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An Unspeakable Horror

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.

References

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.

Music Therapy For Trauma

For this blog post I am going to be looking at a treatment approach for PTSD that was not mentioned in the modules or readings. However, I believe that this approach uses very similar concepts as approaches we have explored in the course. The treatment approach I will be focusing on is music therapy, specifically for individuals who suffer from PTSD or childhood trauma. Music therapy can be implemented in two different ways: passively or actively. Passive music therapy is the act of listening music to relax, improve mood or allow the listener to focus on something else besides a difficult or triggering memory (Robb-Dover, 2021). Active music therapy on the other hand is the act of creating music to relax or process negative emotions or memories (2021). In this post I will discuss these two different approaches to music therapy for trauma survivors and the concepts from the course that they have in common. I will also discuss some of the limitations and criticisms of music therapy as well as my personal thoughts on the approach.

Active music therapy, especially the actions of singing a song or singing along in a group can be very therapeutic for trauma survivors. Singing can create a sense of social reciprocity because it relies on being connected to the rhythm and lyrics of a song and to sing at the same time as others in a group (Hussey et al., 2008). Singing can also allow an individual to process trauma and re-contextualize it in a musical setting. For example, if an individual relates strongly to the lyrics of a particular song, singing this song can create an emotional outlet and a safe space to process trauma (Steward, 2018).

Passive music therapy allows listeners of music to momentarily lose a sense of time, space and even personal identity while maintaining an overall sense of being and feeling (Sutton & De Backer, 2009). This also allows listeners to process their trauma in a different context than originally experienced which can allow for growth and resilience. After hearing music or musical stimuli, a therapist can guide the listener through processing what they have heard and connecting it to personal experiences. While this process allows individuals to be mindful of musical patterns, it can also increase mindfulness of feelings and stimuli in the real world. Therefore, music therapy is often paired with cognitive behavioral therapy (Hussey et al., 2008).

Both approaches use theories that we have discussed throughout the course. Specifically, the fact that trauma affects neurobiological processes, especially those that recognize stimuli and discriminate between threats and non-threats (Rousseau, 2022). Dr. Van Der Kolk stated that this trauma is encoded in the brain as a physical sensation and becomes difficult to express vocally or verbally (2015). PTSD sufferers are also much more sensitive to dopamine reception which can leave them at risk of developing substance use disorders (Brodnik et al., 2017). Music allows a dopamine releasing activity that is much healthier than using controlled substances and can even promote the creation of new neural pathways that are necessary for healing from trauma (Bronson et al., 2018).

Music is of great interest to me as an area of study which I got to explore in some of my undergraduate courses. It is also of great personal interest to me as I play multiple instruments and my mother is a music teacher. Music for me has been a great source of both relaxation from stress and social connection by listening to or playing music in groups. The biggest obstacles of this approach from my perspective are lack of structure across approaches and the risk of exposure to inadvertently triggering stimuli. Lack of structure because becoming a dedicated music therapist is very difficult and creating personalized approaches to care for this type of therapy is very important. Therefore, if an individual is simply exposed to music or tasked with learning how to create music in an unstructured format, they are at risk of either becoming discouraged or even further traumatized by the stimuli around them.

Sources:

Brodnik, Z. D., Black, E. M., Clark, M. J., Kornsey, K. N., Snyder, N. W., & España, R. A. (2017). Susceptibility to traumatic stress sensitizes the dopaminergic response to cocaine and increases motivation for cocaine. Neuropharmacology, 125, 295–307. https://doi.org/10.1016/j.neuropharm.2017.07.032

Bronson, H., Vaudreuil, R., & Bradt, J. (2018). Music therapy treatment of active duty military: An overview of intensive outpatient and longitudinal care programs. Music Therapy Perspectives, 36(2), 195–206. https://doi.org/10.1093/mtp/miy006

Gooding, L. F., & Langston, D. G. (2019). Music therapy with military populations: A scoping review. Journal of Music Therapy, 56(4), 315–347. https://doi.org/10.1093/jmt/thz010

