criminality, and their murderous arc represents a holy war against women and their inherent sexuality (Caputi). Jack the Ripper was adept in removing the genitalia of his victims, suggesting an animosity toward women, particularly, his mother (Caputi). Indeed, research into the crimes of Bundy and the Ripper do suggest that they had cultivated an ambivalence toward their mother (Caputi). Most likely, their childhoods were mired in psychological and physical abuse by their mothers according to the findings of Caputi in the course of her research on sex crimes.
Juxtaposing the sex crimes of Bundy and the Ripper carries the stamp of male dominance, seeking to denounce and punish feminine values in the context of a ritual, serving as a justifiable representation of embedded social values. They were purportedly raised by domineering mothers, having inflicted ambivalence and pain, which would be concomitantly avenged against. As such, killing women evinced a catharsis to countervail their painful and traumatic memories of their childhood. Having overidentified with their mothers, or the feminine sex, evoked a fundamental antagonism toward their sense of masculinity. By committing violent crimes, their status of a eunuch was neutralized through the symbolic warfare against women. For all the credible rationalizations and explanations of these serial murderers, their personas remain a formidable mystery.
Caputi, J. E. (1982). The age of sex crime (Order No. 8227475). Available from ProQuest Dissertations & Theses Global. (303210815).
This blog post is my personal horrific fascination with psychopathy. Psychopaths are ‘social predators who charm and manipulate’. Psychopaths that people think of are usually horrific serial killers and murderers- but there are psychopaths that adjust well to normal life and usually are very successful. We had discussed psychopaths in class and some famous ones from media. Psychopaths are of higher intelligence, not usually violent and are calloused/lacking with emotion. These people are interesting because this illness is not like other mental illnesses. Psychopaths are born with a dysfunction in their brain. They can be born a psychopath or have the traits for it that can be expressed after some environmental factors take place during life. They are known for their lack of empathy and per this class, I have learned that it is in part due to a lack of fear as well as other neuro dysfunctions. Psychopaths don't predict pain ie getting shocked by static electric a person with a normal fear factor would have anticipation for the pain they knew was going to happen, a psychopath would not. My question to explore about psychopaths is if they don’t have emotions, do they ever feel truly happy?
Many psychologists do not envision that they will encounter trauma in their practices, but most individuals in Western society will experience at least one potentially traumatic event during their lifetimes (Hall, Alas, Crespi-Hunt, & Khatchadourian, 2014). The two main types of potentially traumatic events (PTEs) experienced by police officers are harm/threat to self or witnessing harm/threat to another individual (Chopko, Palmieri, & Adams, 2018). Responses to PTEs vary, and affect individuals across cognitive, spiritual, emotional, and physical domains of functioning (Bonnano, 2008). Negative responses to PTEs have been observed and recorded for quite some time; depression, anxiety, substance abuse, personality disorders, and posttraumatic stress disorder are among the most common reactions (Hall, Alas, Crespi-Hunt, & Khatchadourian, 2014). The repeated management of potentially traumatic crime and disaster incidents involving assault, injury, or death place police officers at elevated risk of acquiring trauma-induced adjustment and mental health disorders with potentially considerable implications for their welfare and job performance (Arnetz, Nevedal, Lumley, Backman, & Lublin, 2009). In addition to the negative psychological effects of PTEs, there are physical social and cultural effects that may occur depending on the frequency, intensity, and timing of the trauma (Papazoglou, 2013).
Although there is a plethora of literature on the negative outcomes of PTEs generally and in police officers specifically, less is known about other trajectories, namely resilience and posttraumatic growth (Westphal & Bonanno, 2007). Regarding resilience, or helping individuals get back to their baseline level of functioning (Hall, Alas, Crespi-Hunt, & Khatchadourian, 2014), attention has been given to officers’ stress management strategies. Officers use both adaptive methods of managing occupational stressors (e.g., talk therapy) and maladaptive emotion management coping methods (e.g., suppression of thoughts and feelings) (Patterson, Chung, & Swan, 2014). Often police officers develop their own subculture due to the specific and challenging demands of their work and less frequently verbalize their experiences to mental health clinicians (Andersen & Papazoglou, 2014). Notwithstanding, efforts to promote resilience and stress management in officers have been implemented by clinicians for years and can lead to improvements in fieldwork (Patterson, Chung, & Swan, 2014).
