Home

Seeking the Appropriate Care for Mental Illness

Medication is a common approach used to treat many forms of mental illnesses, including depression, anxiety and PTSD.  It is estimated that approximately 242 million adults in the United States, roughly one in six Americans, take prescription psychiatric drugs (Fox, 2016).  Many people who experience mental health issues seek care from their primary care physician, rather than a mental health expert, which can lead to several issues. 

Psychiatric medication is not a bad thing, as long as prescribed by a mental health professional and it is not abused.  In fact, medication can be very useful in treating symptoms of mental illness.  However, research conducted by the Center for Disease Control and Prevention, has shown that going directly to a primary care physician without consulting a mental health professional, could result in the patient being prescribed the wrong medications (Smith, 2012).  This research also revealed that many people who go directly to their primary care physician for help with mental illness may not be made aware of other evidence-based therapies that could help them (Smith, 2012).  According to Dr.Rousseau,“most literature regarding pharmacotherapy stresses that it works more effectively in tandem with other treatments rather than individually” (Rousseau, 2019, p.12).  Some forms of therapy have been found to be more effective then medication alone, for example, a study using EMDR to treat PTSD, showed that EMDR was more effective than Prozac (Van der Kolk, 2015).      

Medications alone do not cure mental illness, they reduce symptoms by manipulating neurons and neurotransmitters (Rousseau, 2019).  Without curing the underlying issue, the patient will never recover and will need to stay on the medication(Van der Kolk, 2015). This could result in medications being used long-term, which could make them habit forming (Holmes, 2016).  A study conducted by the Agency for Healthcare Research and Quality, found that 84% of participants in the study who reported taking psychiatric pills, reported they had been taking medication for two years or more (Holmes, 2016).  Another factor is that all medications have side effects, so long term use could cause other health issues. 

Although it may be comforting to go to a primary care physician because a relationship has already been established or because medication seems like a quick fix, the best option is to see a mental health professional for mental health issues.  Mental health professional have been specially trained to give proper diagnoses and are able to offer more treatment options then medication alone.   

Work Cited:

Fox, M. (2016, December 12). One in 6 Americans take antidepressants, other psychiatric drugs. Retrieved April 28, 2019, from https://www.nbcnews.com/health/health-news/one-6-americans-take-antidepressants-other-psychiatric-drugs-n695141 

Holmes, L. (2016, December 15). Study Shows Taking Mental Health Medication Is Incredibly Common. Retrieved April 28, 2019, from https://www.huffpost.com/entry/psychiatric-medication-use_n_58515e35e4b0e411bfd49171

RousseauD. (2019). Module 4. Pathway to Recovery: Understanding Approaches to Trauma Treatment. Lecture, BU Blackboard Learn

Smith, B. (2012, June). Inappropriate prescribing. Retrieved April 28, 2019, from https://www.apa.org/monitor/2012/06/prescribing

Van der Kolk, B. (2015). The body keeps the score: Brain, mind, and body in the healing of trauma. Penguin Books.

Model Mugging and the Impact of Trauma Aware Self-Defense

While many self-defense organizations teach important moves that could protect someone during an attack, those moves are useless if they cannot be recalled in a moment of panic. Bessel Van der Kolk (2014) explains how, in situations of danger or panic, “...the old brain takes over, it partially shuts down the higher brain, our conscious mind, and propels the body to run, hide, or fight, or, on occasion, freeze. By the time we are fully aware of our situation, our body may already be on the move” (p. 54). Because during such a moment of reaction to danger our rational minds are not driving our behavior, recalling complex self-defense moves may be near impossible. Van der Kolk (2014) shares a story of a woman with a fifth-degree black belt in karate, and yet who froze and could not fight back when she was being sexually assaulted. Though this woman had all of the knowledge she may have needed to defeat her attacker, “her executive functions- her frontal lobes- went off-line, and she froze” (p. 220). This demonstrates that her high-level training was not enough to protect her from this situation, and the brain’s reaction to such a highly adrenalized situation played an important role in her inability to protect herself from this attack.

In part due to this experience, the model mugging program was developed to teach people how to react when they find themselves exhibiting a freeze response. Van der Kolk (2014) explains that this works, “through many repetitions of being placed in the “zero hour” (a military term for the precise moment of an attack) and learning to transform fear into positive fighting energy” (p. 220).  Thus, placing participants in a real-feeling situation where their emotional brain is activated allows them to notice what their reaction might be and develop self-defense techniques that account for this reaction in a safe environment. This program was developed in California, but iterations of it can be found throughout the country.

