CJ 720 Trauma & Crisis Intervention Blog
When discussing trauma in the incarcerated population I was struck by the stories of what these people had endured. I wanted to dive a little deeper on the connection between incarceration and trauma to give a more well-rounded image of what incarcerated individuals experience.
To begin it has been found that PTSD occurs at significantly higher rates in incarcerated individuals compared to the general population (Hodges-Pietryka, 2022). There is about a 300% increase between the two populations with PTSD symptoms occurring in 4% of a studies community population and 48% of the studies incarcerated population (Hodges-Pietryka, 2022). Incarcerated individuals are also found to have more likely experienced trauma in childhood that non-incarcerated populations (Hodges-Pietryka, 2022). While in prisons though, assaults and other traumatic interactions are found to be underreported but contribute greatly to the increased percentage of people developing or experiencing PTSD symptoms (Hodges-Pietryka, 2022). This does not end after incarceration though. Many of these individuals struggle with reentry into their communities. While in prison they are likely very bottled up and unable to process or share the thoughts and feelings they are having. This can contribute to more negative outcomes due to unmanaged symptoms which is one of many factors that increases the likelihood of reoffending (Morrison, 2022). The process of reentry is heavily reliant on family/friends, service providers, and community members (Morrison, 2022). Symptoms of untreated trauma such as insomnia, hypervigilance, hyper-reactivity, difficulty with attention and concentration, and paranoia can greatly strain these relationships and hinder the process further (Morrison, 2022).
These issues are a significant factor in why incarceration is often cyclical. We need to shift to a more trauma informed approach to both incarceration and reentry if we want a solid way to tackle the relationship between trauma and incarceration. Many of these prisoners do not have a robust support system so I would suggest improving things on the inside of the system first as many problems arise from the culture within prisons. I strongly believe that there is a “light at the end of the tunnel” but we won’t get there unless work is put in to be more informed on how the system and trauma play a role in the damage being done.
Hodges-Pietryka, M. (2022). Stories of Revictimization During Incarceration: The Returning Citizen's Experience (Order No. 29319933). Available from ProQuest Dissertations & Theses Global. (2707688376). https://ezproxy.bu.edu/login?qurl=https%3A%2F%2Fwww.proquest.com%2Fdissertations-theses%2Fstories-revictimization-during-incarceration%2Fdocview%2F2707688376%2Fse-2%3Faccountid%3D9676
Morrison, M. (2022). Trauma Exposures across the Life Course for Individuals Who Experience
Incarceration (Order No. 29325001). Available from ProQuest Dissertations & Theses Global. (2705437979). https://ezproxy.bu.edu/login?qurl=https%3A%2F%2Fwww.proquest.com%2Fdissertations-theses%2Ftrauma-exposures-across-life-course-individuals%2Fdocview%2F2705437979%2Fse-2%3Faccountid%3D9676
Trauma is a unique experience; no two people will experience trauma in the same exact way, thus the impact and responses to trauma are unique as well. To better understand the various responses to trauma, research has found trauma is stored in the body through our somatic memory, specifically, the nervous system in the brain (Van der Kolk, 1994). Furthermore, trauma can manifest through somatic flashbacks in the form of physical sensations, including tastes, smells, pain and haptic experiences. Somatic flashbacks support the notion that memories, particularly trauma experiences, are stored in visual form. When a traumatic event occurs, the Broca’s area of the brain, responsible for language, shuts down. Simultaneously, the amygdala, the recognition center for danger in the brain, is put on high alert, resulting in the brain visually recording the traumatic event (Rausch et al., 1996).
To help individuals work through trauma that is held visually and physiologically, imagery and verbal expression can be introduced. In particular, art expression has been found to effectively assist in grappling with sensory memories and facilitating a narrative to explore memories and flashbacks (Malchiodi, 2003). When somatic memories are explored through art expression, an individual is able to develop an understanding of why they may be experiencing certain physical sensations to a particular event. A unique feature of art therapy is that interpretation of the art created is completely up to the artist, allowing them to create their own language of expression. Moreover, art therapy promotes growth, self-expression, emotional reparation, conflict resolution and transformation (Malchiodi, 1998).
A positive aspect of art therapy is that it provides a medium, art and its subsequent expression, that is not available in many other therapies and forms of expression. However, caution should also be taken when using art therapy. Art therapy should be used as art and therapy, with the understanding art is not therapy on it own. Rubin (1999) stresses “therapy is not enough; art is not enough either”.
There are many forms of trauma-informed art therapy, below are common modalities utilized within carceral settings and how they allow for self-expression.