In contrast to the larger literature on stress management and police officers, there is limited knowledge of the potential for growth and how clinicians can promote it in police officers. Posttraumatic growth (PTG) has been defined as action-focused growth in response to a traumatic event (Westphal & Bonanno, 2007; Tedeschi & Calhoun, 1996). Hall, Alas, Crespi-Hunt, and Khatchadourian (2014) described how PTG positively affects levels of distress, well-being, and many other variables related to mental health. Although it has been widely studied with veterans and the terminally ill, only limited studies were located on PTG in police officers. For example, Chopoko, Palmieri, and Adams (2018) found that PTG in police officers was more associated with events involving a threat to self than events involving a threat to another person. In order to effectively treat law enforcement officers, clinicians need more guidance from the research literature on promoting the psychological response of PTG.
In the text, Inside the Criminal Justice Organization: An Anthology for Practitioners, O’Brien discusses how “occupational stress occurs when an employee’s work environment, such as the nature of job demands or physical or social situations, result in reactions that are detrimental to the person’s well-being (physical or mental health).” O’Brien goes on to discuss how elements of a work environment creates stressors (e.g. relationships or work schedules), these stressors can then cause a reaction such as, strain or anxiety (Mastrorilli, 2018). For example, in the field of criminal justice, officers face stressful situations and traumatic events such as, shootings and witnessing death, these occurrences could then create stressors. In addition to these elements, work-related stress can also “affect the well-being of the organization, in the form of heightened use of sick leave, absenteeism, turnover, and effects on productivity” (Mastrorilli, 2018). Moreover, in order to improve the overall well-being of an employee, it is important to address and implement strategies that can help alleviate these strains or stressors.
In addition to occupational stress is burnout. According Dr. Mastrorilli, burnout is caused by chronic stress and signs of individual burnout include “extreme cynicism and detachment; physical and mental exhaustion, and severe irritability.” Moreover, there are six causes of burnout, which includes too much workload and value mismatch, also not enough control, reward, community, and fairness (Mastrorilli, 2019). For example, in the field of criminal justice, correctional officers can become physically and mentally exhausted from experiencing too much workload that is excessive and demanding. Regarding occupational stress and burnout, these occurrences can have devastating effects on employees and even organizations. Therefore, it is important that administrators and leaders in the criminal justice field be proactive and aware of these occurrences.
As previously mentioned, criminal justice agents who work in the field face traumatic events, which could trigger certain responses and can have harmful effects. Some of these effects can include reliving the event or post-traumatic stress disorder (PTSD). According to Newsweek article, “in a survey of Washington State Department of Corrections employees, nearly 20 percent of participants expressed symptoms indicative of PTSD, the same rate as veterans of the Iraq and Afghanistan wars and higher than that of police officers.” Another study in California found that “ten percent of prison guards have contemplated suicide, three times higher than the U.S. population, facing the same exposure to violence that incites PTSD” (Andrews, 2018). As criminal justice officers are exposed to workplace trauma and is a necessary part of their job, it may be impossible to fully alleviate this mental health issue. However, leaders of an agency can make things possible by being proactive and prepare for strategies that can buffer against this stress-related disorder.
Within a criminal justice department is it important to implement a program that integrates intervention services. These services can be established in two phases. The first phase can provide a one-time incident-specific intervention that handles the effects of “overwhelming trauma on otherwise normal, well-functioning personnel” (Miller, 2014). The second phase of the process incorporates individuals who have reoccurring incidences of PTSD, which calls for a more extensive individual approach (Miller, 2014). Regarding these services, it is important that leaders of an agency consider the timing of the intervention. Specifically, in primary intervention, providing coping skills within the program can be an effective tool. Research suggests that “when people are given specific preparation for viewing traumatic scenes, they are better able to cope” (Mastrorilli, 2018). This research proposes that “people who are mentally prepared for stress fare better than those who are unprepared” (Mastrorilli, 2018). For example, this strategy can be incorporated at the beginning stages of training for officers. Therefore, this is a beneficial tool because it can target officers who are not yet at risk and allow them to learn specific coping mechanisms that can prepare them for a traumatic event.