In Boston, the IMPACT:Ability training offered for people who are disabled as well as able-bodied people utilizes some of the same techniques described by model mugging. One important insight that these self-defense programs utilize is the resource that adrenaline can be during moments of high stress or panic. The production of adrenaline gets our bodies moving, but it can also shut our bodies down, as it did for the woman in Van der Kolk’s example. By simulating adrenaline-inducing situations, these self-defense programs are teaching participants how to react when their bodies are under high stress, thus hoping to make it more likely that in a real-life situation of danger when fight-flight-freeze hormones are coursing through a person’s body, they will be more able to react in self-defense. Van der Kolk’s example of the young woman who had suffered ongoing childhood abuse, but who was able to fight off three attackers late one night outside her college library, indicates that this training can indeed have an impact on a person’s reaction to adrenalized situations (Van der Kolk, 2014).

As a participant in IMPACT:Ability, I found the program to be invaluable in helping me to remember to breathe in scary situations. Remembering to take a breath is one of the main teachings of the course, and I have noticed that during intense moments at work I am able to think more clearly and respond more calmly when I have reacted to a situation first by intentionally taking a deep breath. For more information about Impact:Ability, or to register for a training, please visit: https://triangle-inc.org/impactability/

Sources cited:

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

Breaking the Cycle – Intergenerational Trauma

Intergenerational trauma is “transmitted through attachment relationships where the parent has experienced relational trauma and have significant impacts upon individuals across the lifespan, including predisposition to further trauma” (Isobel, S., Goodyear, M., Furness, T., & Foster, K., 2019). Fortunately, the understanding of this method of the transmission of trauma is now becoming more widespread and given a more serious focus than in the past. It is described by Van der Kolk that the ability to feel safe with others is “probably the most important aspect of mental health” (2015, p.81). But what if those who you are supposed to feel safe with, your own family, are the ones causing said source of suffering and are inhibiting your capability of feeling safe with and trusting in others? In a film created by The International Society for the Study of Trauma and Dissociation, the contributors comment that within society, it is very common to come across children who are victims of abuse, who’s parents were also victims of abuse, who had parents that were victims of abuse, and so on. They mention that usually shoulders are shrugged, and the topic of conversations moves on but that “is what keeps the cycle going” (The international society for the study of trauma and dissociation, 2007).

In addition to PTSD, other forms of adverse childhood experiences, that come from a variety of other mental health disorders, can be considered intergenerational trauma. For example, if a parent is more preoccupied with trauma they’ve faced or are suffering from, they may not be emotionally stable or consistent in providing the proper upbringing of a child. Our emotional development starts from the day that we are born and our ability to form attachments to others is also key to feeling safe and therefore being attuned to other people. Disorganized attachment is understood as “not knowing who is safe or whom they belong to, they may be intensely affectionate with strangers or may trust nobody” (Van der Kolk, 2015, p.119). Through research, it becomes more and more apparent that there is “an intergenerational component, and the more we can work on it and stop it at its root and prevent it, the better it is for all who are suffering and also for society” (The international society for the study of trauma and dissociation, 2007).

Treatment for breaking this cycle can be as simple as educating the public to understand the way that their trauma, past or present, effects their families but also ranging from the training being available to front line professionals to help them whilst dealing with traumatized members of the community. If a Child Protective worker understands that when dealing with a distressed mother that has a more severely stressed baby, research shows it is more efficient to calm the distressed mother first to have a more soothing effect on the baby, they can therefore have a more active role in stopping the trauma from continuing (The international society for the study of trauma and dissociation, 2007).

More formally, it is purposed to utilize the family systems approach to dealing with and preventing intergenerational trauma. In Module 4, Professor Danielle Rousseau explains a form of family systems therapy – Internal Family Systems Therapy (IFS). In this form of therapy, the focus is on the Self. IFS was developed by Dr. Richard Schwartz when he realized that there were significant connections that his clients made between external family systems and internal self-talk. He “began to identify specific “parts” of the self, and determined that they all had value, and could learn to work together rather than against each other” (Rousseau, 2019). Additionally, within the family systems approach therapists are able to redirect and help heal pain from intergenerational trauma by utilizing 4 strategies: use of culture informed treatment, interruption of unhealthy family communication patterns, giving trauma a voice within the family, and helping parents offer children the permission to dissociate (Sells, 2018). When the combination of knowledge, education, training, and various forms of treatment are used, it feels as though the progression towards breaking the cycle of intergenerational trauma is well underway.