- Dance: (hip hop, jazz, tap, modern) creates awareness and develops connection with the body; allows for expression of fear anger, hope, happiness
- Music/Poetry/Writing: expands capacity for self-expression
- Theatre: improvisation, play reading, script analysis; creation of scenes to replay responses to an event
- Visual Arts: (painting, sculpting, pottery, collage) allows for expression of visual and emotional feelings; creates a starting point for dialogue and exploration
San Quentin State Prison, California, has a program called ArtReach which “provides a platform for artists on San Quentin’s death row to exhibit their art and creativity”. I invite you to peruse the site. The art created includes paintings, drawings, poems, and papers. Many of the poems and drawings capture the trauma of incarceration, being on death row, as well as self-revelations, personal growth, and peace. https://www.artofsanquentin.com/
Malchiodi, C. A. (1998). The art therapy sourcebook. Los Angeles: Lowell House.
Malchiodi, C. A. (Ed.). (2003). Handbook of art therapy. New York, NY: Guilford
Rausch, S.L., van der Kolk, B. A., Fisler, R.E. & Alpert, N.M. (1996) A symptom provocation study of posttraumatic stress disorder using positron emission tomography and script-driven imagery. Archives of General Psychiatry. 53(5), pp.380-387.
Van der Kolk, B. A. (1994). The body keeps the score: Memory and the evolving psychobiology of posttraumatic stress. Harvard Review of Psychiatry, 1(5), 253–265.
Life, our existence is nothing more than a condition where we have the rationality and capacity to function. We go through a number of stages that are supposed to teach us everything that we need to know to learn how to live and how to survive until death reaches us. These stages are infancy, toddlerhood, preschool years, early school years, adolescence, young adulthood, middle adulthood, and late adulthood. Yet, no one quite clearly can explain to you what events are going to transpire in your life that will scar you, what experiences are you going to go through that will activate your stress hormones and put them on a loop, how to handle strong emotions or emotions at all, how to understand your feelings or mental state, or how much life really hurts, disappoints, and feels like it suffocates you one day after the other. Now, all of these events are led by one piece, a masterpiece that feels like it dictates your life, stress.
We are all unique individuals that feel, think, and experience differently. Therefore, all of our individual experiences cannot be compared, and since they’re not alike we cannot fully understand what a person goes through until we live that same experience. Nevertheless, stress is a universal factor that causes an impact in all our lives. It might not be identical situations but it’s the same factor. So, what is stress? The World Health Organizations says that is “a state of worry or mental tension caused by a difficult situation…is a natural human response that prompts us to address challenges and threats on our lives. Everyone experiences stress to some degree.”. So, the continuance of this factor in human beings causes an imbalance that affects the mind, brain, and body.
How does stress affect us? When our body is subjected to an event of experience that causes extreme stress our brain secretes stress chemicals and lights the neural circuitry on fire. It sends alerts to the hypothalamus that sends sensory signals to the amygdala. The amygdala then processes these signals as the image, sounds, smells, taste, and touch of the moment and decides how to interpret that information and what level of danger is perceived. In their connection the autonomic nervous system is activated, alongside with the sympathetic and parasympathetic nervous systems. Both of these in their respective ways tackle the fight, flight or freeze response of the body to the stress. Think of it as a car’s pedals (increase to acceleration and decrease to stop). All of these signals and responses are activated so quickly that the brain doesn’t even have a clue, it can’t be aware of the cascade of events happening so fast. So, the sympathetic nervous system stays on, continuously secreting stress hormones (for example, cortisol), thus impacting and aggravating the individual’s balance and well-being. This overwhelming impact to the individual is focused on their physiological and psychological state. It stands in the way of completing tasks, activities, and duties (studying or working), relationships (partners, family and friends), organ health (heart, stomach, lungs), nervous system function (various levels of body ache and pain), use of substances (illegal drugs like cocaine and opioids, alcohol, and tobacco), anxiety, depression, and much more. Therefore, we need to have certain tools ready at hand to cope, manage, and reduce that unavoidable and always present stress.
Now, how do we reduce those levels of chronic long-term stress? Well, some counter responses towards relieving stress that are available to all of us are due to the different techniques that scientists have come upon throughout time. For example, the relaxation response, a combination of different approaches that evoke a state of relaxation (deep breathing, focusing on calmness and tranquility, connection with God through prayer, yoga, tai chi, and more). Physical activity and movement therapy (stretching, walking, running, swimming, aerobics, dancing, singing, and more) to reduce the body’s levels of stress hormones like adrenaline and cortisol; and produce endorphins to heal. Social support triggers benefits in the well-being of a person. Some say that it helps with the setback of the healing process, improves the self-esteem and self-worth, encourages to keep working on one’s health, shows you other strategies or coping mechanisms, and you feel “loved”.
In addition to the previous mentioned, other ways to manage and assume control over stress is to establish a daily routine, nothing fancy, improve eating habits, prioritize getting enough sleep and rest. Also, limit the time that you spend on the internet (it can make you feel overwhelmed and more stressed), connect with nature, and reach out and seek medical assistance to take it one step further. When dealing with life, stress and stressors will always be present, and it’s completely natural to feel drained, frustrated, on edge, without words, enraged, gloomy, and more. But, do things for you, take care of yourself, modify or change your lifestyle if you have to, control your environment and your level of participation, establish your own time and what are your priorities, to what are you going to focus your energy on. All of this is normal, but what is not normal is not doing something about it, letting it beat, stump, and burry you. Putting yourself as number one as a priority in your life is extremely important, and taking care of your health is not something to be ashamed of. It’s something to be proud and joyous about because not many people can or want to do it. That is what proves great important, that you take care of yourself and are one with yourself.