Another program that should be implemented into criminal justice departments is critical incident stress debriefing (CISD). According to Miller, “CISD is a structured intervention designed to promote the emotional processing of traumatic events through the ventilation and normalization of reactions, as well as preparation for possible future experiences.” This specific model is based off a number of criteria in which the support staff will assess the employees and establish proper debriefing services, this criteria includes, “many individuals within a group appear to be distressed after a call; the signs of stress appear to be quite severe; personnel demonstrate significant behavioral changes; personnel make significant errors on calls occurring after the critical incident; personnel request help; the event is unusual or extraordinary” (Miller, 2014). These debriefings usually consist of mental health professionals and takes place within 24-72 hours after the incident has occurred (Miller, 2014). This is particularly beneficial for criminal justice departments, it allows officers to receive one-on-one attention and provides a response to their specific needs. Therefore, implementing these programs and addressing this mental health issue becomes not only beneficial to the officers, in hopes to increase their well-being, but it can also benefit the overall operations within an agency.
Andrew, S. (2018). Prison employees face same rates of PTSD as war veterans, new research claims. Newsweek. Retrieved from https://www.newsweek.com/prison-workers-face-high-rates-ptsd-study-says-1024273
Mastrorilli, M. (2018). Inside the Criminal Justice Organization: An Anthology for Practitioners. Cognella Academic Publishing.
Mastrorilli, M. (2019). Lecture Modules 4 -5. Boston University.
Miller, L. (2014). Law enforcement traumatic stress: Clinical syndromes and intervention strategies. The American Academy of Experts in Traumatic Stress. Retrieved from http://www.aaets.org/article87.htm
Criminal justice jobs are stressful for a number of reasons. Law enforcement personnel have to work long hours, often closer to eighty hours than to forty, and in many places, they have to experience violence and extreme trauma on a daily basis. Not only do police officers frequently get put in highly stressful situations, but they often have to help people who have suffered extreme trauma. What many people do not realize is that it is possible to get PTSD second-hand, from dealing with people who have experienced trauma first-hand. “‘Vicarious trauma is the transformation that occurs within the therapist (or other trauma worker) as a result of empathic engagement with the clients’ trauma experiences’ (Perlman and Mac Ian, 1995)” (Rousseau D., 2019. Module 1.) While this quote is referring primarily to therapists, police officers also experience vicarious trauma because of their interactions with severely traumatized individuals or through looking at media, such as photos or videos, of traumatic incidents including rape, murder, suicide, and other violent deaths. All of this means that law enforcement personnel are usually under a tremendous amount of stress, and not surprisingly the rates of PTSD in Law Enforcement are between 7% and 15% (U.S. Department of Veterans Affairs, 2018), which is significantly higher than the national average, and suicides rates among law enforcement are roughly four times the national average (National Alliance on Mental Illness, 2019). In order for police officers and other emergency services personnel to continue to do their jobs year after year, while being both under stress and exposed to other people’s stress they need to have effective ways to let off steam and relax. Self-care techniques are almost never completely sufficient to eliminate issues such as PTSD, but these techniques can help alleviate daily stress, and can help prevent a buildup of stress that could cause more serious health issues. These techniques can also help those who are suffering from PTSD, as long as they are combined with visits to a specialist who can help with the aspects of PTSD that cannot be effectively self-treated.
Over the years both in school and in various jobs I have had to learn to deal with being in stressful and sometimes frustrating situations. Throughout this time, I have found that working with and being around dogs has made me calmer, more relaxed, and overall less stressed. Growing up I had dogs and I found that when I would get stressed out, if I just played with my dogs, I would feel better. Because of my own experiences I decided to find out if any police departments were using dogs for stress relief and therapy purposes, instead of just the usual tracking and drug sniffing K9 uses. It turns out that in the past two years a few police and fire departments around the United States have started to use therapy dogs to help their employees cope with stress and PTSD. According to the departments who are starting this initiative their hope is to reduce stress, anxiety, and police officer deaths by suicide. One reason why this idea might not very common yet is the high cost of a trained therapy dog.