References:
Isobel, S., Goodyear, M., Furness, T., & Foster, K. (2019, January 1). Preventing intergenerational trauma transmission: A critical interpretive synthesis. Journal of Clinical Nursing. https://doi.org/10.1111/jocn.14735

Rousseau, D. (2019). Module 4 – Pathways to recovery: Understanding approaches to trauma treatment – Lesson 8.

Sells, S. (2018, October 12). A family systems approach to treating intergenerational trauma. Retrieved from https://familytrauma.com/a-family-systems-approach-to-treating-intergenerational-trauma/

The international society for the study of trauma and dissociation (Producer). Fran Waters (Executive Producer). (2007). Trauma & Dissociation in Children I: Behavioral Impacts [Video file].: Cavalcade Productions. Retrieved April 8, 2019, from Kanopy.

Van der Kolk, B. (2015). The body keeps the score: brain, mind, and body in the healing of trauma. New York, NY: Penguin.

The Erasure of Women of Color in the Me Too Movement: Impact of the Sexual Abuse to Prison Pipeline

The Me Too movement has stirred the pot in Hollywood and has helped bring transparency to sexual harassment and assault that happens within the workplace and everyday life. While the Me Too movement has swelled after Alyssa Milano's involvement, it began with Tarana Burke, a woman of color (Onwuachi-Willig, 2018). Women of color have seemingly been left out of the mainstream Me Too movement, which is especially problematic considering that women of color are more vulnerable to sexual harassment than white women and are less likely to be believed when they report harassment, assault, and rape (Onwuachi-Willig, 2018).

The abuse and harassment the Me Too movement calls out is not only in the workplace, and does not only happen to adults. Childhood sexual abuse is appallingly prevalent in our society. Van Der Kolk asserts that child abuse is the nation's largest public health problem (2014). The Adverse Childhood Experiences (ACE) study importantly found that negative experiences in childhood are common (Van Der Kolk, 2014). For girls with an ACE score of 0 (little to no negative experiences), the prevalence of rape in adulthood was 5%, but for girls with an ACE score of four or more, the prevalence of rape in adulthood was up to 33% (Van Der Kolk, 2014). Therefore, it is likely that those affected by the Me Too movement have long term histories of sexual abuse, but the conversation focuses on elite workplaces.

One potential reason for the exclusion of these voices is that they are simply not around to be included. Perhaps even more troubling than the prevalence of childhood sexual abuse and adult rape and harassment, is our punitive response to survivors. Sexual abuse is one of the primary predictors of involvement in the juvenile justice system (Saar, Epstein, Rosenthal, & Vafa. 2015). A study conducted in Oregon in 2006, found that 93% of girls in the juvenile justice system had experienced sexual or physical abuse, and 76% had experienced at least one incident of sexual abuse by the age of 13 (Saar et al., 2015). Girls of color are much more likely to be involved in the juvenile justice system, Black girls are 20% more likely to be detained, and three times as likely to be referred to court; Native American/Alaska Native girls are 50% more likely to be detained and 1.4 times more likely to be referred to court than white girls (Myers, 2016). The charges that call for these actions are minor, girls account for 35% of arrests for disorderly conduct, 37% for simple assault, 38% for domestic battery, 40% of liquor violations, 29% of curfew violations, and 76% of arrests for prostitution (Myers, 2016). The charges of these arrests are closely linked to sexual abuse, curfew violations for running away from abuse, prostitution to survive away from the home, substance use to cope with the trauma, and assault as self-defense against sexual abuse. These statistics highlight the disturbing trend called the sexual abuse to prison pipeline. Young women, especially those of color, are being punished for their abuse, and retraumatized, rather than treated.