Boland, B. (April, 2023). All the Ways Stress Can Impact Your Life. BANNER HEALTH. Web page: https://www.bannerhealth.com/healthcareblog/teach-me/stress
Rousseau, D. (2023). Module 3: Neurobiology of Trauma. Retrieved from: MET CJ 720 O2 Trauma and Crisis Intervention Printable Lectures.
Van der Kolk, B. A. (2014). Part Two, Chapter 4: Running for your life: The Anatomy of Survival. The body keeps the score: Brain, mind, and body in the healing of trauma. Viking Penguin.
Van der Kolk, B. A. (2014). Part Two, Chapter 5: Body-Brain Connections. The body keeps the score: Brain, mind, and body in the healing of trauma. Viking Penguin.
Van der Kolk, B. A. (2014). Part Two, Chapter 6: Losing Your Body, Losing Your Self. The body keeps the score: Brain, mind, and body in the healing of trauma. Viking Penguin.
Van der Kolk, B. A. (2014). Part Four, Chapter 11: Uncovering Secrets: The Problem of Traumatic Memory. The body keeps the score: Brain, mind, and body in the healing of trauma. Viking Penguin.
Van der Kolk, B. A. (2014). Part Four, Chapter 12: The Unbearable Heaviness of Remembering. The body keeps the score: Brain, mind, and body in the healing of trauma. Viking Penguin.
Van der Kolk, B. A. (2014). Prologue, Facing Trauma. The body keeps the score: Brain, mind, and body in the healing of trauma. Viking Penguin.
World Health Organization. (February, 2023). Stress. Web page: https://www.who.int/news-room/questions-and-answers/item/stress#:~:text=Stress%20can%20be%20defined%20as,experiences%20stress%20to%20some%20degree.
“You gotta resurrect the deep pain within you and give it a place to live that’s not within your body.
Let it live in art. Let it live in writing. Let it live in music.
Let it be devoured by building brighter connections.
Your body is not a coffin for pain to be buried in. Put it somewhere else.”
- Ehime Ora
There are many modalities that can be helpful in the treatment of trauma. This post explores the benefits of creative expression as self-care and treatment using a specific and personal example - my mom. More than prescribed ‘art therapy’, the use of art as a therapeutic form of self-expression has helped my family in many ways. Because it is relevant to this story, I will preface this with a context of culture and history.
My mom suffers from PTSD and many physical ailments. There are many parts of her life she is just now correlating with trauma and others she may not remember yet. I inherited parts of her trauma and quickly assimilated into American culture; I was a child when we emigrated. We came to America at an inflection point of its contentious relationship with Iran, a country on the precipice of Revolution. Being a young mother, she left behind home and family for her safety and that of her child. I remember hearing bombs fly overhead while speaking on the phone from the U.S. with my grandparents in Iran during the Iran-Iraq War. We heard and saw much war and death and many loved ones were lost.
Iran is a tumultuous, beautiful, democratic (at its roots), tyrannical, dangerous, powerful country. We are born from the soil of mixed contradictions, rich with historically significant contributions to mankind. Persians were originally of a monotheistic religion called Zoroastrianism, and hail from one of the oldest empires in history. This beautiful land, like any other, is filled with generational trauma.
In recent times, you may have heard the name ‘Mahsa Amini’, one of countless young people killed by a brutal regime for no reason. That trauma runs deep and wide, we felt it here in America and around the globe; it is directly contributory to pain we feel today (physical and otherwise). We protested the oppression and brutality; we donated, cooked, sang, cried, and rallied. It is difficult to process that much grief for that much death alone, so we feel strength in numbers, and we express that grief in artistic ways. Musicians write anthems, writers pen poems and novels, actors appeal on screens, we cook for and comfort each other. Integral to processing trauma, and to our culture, is art and expression. We are a traditional, communal people so our form of therapy usually revolves around community. It is not uncommon to see a group of Persian friends at a restaurant crying, laughing, eating, and crying some more. We express as much trauma as we hold. This is also common for other cultures around the world.
There are many different, effective ways to use creative expression as a form of self-care and treatment.
We learned from Bessel Van der Kolk that (in 2014) there was little known about how artistic forms of therapy “work or about the specific aspects of traumatic stress they address”. Kolk discusses some of the ways that artistic therapies have been measured and produced either disappointing or inconclusive results.