According to Bolton Fire Chief, Jeff Legendre, his department has to raise $8,000 in order to get a therapy dog (Miller, B., 2019). Compared to other expenses that police and fire departments face this cost might not be astronomical, but these types of organizations rarely have extra money, and therefore, they are not inclined to shell out $8,000 for something that might or might not help their departments. I suspect that as more departments get therapy dogs, and the successes of this become more known, then more departments will raise the necessary funds to have their own dog. Other departments, such as Fayetteville North Carolina, have found cheaper ways of obtaining department therapy dogs (McCleary, N., 2017). The Fayetteville Police Department officially acquired a certified therapy dog in January of 2017 by having the dog be owned by one of the department’s employees. One of the Fayetteville Police Department forensic firearm examiners, Jaimie Minns, decided to get their personal dog, Rebel, trained as a therapy dog. Minns then went to her Police Chief and suggested that Rebel become an official member of the department, because she had seen that other departments in the state had started to get therapy dogs. The Fayetteville Police Chief went along with this idea and thus the department acquired a therapy dog for free (McCleary, N., 2017).
I doubt that every single police and fire department needs to have their own therapy dog. That being said, I think that if this idea takes off enough that most police officers and firefighters have access to a therapy dog, even if it works for another department, there is a significant chance that suicide rates among first responders will go down. Therapy dogs have been successful in hospitals and helping soldiers with PTSD, so why not use them to help police officers and firefighters, ideally before they actually get to the point of having Post-Traumatic-Stress-Disorder? I am sure that therapy dogs will not eliminate PTSD or suicide among first responders, but if the dogs can at least reduce the number of first responders who commit suicide each year, then that will be a huge success in my book.
Rousseau D. (2019). Module 1. Introduction to Trauma. Lecture, BU Blackboard Learn
Rousseau D. (2019). Module 6. Trauma and the Criminal Justice System. Lecture, BU Blackboard Learn
U.S. Department of Veterans Affairs. (2018, September 25). National Center for PTSD. Retrieved April 29, 2019, from https://www.ptsd.va.gov/professional/treat/care/toolkits/police/managingStrategiesPolice.asp
National Alliance on Mental Illness. (2019). NAMI. Retrieved April 29, 2019, from https://www.nami.org/find-support/law-enforcement-officers
McCleary, N. (2017, January 27). Therapy dog helps Fayetteville police deal with stress, anxiety. Retrieved May 02, 2019, from https://www.fayobserver.com/048ceda3-354f-5aaf-97a4-8dca37302f5d.html
Miller, B. (2019, May 02). Could bringing back the fire station dog help first responders cope with stress? Retrieved May 02, 2019, from https://www.boston25news.com/news/could-bringing-back-the-fire-station-dog-help-first-responders-cope-with-stress-/945759107
Eye Movement Desensitization and Reprocessing (EMDR) is a psychotherapy treatment that was initially created to diminish the anguish associated with traumatic memories. It is an unconventional treatment that has sparked great debate and controversy over its effectiveness (Rousseau 2019). According to van der Kolk (2015) EMDR challenges the long time belief that severe emotional pain takes many years to heal from. EMDR treatment exhibits that a comparative sequence of occasions happens with mental processes. It is believed that the brain’s information processing system moves toward mental-health by nature. In the event that the framework is blocked or imbalanced by the effect of an exasperating occasion, the injury putrefies and can cause exceptional affliction; when the blockage is cleared healing resumes (EMDR Institute, Inc. 2019). Utilizing the methods learned in EMDR treatment, clinicians are able to assist patients in stimulating their natural healing processes.
According to EMDR Humanitarian Assistance Programs (2019), EMDR treatment targets trauma in eight phases which exhaustively recognizes and addresses encounters that have overpowered the cerebrum's normal strength or adapting limit, and have in this way produced awful side effects or potentially hurtful coping mechanisms. Through EMDR treatment, patients can reprocess horrendous events until they are not mentally disruptive. Through this strategy, patients tend to process the memory in a manner that leads to peaceful resolution.
EMDR was initially used to treat persons suffering from posttraumatic stress disorder (PTSD). Through EMDR treatment, eye movements are utilized for a fragment of the session. After the clinician has figured out which memory to target first, they request that the patient hold distinct parts of the event in mind and use their eyes to follow the specialist's hand as it moves forward and backward in their sight. According to the EMDR Institute, Inc. (2019), as this occurs, for reasons accepted by a Harvard specialist to be associated with the organic instruments engaged with Rapid Eye Movement (REM) sleep, interior affiliations emerge and the client starts to process the memory and disturbing sentiments. In successful EMDR treatment, the significance of tragic/traumatic events changed on an emotional level.
