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MDMA as the future of PTSD treatment

For decades, trauma survivors have been told that time heals, that talking about their pain in therapy can be a tool to let go of their pain, or that using medications can dull the symptoms and effects of their suffering. For many living with PTSD, the reality is far more complicated. Traditional treatments like antidepressants, cognitive behavioral therapy, and exposure therapy to their trauma may help some people, but others may continue to struggle with flashbacks, nightmares, anxiety, and disconnection from life. Studies have shown that MDMA, more commonly known as ecstasy or molly, is becoming more useful as a treatment for PTSD. While usually used as a party drug, MDMA is now at the center of multiple scientific studies regarding its effects on PTSD, and the results are eye-opening.

MDMA affects the brain in ways that make trauma therapy more effective, increasing serotonin, dopamine, and oxytocin, which are the chemicals linked to mood, bonding, and feelings of trust. In a therapeutic setting, MDMA can be used to make patients feel safer and more connected to their therapist, and less overwhelmed with the process of revisiting traumatic memories. Unlike traditional talk therapy, which may retraumatize some patients, MDMA-assisted therapy sessions can allow some survivors to re-engage with painful and traumatic memories without feeling fear or shame. This emotional buffer that MDMA gives patients allows them to process their experiences with clarity rather than avoidance.

According to the VA's National Center for PTSD, MDMA-assisted therapy happens in carefully controlled settings, only one to three settings each lasting six to eight hours, and spaced several weeks apart. Patients will lie down and listen to music while being watched by two therapists.

Research regarding MDMA as a successful treatment for PTSD is showing that while using MDMA as a tool for PTSD and trauma treatment, symptoms dropped significantly, with around two-thirds of recipients of MDMA no longer meeting the criteria for PTSD. It has been found that MDMA can also work with depression, disassociation, substance use and abuse histories, and childhood trauma. This type of therapy, while using a typical "party drug," was deemed safe and well tolerated by patients, with no increase in suicidal thoughts or health-related issues.

It is fascinating to think that a generally known "club" drug can be used to help folks with PTSD and trauma, and help them move past these experiences. While MDMA is still considered a Schedule 1 drug, meaning it is illegal for general medical use, its use is allowed in approved medical clinical trials. When used in a clinical setting with a trained therapist over multiple sessions, MDMA may offer a safe yet powerful route to healing that many PTSD sufferers have not had access to or attempted yet.

References:

MDMA-Assisted Therapy for PTSD. Va.gov: Veterans Affairs. (2025, January 15). https://www.ptsd.va.gov/understand_tx/mdma_assisted_therapy.asp

Riaz, K., Suneel, S., Hamza Bin Abdul Malik, M., Kashif, T., Ullah, I., Waris, A., Di Nicola, M., Mazza, M., Sani, G., Martinotti, G., & De Berardis, D. (2023). MDMA-Based Psychotherapy in Treatment-Resistant Post-Traumatic Stress Disorder (PTSD): A Brief Narrative Overview of Current Evidence. Diseases (Basel, Switzerland), 11(4), 159. https://doi.org/10.3390/diseases11040159

Breaking the Cycle: How Schools Can Better Support Trauma-Affected Students

Understanding the hidden connection between childhood trauma, special education, and harmful school disciplinary practices

Imagine a seven-year-old who has witnessed domestic violence at home. At school, loud noises make them freeze, unexpected touch causes them to lash out, and crowded hallways trigger panic responses. Teachers, unaware of the child's trauma history, see defiance and aggression. Eventually, the child is referred for special education services and classified with "emotional disturbance." They're placed in a specialized program where, when their trauma responses are misinterpreted as behavioral problems, they may face physical restraint, potentially re-traumatizing them all over again.

This scenario plays out in schools across America more often than we'd like to admit, creating a cycle of trauma that our educational system inadvertently perpetuates. 

My Background and Stake

My professional experience in educational settings has involved implementing restraint-based crisis intervention protocols, including Safety Care and Crisis Prevention Intervention (CPI) training. This firsthand exposure to restrictive practices has informed my understanding of their frequency of use and implementation challenges within educational environments. While developing proficiency in crisis intervention and de-escalation techniques, I have observed that physical restraint interventions often complicate subsequent therapeutic rapport and emotional support with students. The prevalence of these practices in settings where entry-level staff regularly implement physical interventions underscores the critical need for empirical examination of their effects on vulnerable student populations.

The Hidden Crisis in Our Schools

The statistics are sobering. More than two-thirds of children in the United States experience at least one traumatic event by age 16 (National Child Traumatic Stress Network, 2019). Yet when these children enter our classrooms, their trauma often goes unrecognized. Instead of seeing survival responses, educators may see "problem behaviors" that lead to special education referrals, with research showing significant correlations between childhood trauma exposure and special education identification (Perfect et al., 2016).