One form of dance therapy paired “nonverbal artistic expression with writing” by social psychologist James Pennebaker and dance/movement therapist, Anne Krantz. The study group that danced then wrote about a traumatic experience showed “better physical health and improved grade-point average. (The study did not evaluate specific PTSD symptoms.)”. Interestingly, when considering just writing therapy that focused on PTSD symptoms, it seems they were less successful when done in “group settings where participants were expected to share stories.” (Kolk, 2014, p.354). Sharing vulnerable thoughts and feelings publicly before readiness can feel more traumatic than healing.
Art & Creativity
Where culture or innate expression may not be a factor for everyone, traditional art therapy is a useful clinical approach:
“Characteristic for art therapy is the methodical use of art means as drawing, painting, collage, and sculpting to shape and express feelings, thoughts, and memories. Art therapy is distinguished from other forms of treatment by active performing and experiencing with art materials, by the visual and concrete character of the process as well as by the result of art making.” (Schouten, et al., 2015).
“Art safely gives voice to and makes a survivor’s experience of emotions, thoughts, and memories visible when words are insufficient.” Art and creativity can tap “into other parts of a person’s experience. It accesses information … or emotions that maybe can’t be accessed through talking alone … Using art therapy to treat PTSD addresses the whole experience of trauma: mind, body, and emotion.” (Fabian, 2019).
Studies have been conducted showing the effectiveness of different forms of art therapy (seen in these examples above) in combination with cognitive therapy for combat veterans with PTSD. “Art therapy may assist with integration of sensory memories and declarative memory and has been shown to reduce symptoms of PTSD in a number of populations.” (Campbell, et al., 2016). They found that “Art therapy in conjunction with CPT was found to improve trauma processing and veterans considered it to be an important part of their treatment as it provided healthy distancing, enhanced trauma recall, and increased access to emotions.” (Campbell, et al., 2016).
Putting it Together
Integrating any type of art or creative expression into trauma therapy is an individual choice. There have been promising studies showing valuable contributions to the treatment of PTSD, enhanced by combining other treatments. Addressing trauma is complex since it can remain hidden in our bodies and minds, so "using a combination of traditional therapy techniques and alternative treatments such as EMDR, yoga, neurofeedback, and theater, patients can regain control of their bodies and rewire their brains." (Kolk, 2014, p.1).
For my mom, art has been helpful and productive as a form of self-care and adjunct to other therapies. Used in conjunction with other treatments, it takes on a calming, meditative quality that stills her mind and body. Joining treatments has helped unlock complex trauma that was hidden from her. This very personal, internal processing does not involve verbal expression, but emotion and thought come through as a physical creation. It is a form of healing during times when she struggles to identify where her trauma resides. Her creations are freehand, and it is in the moment of pure, joyous, creative expression that she does her best work. By her own account, when she is creating, she is 'lost in Zen space' with no concept of time, pain, or physical body. I believe it is in this space that she reconnects with her body and mind in a safe space.
Helpful as PTSD treatment, art “therapies can be helpful in reducing depression and trauma-related symptoms such as alexithymia, dissociation, anxiety, nightmares, and sleep problems… increasing emotional control, improving interpersonal relationships, and improving body image (Johnson & Lahad, 2009).” What is lacking from all articles on the efficacy and full benefits of PTSD treatment, however, appears to consistently be a lack of “robust information on their effectiveness”. It is possible that there have not been any ‘robust’ studies because art can take many forms, is highly subjective and contextual in nature, and is difficult to systematically analyze. From personal experience, I can say that art (in all forms) has been a healing, therapeutic tool for my family. I cannot imagine our lives without it.
Campbell, M., Decker, K. P., Kruk, K., & Deaver, S. P. (2016). Art Therapy and Cognitive Processing Therapy for Combat-Related PTSD: A Randomized Controlled Trial. Art therapy : Journal of the American Art Therapy Association, 33(4), 169–177. https://doi.org/10.1080/07421656.2016.1226643
Schouten, K. A., de Niet, G. J., Knipscheer, J. W., Kleber, R. J., & Hutschemaekers, G. J. (2015). The Effectiveness Of Art Therapy In The Treatment Of Traumatized Adults: A Systematic Review On Art Therapy And Trauma. Trauma, violence & abuse, 16(2), 220–228. https://doi-org.ezproxy.bu.edu/10.1177/1524838014555032
Debruge, P., Earl, W., Gleiberman, O., Moreau, J., Murphy, J.K., Saperstein, P., Shafer, E., Shanfeld, E., Seo, R. The 30 Greatest War Films. Variety.
Van der Kolk, B. A. (2014). The Body Keeps The Score: Brain, Mind, And Body In The Healing Of Trauma. Penguin. Amazon Kindle version.
Fabian, R. (2019, Aug 13). Medically reviewed by Legg, T.J., PhD, PsyD. Healing Invisible Wounds: Art Therapy and PTSD. Healthline.
Art & Talk Therapy. Retrieved on 2023, Aug 15 from https://www.aactherapy.com/art-therapy
Also referenced from: Ora, E. (2023, July). Ancestors Said: 365 Introspections for Emotional Healing. 1st ed. Hay House, Inc.