Hussey, D. L., Reed, A. M., Layman, D. L., & Pasiali, V. (2008). Music therapy and complex trauma: A protocol for developing social reciprocity. Residential Treatment For Children & Youth, 24(1-2), 111–129. https://doi.org/10.1080/08865710802147547

Robb-Dover, K. (2021, November 3). How music is therapy for PTSD and other mental illnesses. FHE Health – Addiction & Mental Health Care. Retrieved December 12, 2022, from https://fherehab.com/learning/music-therapy-ptsd-mentall-illness#:~:text=Music%20therapy%20for%20PTSD%20can,positive%20part%20of%20self%2Dcare.

Rousseau, D. (2022). Trauma and Crisis Intervention

Stewart, K. (2018). All roads lead to where I stand: A veteran case review. Music and Medicine, 10(3), 130. https://doi.org/10.47513/mmd.v10i3.621

Sutton, J., & De Backer, J. (2009). Music, trauma and silence: The state of the art. The Arts in Psychotherapy, 36(2), 75–83. https://doi.org/10.1016/j.aip.2009.01.009

CTE and Law Enforcement

Growing up in high school, one of my favorite movies was Concussion, which covers the issues of concussions, CTE and their effects on players in the NFL. When we started talking about the brain functions and how they correlate to traumatic events, I found some research that discussed how law enforcement can suffer from CTE as well. Understanding the long term effects of Chronic Traumatic Encephalopathy (CTE) in law enforcement can help with strategies of improving officer mental health in the long run. CTE is a degenerative brain disease that is usually found in people who have suffered from concussions or other hits to the head which trigger a protein, Tau, to form in the brain. The protein, Tau, can deteriorate brain tissue which usually results in the individual suffering from side effects such as memory loss, confusion, impaired judgment, impulse problems, aggression, suicidal tendencies, dementia, etc. When we talk about CTE its usually regarding professional athletes and military personnel, there is not much of a discussion regarding law enforcement personnel.

Technically, the only way to see if someone has suffered from CTE, is performing an exam on that person’s brain after they have died to see if the protein, Tau is present. When we think of people constantly hitting their heads or being a part of blasts, we think of athletes and military personnel. However, SWAT members experience exposure to low-level blasts, as well as law enforcement personnel can experience different exposure to gunshots from training and in the field. Subsequently, law enforcement personnel could be suffering from CTE, however it is going by undedicated and instead thought as PTSD.

CTE does need to be studied more inside the law enforcement community to see how the rates of it are impacting law enforcement. We are aware that law enforcement personnel suffer from mental health issues and that they struggle with reaching out for help. There are different interventions that can be made if CTE is more established as an issue. This includes medical interventions, critical incident management teams, and training/education to law enforcement. Medical interventions could include assessing who in law enforcement is more at risk of developing CTE. For example, in Florida a bill was passed in 2018 that basically established that for under certain circumstances, a first responder can medically retire under workers compensation for a PTSD diagnosis. Implementing a critical incident management team would be highly impactful to assist officers when they suffer from a traumatic event. It can remove the stigma surrounding asking for mental health therapy while also serving as a look at who could be showing early signs of PTSD and CTE. Lastly, educating officers on signs of PTSD and CTE could be greatly impactful on their awareness for themselves and their fellow officers. There are plenty of situations in this field where you could be exposed to PTSD or CTE and raising awareness of that could save officers lives. Overall, acknowledging the risk of CTE in law enforcement could reduce the number of officer suicides, not to mention self-destructive behavior that officers can develop and ruin not just their life but their families lives as well.