I am a firm believer that severe emotional trauma takes years to truly heal and recover from. Most people suffer from trauma of some sort. However, different methods work for different people. For those who are apprehensive or uncomfortable with the idea of speaking through their trauma EMDR would be a great treatment to try. It indisputably empowers the patient and has them view their trauma as an event/events they overcame instead of an event/events that define them. While some assert EMDR treatment is ineffective there have been successful cases of treatment. The treatment process is intricate. It reminds me of hypnosis. Targeting traumatic imagery for healing follows the saying “face your fears,” – you face your fears to overcome them. I do question whether there is an undoing of this hypnosis like process. EMDR seemingly is effective, but I would like to do further research to truly trust the long-term effects and success.
EMDR Humanitarian Assistance Programs. (2019). What is EMDR? Retrieved from https://www.emdrhap.org/content/what-is-emdr/
EMDR Institute, Inc. (2019). What is EMDR? Retrieved from https://www.emdr.com/what-is-emdr/
Rousseau, D. (2019). Module 4: Pathways to Recover: Understanding Approaches to Trauma Treatment. Lecture presented in Boston University, accessed online 9 April 2019 via https://onlinecampus.bu.edu/
Van der Kolk, B. A. (2015). The body keeps the score: Brain, mind, and body in the healing of trauma. New York, NY: Penguin.
It’s the near the end of the academic school year and most teens are looking forward to prom night, graduation bash, checking their mailbox for college acceptance letters, and the most important event of all…..commencement day which means the end of one chapter and the starting of the next. But for some teens their hopes are about how to make it through each day after their dreams were shattered by one of the most destructive fires in California history which claimed the lives of 85 people and destroyed more than 153,000 acres (Sacks, 2019). The fire has destroyed three schools in the Paradise community displacing students at different locations some as far as one hour or more commute. Many families were left homeless as the fire engulfed their homes. Some have went on to live with other families who were not affected by the fires while others live in tents and trailers with no electricity making it difficult to access wifi connection for those students who are attending school online. Since the November fire, many teachers have been teaching class in malls, stores, warehouses, airports, empty spaces, or just about anywhere they are allowed to teach. Some students attend class online when they have access to wifi and others use transmitters so they can hear their teacher’s lecture (Sacks, 2019).
Class in session in a temporary office space.
Former Orchard hardware store now being used as a temporary space for a school.
Some students have turned their part time job to full time in order to help their parents get through this devastation and save enough money to afford some place to live. Others have applied for food stamps and trying to apply for an I.D. to obtain their birth certificate and look for employment in order to lease an apartment and pay for utilities. Most people lost their documents in the fire such as birth certificates which makes it more difficult to identify themselves with FEMA and their local Red Cross to obtain services (Sacks, 2019). The devastating event not only left people without a home and kids struggling to attend school but now the community has to deal with the effects of trauma. Acute trauma is a single traumatic event that is limited in time such as death, a shooting, car accidents, fires, hurricanes, and floods (Smithwick, 2019: Module 2 live class). Studies shows 92.5% of youth experience at least one trauma; 84% experience more than one; and over half of those youth experience or are exposed to trauma at least six times or more (Smithwick, 2019: Module 2 live class).
What are we as a society doing to help displaced victims of acute trauma especially such as this event in which an entire community was ravaged by wildfires? Where are the mental health services? What are our politicians doing about this tragedy? What about our president? Can he leave the border wall alone for just one day and do something about rebuilding Paradise community rather than let it disappear by the fire? The issue with illegal immigrants and migrants seeking political asylum has existed since the border wall was built and the issue is not going to go away as long as the wall is there but we cannot just let a community go up in smoke and just let it be. We have to rebuild it and help its community members get back on their feet again.
Professor Rousseau stated that PTSD after the 911 event was much lower than “expected and predicted”. The percentage was actually small. One possible explanation is that people came together and felt “connected” in that common experienced in which they were able to support each other (Rousseau, 2019: Module 5 live lecture). Students from Paradise community are doing just that: coming together and staying connected in their common experience while keeping their spirits up. Resilience hasn’t been easy for these students but one thing they also share in common is their struggle to stay afloat and finish the school year.
Class takes place inside a store.