On a rainy morning, I was getting ready to go on a tour in Dublin, Ireland. The older guide approached us and appeared to be very upset. He asked if we were okay, and if we needed some time before our tour started. Confused, we asked what was wrong. “Did you hear? A mass shooting happened this morning in America.” He was met with a few shrugs and “Yeah, that happens.” Shocked, he replied “If that happened here, we would probably shut down the city for weeks.”
It was in that moment, I began to think about why this group of American’s reacted this way. Besides the lack of action from political leaders, I thought about social media. For years, we have been exposed to violence and tragedy (virtually) right in front of us. In the live classroom this week, it was brought up about social media and having this information right at our fingertips. We have access to more information than ever, and it is quite overwhelming. Even this morning, I woke up to several news notifications involving death and tragedy with pictures attached.
Grace Dowd, a psychotherapist, says “Since we don’t always have enough time to digest one story before another breaks, we can sometimes end up feeling emotionally numb, helpless and immobile. This typically happens when our survival mechanisms are triggered.” Grace then adds, “Our constant access to social media and the news plays into this by continuing to provide access to information to the point where it no longer becomes shocking, and also by taking our attention away with the next crisis.” (Barnes, 2021) Mary Joye, a licensed mental health counselor, says “Repetition of [bad news and images] does damage to us through vicarious trauma.” (Barnes, 2021) Vicarious trauma was also discussed in our live classroom this week. Vicarious trauma is when the trauma does not directly happen to you, but you are affected by it.
Sites created to share memories and watch funny videos have slowly turned dark over time. On apps such as TikTok, you can watch a cooking tutorial and the next video is a house exploding. How do we protect ourselves?
Limiting time on social media has been a great tool for me. I have seen a major decrease in anxiety. It allows me to process anything I have seen and reflect. As bad as it sounds, I have had to adopt the “ignorance is bliss” stance with trends on social media. Most of these “trends” have turned into a rabbit hole of anxiety inducing videos, such as “top 10 household products that will give you cancer”. I even have friends that set time limits on their phones, or have deleted social media all together. I strongly believe that if we decrease our social media use, society will greatly benefit from it.
Barnes, S. (2021, Feb 21). "Social Media is Traumatizing Us More Than We Realize" https://www.huffpost.com/entry/social-media-traumatizing_l_602d2c88c5b673b19b654d88.
Ketamine Infusion Treatment for Post-Traumatic Stress Disorder (PTSD)
Written By Cady Balde
Over the last two decades, the anesthetic drug ketamine has become a popular new treatment approach for mental health disorders such as anxiety, depression, and post-traumatic stress disorder (PTSD). Derived from the psychedelic drug phencyclidine, commonly known as PCP or angel dust, ketamine is a dissociative anesthetic. Legally, ketamine is a F.D. Ketamine is an approved anesthetic that is commonly used in emergency rooms; however, when used recreationally, it causes mind-altering effects that are described as a "separation of mind from body even as the mind retained consciousness" (Witt, 2021). With regard to illicit drugs and human subject research, purposefully inducing these hallucinogenic properties has raised controversy within the clinical and psychiatric realms. However, in 2006, the National Institute of Mental Health, along with Yale clinician Dr. Gerard Sanacora, found schizophrenic patients experienced mood improvement after receiving a single intravenous dose of ketamine.
Patients who suffer from major depressive disorder, chronic stress, or PTSD experience synapse loss. Synapses are wire-like signals that regulate our brain's responsibility for behavior, mood, and cognitive function. Neurotransmitters such as cortisol, dopamine, and serotonin are brain chemicals that signal danger in our bodies. However, when an individual experiences a traumatic event, these chemicals become imbalanced due to the brain synapses thinking they are in a constant fight-or-flight situation. Ketamine therapy, administered intravenously, has shown promise in re-growing lost synapses. Chief Psychiatrist at Yale-New Haven Hospital, John Krystal, identified that "within 24 hours of a person’s first dose of medically supervised ketamine, those lost connections start to regrow. The more synapses they grow, the better the antidepressant effects of ketamine are for them" (Collins, 2022). Dr. Krystal did note that ketamine therapy should not be used as a sole treatment plan but should be used in conjunction with anti-depressant medication and cognitive behavioral therapy (CBT).
A possible limitation of ketamine infusion therapy is the increased risk of psychosis due to its hallucinogenic effects and the possibility for individuals to develop drug dependence. However, I found ketamine infusion therapy overall to be an effective new treatment approach for those with medication resistant depression and treatment resistant PTSD.
Witt, E. (2021, December 29). Ketamine Therapy Is Going Mainstream. Are We Ready? The New Yorker. https://www.newyorker.com/culture/annals-of-inquiry/ketamine-therapy-is-going-mainstream-are-we-ready
Collins, S. (2022, May 4). What is Ketamine? How it Works and Helps Severe Depression. WebMD. https://www.webmd.com/depression/features/what-does-ketamine-do-your-brain
The holiday season can be a time of great joy, social support, gifts, and nostalgic traditions. However, the holidays can also be a challenging time for many people, being reminded of their grief and loss, effects of seasonal depression, and end of the year reflections. Some people might feel extremely joyous and hopeful for the new year, and some might feel great anxiety and hopelessness.