Once identified for special education, particularly under the "emotional disturbance" category, these students are disproportionately placed in alternative or specialized settings where physical restraint and seclusion are used more frequently (Ryan et al., 2018). During the 2017-18 school year alone, over 100,000 students experienced restraint or seclusion, with 80% of them being students with disabilities despite making up only 13% of the school population (U.S. Department of Education Office for Civil Rights, 2018).

When Help Becomes Harm

Here's where the cycle becomes particularly troubling: the very interventions meant to help these students may be causing additional harm. For a child whose trauma responses include hypervigilance, fear of losing control, or physical aggression as a survival mechanism, being physically restrained can trigger the exact neurological and emotional responses that their brain learned during the original trauma.

Research shows that restraint can exacerbate inappropriate behaviors and create new associations of fear, pain, anger, and trauma (Substance Abuse and Mental Health Services Administration, 2011). In essence, we may be re-traumatizing the children we're trying to help and then wondering why their behaviors aren't improving. Studies have documented this re-traumatization effect, showing that restraint use may worsen the very behavioral presentations that initially led to students' special education identification (Knox & Burkhart, 2014).

A Different Way Forward

There are evidence-based alternatives that can break this cycle. Trauma-informed practices in schools focus on understanding trauma's impact on learning and behavior, rather than simply managing the symptoms (Cole et al., 2013).

Key principles of trauma-informed education include:

• Safety first: Creating physical and emotional safety in all school environments
• Trustworthiness: Building consistent, reliable relationships with clear boundaries
• Choice and collaboration: Giving students appropriate control and involving them in decisions
• Cultural responsiveness: Understanding how trauma intersects with cultural and historical contexts
• Healing and resilience: Focusing on strengths and building coping skills (SAMHSA 2014)

Practical strategies might include:

• Teaching emotional regulation skills instead of relying on punishment
• Creating calm-down spaces where students can self-regulate
• Training staff to recognize trauma responses versus defiance
• Implementing restorative practices that repair relationships
• Providing mental health supports within the school setting (Overstreet & Chafouleas, 2016)

What This Means for Students, Families, and Educators

For students: Trauma-informed approaches can mean the difference between a school experience that heals versus one that harms. When educators understand that a student's aggressive outburst might be a trauma response rather than defiance, they can respond with support rather than punishment.

For families: Understanding this connection can help parents advocate for appropriate services and trauma-informed approaches. It also helps explain why traditional disciplinary methods might not be working for their child.

For educators: Learning about trauma doesn't mean excusing problematic behaviors, but rather understanding their root causes so interventions can be more effective. Many teachers report feeling more confident and successful when they understand trauma's impact on their students.

The Research We Still Need

While we know these connections exist, we need more research to fully understand how trauma, special education identification, and disciplinary practices intersect. Critical questions remain:

• How often are trauma symptoms misidentified as emotional disturbance?
• What specific interventions are most effective for trauma-exposed students in ED programs?
• How can we better train educators to recognize and respond to trauma?
• What policy changes are needed to support trauma-informed practices?

Moving Forward: From Punishment to Healing

Breaking the cycle of trauma in schools requires a fundamental shift in how we think about student behavior. The goal isn't to eliminate accountability or lower expectations, but to create educational environments where trauma-affected students can learn, grow, and thrive. When we get this right, we don't just improve outcomes for individual students, we contribute to breaking intergenerational cycles of trauma that affect entire communities.

As we continue to learn more about trauma's impact on learning and development, one thing is clear: our schools have the power to be places of healing rather than harm. The question is whether we're willing to make the changes necessary to ensure every child, regardless of what they've experienced, has the opportunity to succeed.

References

Cole, S. F., Eisner, A., Gregory, M., & Ristuccia, J. (2013). Helping traumatized children learn: Creating and advocating for trauma-sensitive schools. Massachusetts Advocates for Children.

Knox, M., & Burkhart, K. (2014). A multi-site study of the ACEs pyramid: Sedgwick County's traumatic experiences and their relationship to adult health and social issues. Wichita State University.

National Child Traumatic Stress Network. (2019). Child trauma toolkit for educators. https://www.nctsn.org/resources/child-trauma-toolkit-educators

Overstreet, S., & Chafouleas, S. M. (2016). Trauma-informed schools: Introduction to the special issue. School Mental Health, 8(1), 1-6.

Perfect, M. M., Turley, M. R., Carlson, J. S., Yohanna, J., & Saint Gilles, M. P. (2016). School-related outcomes of traumatic event exposure and traumatic stress symptoms in students: A systematic review of research from 1990 to 2015. School Psychology Review, 45(4), 406-439.