Rousseau, D. (2019). Module 5 live lecture: Genocide. Accessed online April 17, 2019. https://learn.bu.edu
Sacks, B. (2019). Students live in tents, do homework under flashlights, and deal without textbooks months after California’s massive camp fire. Retrieved April 25, 2019, from https://apple.news/Aq4r7U0w2Tg-wTG842Up8rg
*pictures on the blog were retrieved from this source.
Smithwick, L. (2019). Module 2 live lecture: Best Practices-Juvenile Justice and Gender Responsivity. Accessed online March 26, 2019. https://learn.bu.edu
Prolonged Exposure Therapy: An Integrated Approach that Incorporates Coping Techniques and Trauma Confrontation
Trauma is an overwhelming emotional response experienced by an individual who has experienced a threatening event. The emotional response of trauma could have a long lasting effect and presence within an individual long after the threat is gone, leaving the individual to experience those high emotional responses in the absence of such threat where they originated from. This persistence of trauma symptoms is identified as Post Traumatic Stress Disorder in which “an individual gets stuck chronically in a stress and trauma response – either because of chronic stress and trauma or because the mind and body lose the capacity to accurately assess a true threat of danger” (Rousseau 2019).
Although there are many approaches to trauma therapy I believe that The Prolonged Exposure Therapy Approach truly targets the issue in individuals who are suffering from PTSD as it helps individuals gradually revisit traumatic memories to help process and manage the emotional response associated with that experience. Other therapy approaches focus on the development of coping methods and emotion recognition/ self awareness to essentially suppress the emotional response when presented with a traumatic trigger. However through prolonged exposure therapy the root of the problem is addressed and that is the threat of the specific event.
When an individual is presented with a situation it is the brain's job to detect it and organize it. Sensory information comes in through the senses (eyes, ears, nose, and skin) these sensations then reach the thalamus in the brain which essentially “ stirs all the input from our perceptions into a fully blended autobiographical soup, an integrated, coherent experience of “this is what's happening to me””(Van der Kolk p.60 2015) These sensations are then passed to the amygdala and the frontal lobes. The amygdala is located in the unconscious brain and upon receiving the input its function is to determine whether that input is relevant for survival, if so it initiates a fight or flight response for preservation even before the input reaches consciousness. The frontal lobes receive the input and interpret its context based on past experiences and knowledge in order to further carry out a response (Van der Kolk 2015) .
Peter Tuerks elaborates on the organizing function of the brain as it provides evolutionary predictability in disorganized situations. He states that it is the purpose of the human mind to process their surroundings in order to make sense of it and develop a response. Tuerks uses the example of a routine activity such as grocery shopping, when an individual is familiar with a routine or schema it becomes a mindless unmemorable task. However if that schema is interrupted by an unusual event such as an elephant in the back aisle , the brain actively searches for a similar schema which would make the information at hand make sense. If the brain is unable to organize and make sense of this information it remains readily accessible in the mind. This applies to trauma in which an individual experiences a new and heightened emotional response, that of which is not familiar to the brain. As a result of this situation that has not been categorized an put away in the mind, when an individual is presented with a similar triggering situation, that hyper aroused emotional response becomes cued and reactivated. The heightened emotions experienced by the individual in the triggering situation interrupt the peace of the individual. Therefore it is natural for individuals to avoid such similar and triggering situations that may elicit the same emotional response. This avoidance prevents the individual from being able to process and revisit the situation in order to make sense of it and put it away.
Prolonged Exposure Therapy is typically provided over a period of three months with weekly individual sessions. In the primary sessions the therapist goes over past experiences with the patient to form a relationship, and then also teaches coping techniques such as breathing those of which are to be practiced while revisiting the traumatic experience. These techniques are taught to manage anxiety and to avoid further traumatization as they help patients maintain control of their emotions that may be overwhelming. Once these calming techniques are practiced and understood the therapist them proceeds to initiate exposure of the traumatic experience with the client. This exposure can be done on two ways, imaginal exposure in which the patient describes in detail the events of the experience in present tense with the guidance of the therapist. This present tense guided description is recorded and allowed for the client to take home to further listen and revisit the experience while using calming techniques at home. The second method is usually approached later in the sessions, in vivo exposure, in which the client and therapist agree on which stimuli to confront outside of therapy as homework. The client works with the therapist to devise a plan on how this exposure is approached (Prolonged Exposure 2019).