In this post, I want to share warning signs for suicidality that may show up in the workplace. Employees that are often sad. There may be changes in the appetites, extreme weight gain or weight loss, and they might be more agitated over time. A decrease in productivity could be an indicator of other issues. Some employees may have trouble concentrating, remembering things, and following through on tasks, and this may be a change in their regular work behavior. You might notice employees having a lot less energy, expressing changes in sleep patterns, showing up late, or not keeping up with their appearance in the same way. They may potentially come to work less, calling out sick, or not attending events as they used to. On the more dangerous spectrum, employees may be under the influence of drugs or alcohol at work and they may even just express thoughts or comments about suicide.
If you are a supervisor or another employee seeing these changes in someone you work with, I would encourage you to approach their behavioral changes with curiosity instead of judgment. An example could be “Hi, I just wanted to check in and see how you’re feeling or if there is any way I can help. I’m noticing that your tasks are being completed late when you used to complete them early.” Also, maintaining confidentiality. If any information is shared, sharing with the proper people in the workplace who can help provide necessary care. It would not help for someone’s mental distress to become workplace gossip. Lastly, reach out to people who can help. Encourage the employee to utilize appropriate hotlines, ask Human Resources for accommodations, or use EAP benefits to get mental health treatment. Don't feel that you have to manage someone’s suicidality alone.
988 Suicide and Crisis Lifeline
Goel, C. (2022, August 8). Top 7 employee suicidal warning signs . Axiom Medical. Retrieved December 15, 2022, from https://www.axiomllc.com/blog/employee-suicidal-warning-signs/
When Routine Workplace Stress Is More Than Routine and More Than Stress – Secondary Trauma, First Responders, and the Case of Jeffrey Reynolds
October 23, 2012 started out like any other day for me at my office in Livingston, Louisiana. I had only been a prosecutor for a little more than two years and was expecting another quiet day in the office. Sometime that afternoon a police officer came by my office to drop off paperwork and informed the receptionist that there was a bad case developing in the City of Walker. The officer informed the receptionist of what he knew about the case and left. A few minutes later, the receptionist came to my office and informed me that a woman had been stabbed by her husband, killing their unborn child. She also informed me that she thinks the woman was a victim on one of my domestic violence cases. I decided that I would walk over to the Detectives Division of the Livingston Parish Sheriff's Office to gather more information. Speaking with one of the detectives, whom I know well, he apprised me of what was going on and we were able to figure out that this case was unrelated to anything my office was currently prosecuting. He also played me the 911 call of this dreadful incident. I will say, at this point, hearing the screams of this woman as she was being attacked by her own husband was traumatic in itself, but hearing the full details of what all transpired has left an indelible mark in my memory and in my career as a prosecutor. Still, what I experienced was nothing compared to what this woman was made to endure and what the first responders witnessed as they came on scene.
On that date 31-year old Jeffrey Reynolds ingested some sort of synthetic marijuana, which he claimed produced a hallucinating effect on him and led him to believe that the fetus inside of his wife Paula, who was 8 months pregnant, was actually a demon (Gaulden, 2015). Reynolds called 911 to tell them that he had ingested synthetic marijuana and that he was afraid that he was about to do something bad and they better send someone to stop him (Gaulden, 2015). While on the phone with 911 and while seeming very calm to the operator, Reynolds proceeded to grab a pairing knife, slash his wife's throat and proceed to attempt to cut the fetus from her womb (Gaulden, 2015). Paula Reynolds can be heard on the 911 call screaming as the attack first takes place and then yelling, "I'm dying! I'm dying!" (Gaulden, 2015). Reynolds can also be heard asking his wife why she is not dead yet. When first responders first arrived and observed the gruesome scene, some immediately apprehended Reynolds, one swaddled the child though it was clearly dead from a knife cut across its head, while others tended to Paula. None of these first responders would ever be the same. Sheriff Jason Ard agreed to have his department pay for counseling for all law enforcement, firemen, coroner's investigators, and medical personnel that were on scene that day.
Though he continues to blame a drug-induced psychosis for his actions that day, Jeffrey Reynolds was charged with and later pled to 15 years for the attempted second degree murder of his wife and 20 years for the first degree feticide of his child "baby Isaac" (Hardy, 2015). There were many who were upset with my office's decision to accept this plea deal. Unbeknownst to the general public and even misunderstood by many of the officers involved with this case, there was a legal technicality that may have resulted in no conviction at all or perhaps a finding of not guilty by reason of insanity. While Louisiana law states that voluntary intoxication is not a defense to any crime, it does vitiate specific intent. Both attempted second degree murder and first degree feticide require prosecutors to prove that the defendant acted with specific intent. Furthermore, a divided sanity commission could not agree whether Jeffrey Reynolds suffered from a drug-induced psychosis, such that he was deprived of the ability to distinguish between right and wrong, and therefore not guilty by reason of insanity. While we had very little doubts that a jury would find him guilty, this plea deal was, in effect, a compromise to avoid lengthy appeals that would not only re-traumatize Paula and her family, but also run the risk of an appellate court overturning the conviction on these legal grounds altogether. Though I was not the prosecutor in charge of this case, all of us in the office agreed with the decision; as did Paula and her parents.