Ryan, J. B., Katsiyannis, A., Counts, J. M., & Shelnut, J. C. (2018). The growing concerns regarding the use of seclusion and restraint in schools. Intervention in School and Clinic, 53(3), 129-138.

Substance Abuse and Mental Health Services Administration. (2011). Trauma-informed care in behavioral services: A treatment improvement protocol. SAMHSA.

Substance Abuse and Mental Health Services Administration. (2014). Trauma-informed care in behavioral services treatment improvement protocol (TIP) series 57. SAMHSA.

U.S. Department of Education Office for Civil Rights. (2018). 2017-18 Civil Rights Data Collection: School climate and safety. U.S. Department of Education.

Paws for Resilience

Nearly every police officer at somepoint in their career has been asked to share the worst, most horrific call they’ve been on. The unfortunate truth is, officers experience far more than just a handful of critical incidents, with an average of 178 for mid-sized police departments (Jaeger, 2023), compared to the general population, which usually encounters two to four critical incidents in their lifetime. Studies have repeatedly shown that police officers have higher rates of Post Traumatic Stress Disorder (PTSD), at two to four times the rate seen in the general population. While the statistics are alarming, they are not meant to frighten, but to remind us that trauma exposure is part of the job, and wellness must be prioritized alongside it (Santre, 2024). In addition to numerous traumatic exposures, extended hours and excessive workload are significant sourcesof job stress that impact police officers’ mental health (Purba & Demou, 2019).

As a police sergeant and Critical Incident Stress Management peer, I have seen firsthand the traumas we face and the long-lasting negative impacts they can leave on both the officer and their families. Addressing the negative stresses in law enforcement agencies requires leaders to think outside the box and go beyond the traditional cultural norms that suggest officers can just handle post-traumatic issues on their own.

I’m leading the launch of something new for my agency: a facility canine embedded with our Critical Incident Stress Management (CISM) peer team. This isn’t your typical police patrol dog, nor a personal therapy dog, but a professionally trained service dog designed to support people during stressful moments. Organizations like Mutts With A Mission in Virginia Beach, Virginia, have been providing facility dogs to police agencies and courtrooms to “assist multiple people in coping after a traumatic event or overly stressful environment” (Mutts with a Mission, 2019). Moments such as a Critical Incident Stress Debriefing (CISD), roll calls after a bad call, family notifications, and even victim interviews are settings where these dogs can help those in the aftermath of a traumatic event.

Why Bring a Facility Dog to a Police Agency?

There is a substantial amount of research showing that a brief, positive interaction with dogs is linked to lower cortisol levels (a stress biomarker) and higher oxytocin levels (associated with bonding and calming) (Petersson et al., 2017). Combined with organizational peer support and crisis-focused interventions, such as a CISM Team, studies indicate that a more targeted intervention like a CISM team is associated with better outcomes than organizational interventions without a structured team (Anderson et al., 2020).

An agency with an already established peer team can incorporate facility dogs into these teams to serve as a powerful force multiplier. Just like an officer has a utility belt with various tools for different tasks, a facility dog is another versatile tool in the peer team's toolkit.

An Example of a Facility Canine in Practice

A major post-incident debrief took place after the fatal crash where a child lost their life. The room feels heavy, almost thick enough to cut with a knife, filled with anxiety and adrenaline. Attendees are caught between feeling numb and jittery. A facility canine lies beside the handler and acts as a social bridge to those he/she approaches. Even those who are crossed-armed and came in refusing to speak will reach down to scratch an ear. This is often followed by the individual beginning to speak. The facility dog served, for lack of a better term, as a breaching tool so the peer team could enter and work from there.

Expectations

Facility dogs will not fix organizational trauma, but they can open the door for trained peers to make a connection. By pairing this connection and providing evidence-based peer support, like those in the CISM model, we can help shift the culture and become more resilient.

Reference –

Jaeger, S. (2023, July 11). Perspective: The Impact of Life Experiences on Police Officers. FBI: Law Enforcement Bulletin. https://leb.fbi.gov/articles/perspective/perspective-the-impact-of-life-experiences-on-police-officers

Santre, S. (2024). Mental Disorders and Mental Health Promotion in Police Officers. Health Psychology Research, 12(93904). https://doi.org/10.52965/001c.93904

Purba, A., & Demou, E. (2019). The relationship between organisational stressors and mental wellbeing within police officers: A systematic review. BMC Public Health, 19(1). https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-019-7609-0

Mutts With A Mission. (2019). Mutts with a Mission. https://www.muttswithamission.org/facility-dogs-1