Reference:

Rousseau, D. (2022). Module 6: Trauma and the Criminal Justice System

Walsh, M. (202, August 4). What is the prevalence of chronic traumatic encephalopathy (CTE) in law enforcement? Police1. Retrieved December 12, 2022, from http://www.police1.com/treatment/articles/what-is-the-prevalence-of-chronic-traumatic-encephalopathy-cte-in-law-enforcement-xdFEAJObPoByLM9y/

Our Bodies Reactions to Childhood Trauma

By Krystle Ramdhanie December 12,2022

*Warning* May contain some triggering information*

A time in our lives when we are in our most innocent stage of our life, our childhood. Most people hear the word childhood and think of all the wonderful memories like riding their first bicycle, ice cream trucks, birthday parties, playing in the snow or a fond memory of an activity with a parent that replays in their minds when they see or smell something familiar. Then there are some of us who hear the word childhood and we completely have a blank thought, our stomachs began to twist a bit, or we start to feel nervous, anxious, or angry. This is because CDC research shows more than 60 percent of American adults have as children experienced at least one ACE (Adverse Childhood Experience), and almost a quarter of adults have experienced 3 or more ACEs, likely an underestimate. Childhood or early childhood trauma can occur in many different forms from physical or sexual abuse, witnessing a traumatic event, witnessing domestic violence, bullying, mental abuse, and sometimes situations like refugee trauma or natural disasters. As children we often are unable to fully process what is happening to us, especially in cases of physical, mental or sexual abuse we tend to blame our selves as children or convince ourselves that the person did not mean to do it to us. As we develop and grow into adults our brains block out these horrific event until we are reminded of them in some way as adults. How does this trauma affect our bodies, well our bodies and our brains are built to protect us from imminent danger, we call this the fight or flight response where our brains release stress hormones like epinephrine, cortisol and adrenaline in response to it.  The effects of childhood trauma can last well into our adulthood and effect our health and lifestyles choices. There is a higher likelihood of developing chronic illnesses in adults because of the trauma they experienced as children, they are more likely to engage in high-risk activities, poor dieting and more likely to develop depression. "Exposure to trauma during childhood can dramatically increase people’s risk for 7 out of 10 of the leading causes of death in the U.S.—including high blood pressure, heart disease, and cancer—and it’s crucial to address this public health crisis, according to Harvard Chan alumna Nadine Burke Harris, MPH ’02." Trauma puts so much strain on our bodies as we internalize the pain and events that happened to us as children. As this trauma is stored in our bodies it releases hormones at higher than normal levels that begin to impact our mental and physical health. Headaches, upset stomach, muscle tension, and fatigue are just a few of the other things that happen to our body as we store trauma in it. Research has proven that children who experienced severe trauma such as verbal, physical or emotional abuse or lived with drug or alcohol abusers were 50% more likely to develop cardiovascular disease later on in life than those who had low exposure to childhood trauma. 

But why just blog about how trauma affects our bodies, while taking this course I began to face a lot of my own traumas. At the beginning of it I became very ill and was sick for weeks trying to recover but it just felt like my body would not bounce back from this illness. The more I read the more I realized that maybe because of the trauma I had experienced as a child and not properly facing it, I myself developed all these other physical health issues. Compromised immune system, hypertension, chronic migraines, sleeping disorder, eating disorder, heart palpitations and several autoimmune diseases, and depression are just some of the things I battle with daily. I grew up in Roxbury, an inner city town that people referred to as "the ghetto", young parents who barely knew what they were doing but trying to survive, I encountered my first trauma when I was just 4 years old. An older male cousin you molested me for 3 years until my parents moved to another part of Roxbury, and when I thought I had finally gotten away from the pain of that my father began using drugs and physically abusing me to punish my mom when she didn't give him money to support his habits. There were nights I would just pray to die and other night I would just forget about what happened, but after reading The Body Keeps the Score by Bessel Van Der Kolk, I started remembering about nights when I would get beat and I would go to the bathroom and stick my fingers down my throat to vomit just so I would forget the pain from the belt. I realized that in fact these health issue were indeed a direct response to my trauma. Van Der Kolk says “As long as you keep secrets and suppress information, you are fundamentally at war with yourself…The critical issue is allowing yourself to know what you know. That takes an enormous amount of courage.”. The more trauma we suppress the more danger we put our bodies through, our minds begin war with our bodies and lead to dangerous outcomes. 