While the criminal case may be over, the trauma inflicted that day has had a ripple effect that continues to this day, not only for Paula, who has since divorced her husband and remarried, though she still bears the scars (physically and emotionally), but also for the first responders who witnessed the horrors of that day. I have a hard time calling the trauma they experienced "vicarious" or "secondary," as if that somehow lessens the reality of what they went through. It is said that vicarious trauma "occurs when someone experiences a crisis secondhand" (Marin, 2021). Quoting Susan Ferrin, founder and executive director of First Responders Resiliency, Inc., Kate Marin (2021) writes in her blog: "'Research indicates that when you're exposed to things that are traumatizing to your brain, your brain spends an enormous amount of energy trying to sort it out, trying to make sense of it, trying to create reasons for this kind of thing.' This process is exhausting, particularly when an individual is emotionally invested in the people and events they work with." This is at the heart of vicarious trauma, particularly with criminal justice professions. While being a first responder is an inherently stressful occupation, including for law enforcement, when these routine work environment stresses are combined with traumatic experiences, the risk of developing PTSD symptoms increases (Maguen et al., 2009). While the first responders who came on that traumatic scene in October 2012 may have learned to deal with their experience and relieve any PTSD symptoms they were suffering, I know personally that they are still trying to understand why this happened emotionally, maybe even spiritually. While I doubt that I have been able to give to them a satisfactory answer, I have never let them doubt my support for them. So, keep the faith brothers and sisters and keep up the good fight. There will be more Paula's out there that will need you to hold their hand in their darkest hour. Just make sure there are people in your life who are there to hold your hand as well.
Gaulden, T. (2015, Sep. 18). 911 call details brutal feticide attack. WBRZ Channel 2 News. https://www.wbrz.com/news/911-call-details-brutal-feticide-attack/
Hardy, S. (2015, Sep. 23). Livingston Parish man pleads no contest in feticide case; cut unborn child from wife's body while high on synthetic marijuana. The Baton Rouge Advocate. https://www.theadvocate.com/baton_rouge/news/communities/livingston-parish-man-pleads-no-contest-in-feticide-case-cut-unborn-child-from-wife-s/article_6352ade9-6f16-593f-9a08-33804bbb31b4.html
Maguen, S., Metzler, T.J., McCaslin, S.E., Inslicht, S.S., Henn-Haase, C., Neylan, T.C., & Marmar, C.R. (2009). Routine work environment stress and PTSD symptoms in police officers. Journal of Nervous and Mental Disease, 197(10), 754-760. doi:10/1097/NMD.0b013e3181b975f8.
Marin, K. (2021, Aug. 20). Vicarious trauma: Understanding traumatic stress in first responders [Blog]. Perimeter Platform. https://perimeterplatform.com/vicarious-trauma-understanding-traumatic-stress-in-first-responders/#:~:text=Experiencing%20vicarious%20trauma%20as%20a%20first%20responder&text=This%20process%20is%20exhausting%2C%20particularly,than%20to%20work%20through%20them.
Trauma can have devastating effects on the body and mind; physically, trauma can cause lethargy, exhaustion, fatigue, and racing heartbeats, among others; emotionally, trauma can cause anxiety, depression, post-traumatic stress disorder, and dissociation, among others. In the aftermath of a traumatic event, one of the most vital things one can do for oneself is practice effective self-care strategies. The traditional forms of care and support for survivors include cognitive behavioral therapy, dialectic behavior therapy, EMDR therapy, and prolonged exposure therapy. In addition to these therapies, self-care strategies that survivors should practice outside of treatment are also essential to aid in the healing process.
Utilizing self-care strategies can help trauma survivors heal in a variety of ways:
- Breathing exercises: Several breathing exercises can calm an individual when experiencing a stressful situation or flashbacks. The applications "Calm" and "Headspace" are excellent for beginners interested in using breath work to relieve symptoms.
- Journaling: Writing down thoughts and feelings is a great way to safely express one's emotions and feelings. Trying to suppress feelings and emotions will ultimately result in an even more intense outburst; regardless of how hard you try, those emotions will eventually surface. Journaling can provide insight into why and how the individual is experiencing the feelings they are experiencing, as well as being a very introspective experience. It's also helpful for assessing situations and coming up with solutions.