Petersson, M., Uvnäs-Moberg, K., Nilsson, A., Gustafson, L.-L., Hydbring-Sandberg, E., & Handlin, L. (2017). Oxytocin and Cortisol Levels in Dog Owners and Their Dogs Are Associated with Behavioral Patterns:An Exploratory Study. Frontiers in Psychology, 8. https://doi.org/10.3389/fpsyg.2017.01796

Anderson, G. S., Di Nota, P. M., Groll, D., & Carleton, R. N. (2020). Peer Support and Crisis-Focused Psychological Interventions Designed to Mitigate Post-Traumatic Stress Injuries among Public Safety and Frontline Healthcare Personnel: A Systematic Review. International Journal of Environmental Research and Public Health, 17(20), 7645. https://doi.org/10.3390/ijerph17207645

The Impact of Dogs on Resilience: Facility and Therapy Dog Programs to Enhance Officer Wellness Relationship Between Dogs and Resilience. (n.d.). https://www.theiacp.org/sites/default/files/278439_IACP_TherapyDogs_508c%5B1%5D_0.pdf

The People v. Vicarious Trauma Responses; Can a Prosecutor Cry?

In September of 2024, a defendant was instructed to “please rise” and face the jury foreman. The soft-spoken foreman reiterated a word of monumental gravity six times: “guilty”. One count of Rape in the First Degree, two counts of Criminal Sexual Act in the First Degree and three counts of Incest in the Third Degree stood then, not as before, as proven convictions rather than mere accusations. As a younger felony assistant, I bowed my heard into my arms and laid upon the table, all while the defendant was standing receiving the news of his fate, perhaps standing for the final time as a free man. The older assistant who worked on the trial with me looked at me and uttered, “first time?” as I laid my head on the prosecutor’s table, slumped over, holding back tears.

You know there is an old rumor around the district attorney’s office that if the prosecutor cries during a trial, it results in a mistrial. I have not done the research myself, but I imagine it is true. Witnesses are allowed to cry on the stand, certainly there is no rule regarding the defendant’s tears and acrimony, perhaps not for the defense attorney either. But as a prosecutor, we are made to stand tall. In September of 2024 during that trial, I had trouble keeping my emotions in check. A man raped his own daughter, I thought to myself! That is what we proved at trial and that is what the verdict of the jury cemented. The culmination of months of preparation, including meeting with and consoling a woman we all knew was raped by her own father, hinged on that one word. How could my counterpart—the other attorney on the case—not show any emotion? What tools did he possess that I did not? Does secondary stress not affect him?

It is not an easy task to prepare a rape case for a woman who was raped by her own father. Even worse, what if you know there is a good chance of losing at trial? Rape in New York is tricky business; the law does not necessarily recognize a victim who freezes and does not say NO. No means no, but what about freezing still while it happens? Well, that is what happened in this case, and sickeningly enough, the defendant had a decent case of arguing that the victim consented to having sex with her own father. Secondary trauma is knowing that a convenient quirk in the law could allow a rapist to walk. More to that point, what secondary trauma response would I have—if I have not already—if the defendant were acquitted?

I have seen other victims cry, sometimes into my arms, during meetings. This case, though, will stick with me. Sure, the victim cried during our various preparations, but it was the times she did not cry that were jarring. She would freeze. Perhaps, this was the same freezing that took place while her own father ejaculated in her. That look in her eye while she recalled that traumatic experience still sticks with me, and I am the professional who is supposed to not be bothered by it; in fact, showing too much emotion can cause a mistrial.

As a prosecutor, we are kept up at night by various things, often, they are tragic. In effect, the time I spend outside the job can resemble the “signals of a stress reaction” as elicited by Rousseau (2025). The symptoms of a stress reaction include: anxiety, guilt, grief, denial, and fear (Rousseau, 2025). As a result of handling cases that involve the stark trauma response of others, I find myself having many restless nights. My average bedtime is 1:30 a.m.; I need to wake up at 7:30 a.m. I feel like the job I do is important, but I also have to face the fact that I do not feel well or content. I would say I suffer from confusion, poor attention, poor concentration, and withdrawal, all factors identified by Rousseau (2025) as a stress reaction. I feel like, as prosecutors, our “trauma almost invariably involves not being seen, not being mirrored, and not being taken into account” (Van der Kolk, 2014, p. 97).

I often wonder if the adversarial system of justice is a way to disguise the shared trauma that criminal justice stakeholders face. If I am to act like I won a battle by getting a conviction, perhaps that can mask the depressing realities and facts behind the alleged criminal conduct. Much as a veteran in a war cannot win the war on his own, one prosecutor cannot win the war on crime. Knowing this futility, without distracting ourselves, can cause us to become “withdrawn and detached, even if [we] had functioned well before” (p. 30). Thus, I do think prosecutors are trained to be warriors, based on my experience, for this very reason: we will not work as hard if we realize there is a certain futility to all the hard work we do. Much like a veteran who returns from war and becomes detached, there are certain aspects of criminal law that mirror trauma responses. Instead, when confronted with stressful and traumatic experiences, “the greatest sources of our suffering are the lies we tell ourselves” (p. 31).