There are ways to prevent this from taking over your life and healing from the trauma. Therapy is at the top of the list, starting it as soon as possible is the best. Working through traumatic events with a therapist helps your body and brain understand and process the memories of your trauma. Practicing calming techniques or mindfulness practices like yoga, meditation or breathing exercises help with decreasing your anxiety and redirecting negative thoughts around your trauma. Establishing healthy lifestyles like introducing exercise routines, better sleeping habits, avoiding alcohol and drug consumptions also help your brain rewire giving you space to slowly process all you have been through. Working these into our lives help us find a way to make peace with the trauma we are at war with and helping our bodies recover to live longer and healthier lives.

“The essence of trauma is that it is overwhelming, unbelievable, and unbearable. Each patient demands that we suspend our sense of what is normal and accept that we are dealing with a dual reality: the reality of a relatively secure and predictable present that lives side by side with a ruinous, ever-present past.”
― Bessel A. van der Kolk, The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma

https://www.heart.org/en/news/2020/04/28/traumatic-childhood-increases-lifelong-risk-for-heart-disease-early-death

https://www.cdc.gov/washington/testimony/2019/t20190711.htm#:~:text=CDC%20research%20shows%20more%20than,likely%20an%20underestimate%5B5%5D%20.

https://www.hsph.harvard.edu/news/hsph-in-the-news/childhood-traumas-devastating-impact-on-health/#:~:text=Exposure%20to%20trauma%20during%20childhood,Burke%20Harris%2C%20MPH%20'02.

https://www.webmd.com/mental-health/features/emotional-trauma-mind-body-connection

van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Viking.

Genocide, Slavery, and the Traumatic effects on the African American Community

It can be extremely difficult, as a black person, to reflect back on the atrocities that have taken place such as slavery on African American people  in our country. The outrageous monstrosity of what has occurred and has been afflicted on the African American race for many, many years imprinted trauma in a ways that can not be removed. There are ways my people and I have been traumatized by the memories and are still having to navigate through injustices that still happen systemically in our Justice system. Police shootings, mass incarceration and even unfair opportunities when it comes to employment.

That said, my community still has more to work to do. At times I feel that we fall in line with what has been norm to us and don't take a stand on the mistreatment that is handed to us. Like the Reserve Police Battalion 101, discussed in our course readings, I have realized that although genocide was happening via Holocaust, these soldiers ended up overlooking, because of the trauma endured, ordinary men became murderers.

Aryanne

Service Dogs Blog Post

For my blog post, I chose to further my previous post on the therapeutic approach of having a service dog to help address trauma. The therapeutic approach to addressing the impact of trauma that I originally chose was service dogs. The purpose of having a service dog for someone with trauma is to help aid them in times where the owner's symptoms prevent them from being able to do a task. For instance, some of the more basic services that these dogs can provide are, "to guide a disoriented handler, find a person or place, conduct a room search, signal for certain sounds, interrupt and redirect, assist with balance, bring help, bring medication in an emergency, clear an airway, and identify hallucinations" (Rousseau, 2022). Service dogs not only help people with PTSD, but can help people with all different types of disorders, whether from trauma or other similarly mentally altering experiences. They are also commonly used for people who are blind, for those who have seizures, and for those with severe anxiety, from what I have witnessed.

Some people prefer to have their service dogs where a vest, so that people do not try and pet or distract the dog from doing its task (servicing his/her owner). These vests tend to say things like "working dog", "do not pet", or "service animal", etc. in hopes that people will leave the animal be while it is actively working. It is crucial that service dogs stay completely focused on their task while they are "on duty". However, some people have used the term "service animal" lightly and as an excuse to be able to bring their dog(s) from home and into stores with them. This could especially be concerning if the fake service dog reacts to the real service animal, and in turn, distracts the service dog from staying focused. 