- Physical self-care: Taking a hot or cold shower, applying a face mask, and exercising are excellent self-care strategies. By taking a hot shower, you can stimulate the release of oxytocin in the brain. In contrast, a cold shower and exercise will produce endorphins responsible for boosting happiness and reducing stress. Cold conditions also stimulate the vagus nerve, which regulates internal functions that promote calmness and clarity by slowing down the sympathetic nervous system and activating the parasympathetic nervous system.
- Spirituality: Practicing gratitude, breath work, meditating, yoga, manifesting, and self-reflecting can be powerful tools to foster a new sense of being, leading to a better quality of life. Spirituality has been a vital part of my life for the past few years.
- Healthy eating habits: Eating unprocessed whole foods is the key to fostering a healthy body and mind. There is a direct link between our gut microbiome and our mental health. Instabilities in our gut flora can lead to various health issues, including brain fog, depression, and anxiety. It is possible to alleviate those symptoms by improving gut health. There should always be a balance; it's essential not to restrict oneself, and occasionally indulging is fine. Maintaining a healthy relationship with food can be difficult, but it is necessary for our mental well-being.
- Goal setting: Goal setting and creating a plan for the future is a great way to stay focused and excited about the future. During times of distress, focusing on the positive aspects of life can be difficult. It is helpful to remain present when one is working toward a goal.
- Music: Music is an essential source of comfort when facing mental challenges. It is an excellent form of self-care and helps to relieve trauma and negative emotions. It's a great way to express feelings and improve your mood and mind.
We all find it difficult to remember to take care of ourselves. Trauma can exacerbate these difficulties, making it easy to fall into a vicious cycle of self-destruction. In addition to more traditional forms of therapy, these self-care strategies are incredibly beneficial for healing trauma and promoting long-term recovery.
Self-care after trauma. RAINN. (n.d.). Retrieved December 12, 2022, from https://www.rainn.org/articles/self-care-after-trauma
Self-care after trauma. RAINN. (n.d.). Retrieved December 12, 2022, from https://www.rainn.org/articles/self-care-after-trauma
Self-care for PTSD. Mind. (n.d.). Retrieved December 12, 2022, from https://www.mind.org.uk/information-support/types-of-mental-health-problems/post-traumatic-stress-disorder-ptsd-and-complex-ptsd/self-care/
Traumatic flashback or stroke?
In her book, “Trauma and Recovery”, Dr. Judith Herman writes that, “remembering and telling the truth are two essential steps in the process of recovery”. Yet the neurobiological impact on the brain makes it nearly impossible for an individual to speak during or after the effects of a traumatic flashback. The phenomenon of a traumatic flashback operate as a vivid experience in which an individual is exposed to reliving some aspects of the traumatic event in the now. The composition of a traumatic flashback is said to be experienced as if watching a highlight reel of what happened but does not necessarily portray seeing images, events, and sensations in a chronological narrative.
An individual experiencing a traumatic flashback may experience any of the following:
- Seeing full or partial images of what happened
- Noticing sounds, smells or taste connected to the trauma
- Feeling physical sensations, such as pain or pressure
- Experiencing emotions that were felt during the trauma
Dr. Bessel van der Kolk, author of the critically acclaimed book, “The Body Keeps the Score”, recites results from a patient who was being medically observed at the time of their physiological reactions during a traumatic flashback. Van der Kolk expresses that the moment they turned on the tape recorder to play back an auditory narrative similar to the patient's traumatic experience, the patient’s heart began to race, and their blood pressure jumped immensely (van der Kolk, 2015). The sole exposure to hearing something remotely related to their trauma, despite occurring 13 years prior, activated specific areas of the left frontal lobe cortex of the brain, also known as Broca's area. The Broca's region is responsible for the functionality of speech and is often detrimentally affected in patients who have suffered from a stroke, an instance in which the blood supply to the brain region is cut off. Without the proper functioning of Broca's area, an individual is unable to emphasize their thoughts or feelings into words. The finalized results of the patient’s scan illustrated that Broca's area went off-line whenever a flashback was triggered. Highlighting the notion in which the effects of trauma are not necessarily different and can overlap with the effects of physical lesions like strokes (van der Kolk, 2015).
The holistic experience of trauma is curated through a variety of physical manifestations in the body. Even years later, individuals who have experienced trauma have enormous difficulty re-telling their story. A traumatized persons bodily composition becomes completely rewired and plagued with overwhelming emotions such as terror, rage and helplessness. The medical correlation between the physical complications of a stroke and the experience of a traumatic flashback is not to be understated. Strokes' effects on the body are often severe, similarly leaving an individual paralyzed or with the inability to speak for the remainder of their lifetime. Understanding the interplay between this phenomenon and the effects of trauma definitively highlights the intersectionality in which traumatic incidents have the ability to completely rewire the body's autonomy and in the worst cases, permanently.
Herman, J. (2015). Trauma and recovery. Basic Books.
Van der Kolk, B. A. (2015). The Body Keeps the Score: brain, mind, and body in the healing of trauma. Penguin Books.