As of the writing of this post, another trial victory was secured by this writer. Eerily enough, a similarly soft-spoken jury foreperson recited the words “guilty” three times. Although not an incest/rape case like before, this case involved a child victim. This time, there was no holding my head in my arms on the prosecutor’s table, rather, I felt numb. This is not to say that I did not care, but I did not react. It provided me with a mental crossroads: would I rather feel emotionally invested or would I rather feel numb? By this point, I have felt both; I do not know which is scarier. Much like the original rape trial, this trial also involved weeks of preparation. Do you think it is easy preparing a 10-year-old child for trial testimony; is it easy explaining to the child’s parents that (in Spanish, which this writer learned how to speak) "nada malo va a suceder si ganamos el juicio, podemos pedir la corte por una orden de proteccion." That is, we often have to make assurance to crime victims that we will try to protect them even before we even know if guilty verdict will be reached.

Such experiences make the prosecutor an expert in what this writer calls street therapy. Van der Kolk (2014) notes that other professionals like teachers are “thoroughly schooled in emotional-regulation techniques” (p. 304). Believe you me that prosecutors receive no such training. We learn it as a matter of necessity, on a need-to-know basis. While “the cultures of Japan and the Korean peninsula have spawned martial arts” as a means to combat trauma responses, we have a diploma on a wall and our law license (all of which require much stress to obtain). While “other traditions around the world rely on mindfulness,” we rely on one or two words: “guilty” or “not guilty”. We are tasked with easing the minds and building up the mindfulness of the people we represent, but no one is really there to erect the prosecutor’s mindfulness.

On a similar note, we are responsible for the memories of victims who, as a result of their trauma, might forget critical details. Whereas in the confines of the psychiatrist’s office it may be perfectly fine for a rape survivor to not recall certain details to his or her therapist. On the witness stand, however, if a witness forgets something, it can be used against them, and by extension, against us. This is just the ghost in the machine of the criminal justice system; every defendant has a right to be tried and convicted upon competent evidence. But, as we know from the trauma research, traumatic experiences can render an otherwise competent person into an incompetent one. It is noted “how fickle memory” is on a good day; furthermore, “autobiographical memories are not precise reflections of reality; they are stories we tell to convey our personal take on our experience” (p. 261). As a prosecutor, is it any wonder that the trauma response of our victims are also the trauma responses of our own? We have to own their testimony; we take our victims as we find them. Thankfully, the way humans process traumatic events, like being forcibly raped by one’s own father, help provide veritable testimony as, “the adrenaline we secrete to defend against potential threats helps engrave those incidents into our minds” (p. 262).

A lawyer named Tom, a subject noted in Van der Kolk (2014), seemed to experience the same phenomena as this writer; “maybe the worst of Tom’s symptoms was that he felt emotionally numb” (p. 35). Anyone involved in the daily accrual of vicarious trauma, such as a prosecutor, has had days where he or she “could not really feel anything except for [their] momentary rages and [their] shame” (p. 35). Perhaps, I would prefer to feel emotional as I did during my first trial rather than the second one; “he always felt as though he were floating in space, lacking any sense of purpose or direction” (p. 35). I am proud of the job that I do, and I like to do it well. Good prosecutors, who are abundant in the office I work for, ensure the defendant receives a fair trial. But the vicarious trauma, as shown by the experiences of this writer, show how it can wear one down.

Rousseau, D. (2025). Signs and Signals of a Stress Reaction. Boston University.

Van, K. B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma.

The Effectiveness of Prolonged Exposure Therapy

There are various ways to address the impact of trauma, and no single approach is universally the best option. The effectiveness of a method largely depends on the individual seeking therapy. One particularly effective therapeutic approach is Prolonged Exposure Therapy (PE). This evidence-based behavioral treatment is grounded in the principle that repeated exposure to trauma-related stimuli can help reduce a patient’s distress in response to thoughts, memories, visual reminders, smells, or other triggers associated with their trauma (Rousseau, 2025). The key components of PE include psychoeducation, breathing exercises, gradual real-world practice, and open discussions surrounding the traumatic event itself (Rousseau, 2025).