Although service dogs are great for aiding people with trauma, they are in no way capable of completing relieving one of the symptoms that they experience. Unfortunately, none of the therapeutic approaches addressing trauma can guarantee to completely cure someone of their trauma, but they most certainly can help a great deal. Overall, these dogs focus on ways to support their person before, during, and after a trigger may occur. In some instances, a service dogs actions could be the difference between life or death for someone who cannot get the help for themselves. Service dogs are very effective for many people who have trauma, and they can make for a great therapeutic approach in addition to other forms of therapy.

As mentioned before, even for people that are not diagnosed with PTSD, but who have mental health related issues, service dogs can be great. Additionally, other types of animals can be just as therapeutic, as we are continuing to learn about the benefits of animals with mental health. I personally have met people who struggled with trauma or their mental health, and had a service animal other than a dog. Although the animal may not be able to do certain tasks that a dog could, not everyone has the same opportunities to own a dog. Therefore, other (smaller) animals are still helpful in providing that 24/7 comfort to someone who struggles with their mental health and may need in order to function throughout their day.

References:

Rousseau, D. (2022). Module 4: Pathways to Recovery: Understanding Approaches to Trauma Treatment. Blackboard

By: Cameron Kunkle

Workplace Violence in the Emergency Department

Workplace violence (WPV) in the emergency department is entirely too common. Emergency medicine has one of the highest rates of WPV each year (Hartnett & Jasani, n.d.). The movement against WPV in healthcare is geared toward resources for nurses, as they spend the majority of the time with a patient, but it is an important factor for techs, CNAs, doctors, and any healthcare staff present in the midst of an incident. I have worked in the emergency department for about seven or eight months now and I have seen and heard of at least five or six different incidents of WPV, one of them being my own experience. The types of WPV range from tight grips in which a patient refuses to let go (this was the matter in my case) to having bones in the face or hand broken to the point where someone's career is ended. During my orientation on the job, I was informed that the reason we have signs for some patients saying "see patient's nurse before entering room" is because a nurse was killed by a patient when she was not fully informed of the background of a patient.

This leads to primary trauma being prevalent on the job for healthcare workers as well as the already established secondary (vicarious) trauma that is frequently experienced by first responders in the field and in the emergency room. One of the first steps to resolving WPV as a whole is to know how often it is happening, who is perpetrating it, and who is being targeted. One of the main barriers to this is the fact that staff often do not know what acts constitute violence (Stene, Larson, Levy, & Dohlman, 2015). I was surprised that my incident had to be reported as WPV. It was scary, of course, because the guy was like 6'5", 200-something pounds, psychotic, and wouldn't let go of my wrist that he was holding incredibly tightly, but it didn't seem like a particularly violent act (though my wrist was and still is sprained). It wasn't until I had to document the report (because security had to be called) that I was told by a senior nurse that the proper documentation would be listed under WPV.

Most healthcare workers in the emergency room report that they feel that violence is an expected part of their job as a part of the emergency department (Hartnett & Jasani, n.d.) I think that part of this is due to the fact that many times, even when not necessarily indicated, police will bring in patients who are a risk for violence. Then when we try and press charges because we've been assaulted, the police will often want to leave that patient at the hospital because they don't have the resources to deal with them or believe they still have to be treated, even when the doctors have cleared the patient. This also leads to a large number of healthcare workers not pressing charges against those who perpetrate WPV. Even when our employers back us up, this lack of support from the other emergency services that exist for purposes such as responding to WPV leads to a sense of learned helplessness. Asking for help feels like it won't do that much, so people don't ask for help. We just expect this to be a part of the job.

This expectation, primary trauma, and secondary trauma are all significant factors leading to professional burnout and stress disorder symptomology (not to mention the actual physical trauma that often accompanies WPV).

References

Hartnett, E., Jasani, G. (n.d.) Emergency Medicine on the Frontline: Workplace Violence in the Healthcare Setting. AAEM and Student Association. Retrieved from https://www.aaemrsa.org/advocacy/resources/workplace-violence

Stene, J., Larson, E., Levy, M, & Dohlman, M. (2015). Workplace violence in the emergency department:
Giving staff the tools and support to report. The Permanente Journal, 19(2), 113-117. doi: 10.7812/TPP/14-187