I believe that Prolonged Exposure Therapy theoretically checks out as it incorporates hyper arousal suppression techniques and education which is used while confronting and processing traumatic memories and new seemingly similar situations or triggers. Through Prolonged Exposure Therapy the client not only learns new techniques to help them in potentially threatening and stressful situations in the future but it also gives them the tools to gradually confront their traumatic memories giving them the time to process the actuality of the situation little by little resulting in their ability to become more familiar with the situation allowing for processing and putting away of the event.
Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder: Prolonged Exposure (PE) Retrived April 27, 2019 https://www.apa.org/ptsd-guideline/treatments/prolonged-exposure
Rousseau, D. 2019 Trauma and Crisis Intervention Module 1 : Introduction to Trauma / Module 4: Pathways to Recovery
Van der Kolk, B. A. (2015). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. New York, NY: Penguin.
Before we begin on strategies for Self-Care, it is important to define Self-Care.
Self-Care - the practice of taking action to preserve or improve one's own health. (Oxford English Dictionary).
Sounds simple enough right? Wrong. Many of us do not take the proper steps and time to take care of ourselves. We are often too busy with every day life, work, children, taking care of others, we don’t leave enough time to take care of the most important person in our lives – which is our own health and well-being.
There are many things we can do to take care of ourselves and self-care can mean different things to different people; however, there are some basic rules that can be applied to everyone. Self-care does not need to be complicated or too time consuming; however it needs to be actively planned rather than something that just happens every now and then.
Here are some basics to stick to when planning for self-care:
1. Get enough sleep
2. Develop healthy and nutritious eating habits
3. Exercise regularly (not obsessively)
4. Learn how to say NO
5. Do something that makes YOU happy
6. Pamper yourself without feeling guilty
7. Surround yourself with people that uplift you
It is important to note that you don’t have to do all of these activities all the time or at once, however picking a few that are important to you is a good way to make it a part of your daily routine.
For myself, the top three from the above-list are: sleep, exercise and doing something every day that makes ME happy. Although I think that some of these can be combined, but for the sake of simplicity, I will keep them separate.
I have battled with sleeping issues for a long time due to stress and injury and I must say not getting proper sleep is a slippery slope to many unhealthy choices that follow. If you don’t get enough sleep, it can truly mess up your immune system, make you irritable and the rest of your day is easily ruined. Some people need 8 hours of sleep, some people need 5, but it is important to get restful sleep. Meditation before bed or reading can help tremendously when having trouble sleeping.
Exercise for me is key to getting my day started on a positive note – it does not have to involve hours at the gym. It can be as simple as taking a 20 min walk followed by some yoga with light weights at home or just using your own body weight to get your blood flowing. Personally, I love to run and do Pilates – both combined is one of the biggest stress relievers for me. I love working out first thing in the morning as it sets the tone for the rest of my day. I have noticed if for whatever reason I am unable to exercise in the morning, my mood is not quite as good and I am more irritable and on edge. Not only does it make my body feel great and strong, but most importantly helps to keep my mind sharp. Furthermore, it increases serotonin levels and leads to good energy and good mood.
Last but not least, doing something every day that makes ME happy is very important. At times this may sound selfish to others, but to make others happy and be a good friend/partner/employee etc. you must take care of yourself first and be content before you can do that for others. This strategy sounds vague, but it can create a lot of positives for one’s well-being. It can be something so simple as walking to your favorite coffee shop to get coffee in the morning; to getting a massage or hanging out with a particular friend that day. The most important aspect of this is you are doing something that makes YOU happy. For me, each day it varies, but sometimes I just want to stay home and listen to music while other times I want to be surrounded by friends at a nice dinner and cocktail or going to a comedy show or spending time with my nephews – it all depends on what small or big thing I want to do that day. It is also important not to feel guilty when doing so. We often do things we don’t necessarily want to do or if we take time for ourselves, we feel guilty about it – that has to stop!
These are some simple steps we can take towards taking better care of ourselves.
Life is not perfect, and we are all busy, but we must take time for ourselves; it does not have to be complicated, time consuming or costly, even 20 minutes a day can have a great impact. When we don’t take time for self-care, our energy and motivation can decrease, making it even more challenging to stick with healthy lifestyle choices.
Michael R. 2018 – What self-care is and What it isn’t?