What I find compelling about this approach is its ability to help individuals confront and process aspects of their trauma that they have actively avoided since the event. By guiding clients through the journey of shifting their mindset from “I can’t” to “I can,” PE encourages them to prove to themselves that they can face their fears, all within a supportive and structured environment provided by a trained therapist (National Center for PTSD, 2025). While the thought of revisiting trauma can be daunting, many individuals find that, with time and practice, it becomes increasingly manageable. The process of recounting one’s experience can facilitate healthier expressions of emotions such as anger, guilt, and sadness. After several months of therapy, many clients report a significant decrease in their emotional distress, allowing them to talk about their trauma with less overwhelm (National Center for PTSD, 2025).

I can relate to this therapeutic approach and can attest to its effectiveness in my own life. Initially, I was hesitant to continue discussing my trauma with my therapist, but by breaking it down into smaller steps, I found it easier to engage with the memories and feelings associated with my experience. It’s crucial to understand, however, that while this type of therapy can be transformative, it does not erase the trauma itself. Instead, it enables individuals to manage their experiences in a way that allows them to reclaim their lives. PE is suitable for both men and women, does not require medication, and has demonstrated significant improvements in symptoms, with some individuals no longer meeting the criteria for PTSD after completing the therapy (National Center for PTSD, 2025).

Prolonged Exposure Therapy is firmly backed by research, illustrating its efficacy across various studies. However, it’s also essential to recognize that PE may not be suitable for everyone; for some individuals, confronting traumatic memories can exacerbate their symptoms rather than alleviate them (Rousseau, 2025). Throughout the therapy process, clients routinely provide feedback on their distress levels, which have consistently shown a reduction. Tuerk’s research (2015) emphasizes the value of making this process meaningful for each participant by incorporating objective physiological assessments delivered through wireless technology and mobile applications. By visually tracking physiological responses over time, therapists can demonstrate to clients how their discomfort diminishes with consistent treatment. This evidence often provides positive reinforcement and reinforces the therapeutic benefits of PE.

References:

National Center for PTSD. (2025). Prolonged Exposure. U.S. Department of Veterans Affairs. https://www.ptsd.va.gov/appvid/video/index.asp

Rousseau, D. (2025). Exposure Therapy. Boston University.

Tuerk, Peter. (2015). Return from Chaos: Treating PTSD. TEDxCharleston. https://www.youtube.com/watch?v=ORs3-tRokGU&t=3s

Book Review: “Reviving Ophelia” by M. Pipher & S. Pipher-Gilliam

In a semi-recent review posted on GoodReads, a user had this to say about the nonfiction book “Reviving Ophelia”: “Girls lose themselves in adolescence just as Ophelia in Hamlet strives to please by changing herself into what she thinks others want… [The key theme of this book is] true self versus false self, dichotomy, and the importance of girls finding and staying with their true self while ignoring pressure from the culture to become a false self” (GoodReads, user Brittany, 2024). Though the book explores various scenarios and themes, including how different types of traumatic events affect the adolescent brain, this quote attempts to explain the major argument that the book’s two authors repeat throughout the text. When someone is exposed to trauma as a child or adolescent, the effect is lifelong since the trauma changes the mental and emotional structure of the brain. This is especially present in girls affected by trauma, since they are also socialized in a manner that breeds insecurity, depression, and apathy to pain.

            Pipher and her co-author (who also happens to be her daughter) dedicate chapters to specific issues faced by many adolescent girls: eating disorders, social anxiety, substance abuse, family issues, among others. Each chapter explores the current psychological understanding of these issues, then transitions into interviews with several former and current patients of Pipher’s who have dealt with the specific issue in discussion. It’s the striking differences in the professional explanations and the interviews that make this book a worthwhile read; it becomes clear in the first few chapters that current psychological research still has much to learn on how demographic factors change the expression of traumatic symptoms. Adolescent girls deal with unique forms of trauma and cultural socialization that can cause extreme forms of disordered thinking, feeling, and identity (Pipher & Pipher-Gilliam, 2019).

It’s Mary Pipher’s experience as a trauma therapist that informs her writing, along with the mother-daughter relationship at the center between her and her co-author, specifically in how they regard discussing identity and growth in young people. When discussing child abuse and separation of the true self, the authors have this to say: “[The therapist] encouraged her patients to recognize, grieve for, and eventually accept what happened to them as young children. Only then could they become authentic adults” (Pipher & Pipher-Gilliam, 2019, pg. 30). Again, the authors are bringing up the experience of splitting that occurs directly because of a traumatic event. When someone cannot deal with what has occurred (i.e. a severe traumatic experience), they have to create a new false self that denies and/or represses the traumatic event. This is especially seen in adolescent girls who suffer from trauma due to the patriarchal socialization that also occurs at this age. In many of the sections, the authors also make the important point that this fracture is critically stark in children whose home lives are unsafe, tying the subject back to the parent-child relationship.

The core thesis of the book culminates in one quote: “Our culture is one that runs from pain and treats suffering – which is an inevitable part of life – as an avoidable problem. It still teaches girls the values of junk culture: shop, stay thin, and buy or consume when you feel pain” (Pipher and Pipher-Gilliam, 2019, pg. 300). The reason for my choosing this quote is because it hits closest to the crux of the issue at hand, and specifically why trauma affects adolescent girls in a unique manner. The more that our culture avoids pain, especially if it is pain caused by ongoing trauma, the more that it will harm the upcoming generation growing in this environment.

References

GoodReads. (2024). “Brittany’s Reviews: Reviving Ophelia.” GoodReads. https://www.goodreads.com/review/show/1301704659

Pipher, M. & Pipher-Gilliam, S. (2019). “Reviving Ophelia: Saving the Selves of Adolescent Girls (25^th Anniversary Edition).” Riverhead Books.

The Importance of Post-Critical Incident Debriefs for First Responders

First responders—police officers, firefighters, paramedics—face trauma as a routine part of their jobs. They witness tragedies, violence, and loss that most people cannot imagine. While a single traumatic event can be deeply impactful, what’s often overlooked is the cumulative effect of repeated exposures to critical incidents. Research shows that police officers experience PTSD rates up to three times higher than the general population, with estimates suggesting that as many as 30% of officers will suffer from PTSD symptoms during their careers (Maguen et al., 2009). This cumulative trauma can cause emotional exhaustion, burnout, and contribute to a host of mental health challenges if not properly addressed. That’s why post-critical incident debriefs are not just helpful—they’re essential.

Critical Incident Stress Debriefing (CISD) is a structured process designed to help first responders process their emotional responses to traumatic events soon after they occur. CISD typically involves seven phases, beginning with fact sharing, moving into emotional expression, and concluding with education about stress reactions and coping strategies. The goal is to create a safe environment where responders can openly discuss their experiences without fear of judgment or professional repercussions. This separation from investigatory or disciplinary proceedings is vital to building trust in the process.

The benefit of these debriefings is twofold. First, CISD helps to reduce acute stress reactions and prevents these early symptoms from developing into chronic conditions such as PTSD. Early intervention is critical because repeated unprocessed trauma compounds over time, increasing the risk of severe psychological distress. Second, these sessions foster team cohesion and social support—both protective factors shown to mitigate the effects of trauma. Sharing experiences with colleagues who understand the unique pressures of the job builds resilience and strengthens working relationships.

One of the most urgent reasons to implement post-incident debriefings is their potential to reduce the risk of suicide among first responders. Suicide rates for law enforcement and firefighters are alarmingly high—estimates suggest they are between 1.5 and 3 times greater than the general population (Violanti et al., 2018). Factors like cumulative trauma, stigma around mental health, and concerns about career consequences often prevent officers from seeking help until crises occur. Debriefing programs, combined with ongoing peer support and leadership advocacy, can reduce stigma by normalizing conversations about mental health and encouraging early help-seeking behaviors.

However, despite clear evidence supporting the benefits of CISD, many agencies struggle with consistent implementation. Barriers include insufficient training for debrief facilitators, cultural norms emphasizing toughness and self-reliance, confidentiality concerns, and limited organizational resources. Overcoming these challenges requires committed leadership, policy development, and education to promote mental health as a core aspect of officer wellness. Agencies can also enhance access by integrating debriefings into regular shift schedules and ensuring mental health professionals facilitate sessions.

Finally, it’s important to note that CISD is one part of a comprehensive approach to managing first responder mental health. Pre-crisis education, ongoing wellness programs, peer support networks, and access to confidential counseling services all contribute to reducing the cumulative burden of trauma. When combined, these efforts create a culture that values mental well-being as much as physical safety, ultimately benefiting both the responders and the communities they serve.

In conclusion, given the high rates of PTSD and suicide among first responders, post-critical incident debriefings are a critical tool for early intervention and resilience building. By addressing trauma promptly, fostering social support, and reducing stigma, these programs help protect the mental health of those who put themselves on the line every day to keep others safe.

References:

Maguen, S., Metzler, T. J., Bosch, J., Marmar, C. R., & Neylan, T. C. (2009). Routine work environment stress and PTSD symptoms in police officers. Journal of Traumatic Stress, 22(6), 615–622. https://doi.org/10.1002/jts.20466

Violanti, J. M., Mnatsakanova, A., Andrew, M. E., & Burchfiel, C. M. (2018). Police stressors and health: A state-of-the-art review. Policing: An International Journal, 41(6), 642–656. https://doi.org/10.1108/PIJPSM-03-2018-0037

International Critical Incident Stress Foundation. (n.d.). Critical incident stress debriefing. https://icisf.org/critical-incident-stress-debriefing/

Supporting Mental Health in Law Enforcement

Police officers see and experience more trauma than most people can imagine. Despite the mental and physical toll that comes with the job, they don't seek help when they most need it. Why, you might ask.

It's because they're afraid.

They're afraid of being seen as weak, as incapable of doing their job. That they will be seen as unfit and get downgraded to a "safer" version of their position. Aside from the fear in terms of logistics, they're worried they'll be humiliated by colleagues in the same position as them who still view emotional pain as a character flaw.

What most do not realize is that not addressing trauma doesn't make it go away; it only buries it deeper until it resurfaces more assertively and aggressively.

Daily Reality - Trauma Not Just a One-Time Thing

Most often, we associate PTSD in police officers who go through huge traumatic events such as shooting or hostage situations. Research shows that routine police work can be equally as traumatizing, and at times could be even more traumatizing (Maguen et al., 2009).

Every day issues, such as the lack of leadership support, poor communication, overwhelming workload, and unclear roles, can increase PTSD symptoms significantly. These stressors within the organization accumulate quietly in the background, creating an environment where officers constantly feel on edge.

Why?

Let's delve a little deeper into the reason why officers don't seek help. When we look at police culture, it's a culture that rewards toughness. So the way the officer views it is they admit that they are struggling, then that equates to them being a failure.  They feel that they entire reputation within the department lies on their toughness.

Research completed by the International Critical Incident Stress Foundation (ICISF) outlines several common fears among officers. These include concerns about losing their job, having their license to carry a firearm revoked, being reassigned to a less desirable position, or becoming the target of ridicule and social isolation within the department. These fears, though rarely spoken out loud, are deeply embedded in the culture of law enforcement and act as major deterrents to seeking help.

So although resources like Critical Incident Stress Debriefing (CISD) may be present, and accessible to officers, they may still avoid them, afraid that if they participate, it could label them as unstable or unreliable (ICISF, n.d.).

Let's Reframe the Meaning of Strength 

What we've done is normalize this type of culture, but it doesn't have to be this. We can change the way law enforcement agencies handle mental health.

One critical change we can focus on is the strengthening of peer support programs, as well as Employee Assistance Programs also known as EAPs. The biggest emphasis that needs to be put on these programs is that they must fully and truly be confidential. Without that trust none of these programs will work, and it will only push officers away from using them.

Another equally important change is making sure to implement compassionate and clear policies, where officers feel reassured that accessing mental health support will not lead to any consequences. Seeking help should not automatically trigger reassignment, suspension, or removal of firearm privileges unless there is a clear and documented safety risk (Maguen et al., 2009).

And maybe for the most transformative role, leadership. When leadership, respected officer, and heads of departments share their own personal experiences and struggles it will encourage others to do the same. It will create a ripple effect due to them acknowledging their struggles. By modeling openness and self-care, they challenge the outdated notion that strength means silence.

Finally, emotional processing must be normalized. CISD and other debriefing programs should be routine following traumatic events, not as a sign of weakness, but as a standard part of officer care and team building (ICISF, n.d.).

A Take From Restorative Justice

The contemporary shift in police mental health aligns closely with principles articulated in restorative justice. Armour and Umbreit (n.d.) articulate forgiveness in The Paradox of Forgiveness as a process that involves facing pain, not avoiding it. This commitment is insufficiently captured by passivity; rather, it requires the courageous willingness to engage with the most difficult dimensions of our shared humanity.

The same applies to officers confronting trauma. When an officer turns toward mental health resources, it should be seen as a bold and transformative act of courage. I believe it allows officers to process the things they have experienced, gives them time to reframe their emotions, and to just sit in it for a bit. This will allow them to move forward with a renewed sense of purpose and clarity,

It Doesn't Have to Be This Way

Law enforcement doesn’t have to be emotionally destructive. When the right support, leadership, and policies are implemented, a system where officers feel empowered to take care of themselves, and of their mental health will flourish.

References

Armour, M. P., & Umbreit, M. S. (n.d.). The paradox of forgiveness in restorative justice. In L. W. Everett (Ed.), Handbook of Forgiveness.

International Critical Incident Stress Foundation (ICISF). (n.d.). Critical Incident Stress Debriefing. In Training Manual, Chapter 4.

Maguen, S., Metzler, T., McCaslin, S., Inslicht, S., Henn-Haase, C., Neylan, T., & Marmar, C. (2009). Routine work environment stress and PTSD symptoms in police officers. Journal of Nervous & Mental Disease, 197(10), 754–760. https://doi.org/10.1097/NMD.0b013e3181b975f8