Van Der Kolk discusses many effective treatment methods for persons who have experienced childhood sexual abuse including, yoga, EMDR, and IFS. Unfortunately, our systematic response ignores these options in favor of incarceration, despite what is known about development. Van Der Kolk explains that girls who have experienced sexual abuse have an entirely different developmental pathway, their biology is up against them, leading them to overreact or numb out (pg. 165, 2014). While incarcerated, girls are further traumatized through invasive search procedures and restraints, and are subject to potential abuse from correctional officers. A study of incarcerated girls found that 46 percent of participants reported that the staff, programs, and treatment in county juvenile justice facilities did not help them deal with past trauma in their lives; 4 percent said their time in county facilities did more harm than good in dealing with past trauma (Saar et al., 2015). The National Child Traumatic Stress Network (NCTSN) holds that, “[m]any characteristics of the detention environment (seclusion, staff insensitivity, loss of privacy) can exacerbate negative feelings and feelings of loss of control among girls, resulting in suicide attempts and self-mutilation" (Saar et al., 2015).

The NCTSN has found that 70% of girls with juvenile justice involvement had been exposed to some form of trauma, and over 65% had experienced symptoms of PTSD (Saar et al., 2015). Further, 80% of justice involved girls have mental health diagnoses, but mental health screenings are rarely administered, and there is a severe lack of services, only half of youth are in facilities that even offer services (Saar et al., 2015). Trauma based interventions have been effective post release at decreasing recidivism (37% less likely), and reducing teen pregnancy (only 26.9% of those who received the intervention became pregnant at a young age, compared to 46.9% of those who did not) (Saar et al., 2015). The justice system does not meet health needs for expecting girls, or any gynecological or obstetric care (Saar et al., 2015).

The Me Too movement cannot be effective if it continues to exclude the voices of girls and women of color, and those in the sexual abuse to prison pipeline. The great successes the Me Too movement has had in creating transparency should be shared with those experiencing the sexual abuse to prison pipeline. The moralistic, punitive approach we hold towards these girls and women must be changed to stop the re-triggering and further traumatization of these girls.

Myers, A. (2016, June 22). What You Need to Know About the Sexual Abuse to Prison Pipeline.   Retrieved from https://now.org/blog/what-you-need-to-know-about-the-sexual-abuse-        to-prison-pipeline/

Onwuachi-Willig, A. (2018). What About #UsToo?: The Invisibility of Race in the #MeToo Movement. The Yale Journal Law Forum. Retrieved from             https://www.yalelawjournal.org/pdf/Onwuachi-Willig_h1vexk3y.pdf.

Saar, M. S., Epstein, R., Rosenthal, L., & Vafa, Y. (2015). The Sexual Abuse to Prison Pipeline:        The Girls' Story (Rep. No. 031215). Retrieved https://nicic.gov/sexual-abuse-prison-          pipeline-girls-story

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

Juvenile Detention Centers: The Importance of Assessing Childhood Trauma

Childhood trauma has a profound impact on victims’ lives as they grow up and can continue well into adulthood. Children are vulnerable; trauma at a young age can influence their future behavior and cause them to get into trouble with the law. If this behavior lands adolescents in the criminal justice system it is important they receive help. Addressing their traumas and providing these individuals with treatment can give them the tools needed to change their lifestyle and rejoin society. Many victims of childhood trauma exhibit criminal behavior because they have not coped with what happened to them. They are not necessarily bad people, they are just angry and out of control. Assessing adolescents in juvenile detention centers for childhood trauma and offering help to those who are affected by trauma can prevent a lifetime of crime, incarceration and resentment. A center’s failure to asses and treat incoming adolescents can inflict further trauma and lead to serious consequences. The environment and treatment in juvenile detention centers can put victims of childhood trauma in distress; without treatment adolescents are more likely to become repeat offenders and/or commit suicide.

Victims of childhood trauma have experienced pain at their most vulnerable state; they were too young to defend themselves and adults nearby failed to protect them. Children are more sensitive to trauma because of their size, age, and dependence (Rousseau, 2019). After a traumatic event it is likely a child will experience traumatic stress. Traumatic stress influences a child’s behavior and can cause fear, anger, withdrawal, trouble concentrating, digestive problems, and nightmares (Rousseau, 2019). The most common symptoms displayed by children experiencing traumatic stress are the symptoms exhibited by children with behavior disorders (Rousseau, 2019). If traumatic stress is not treated, these behaviors are adopted and severity of misconduct escalates as time passes. This explains how adolescents with childhood trauma find themselves in trouble with the law. There has recently been a focus on delinquent behavior that stems from unresolved post traumatic symptoms (Rousseau, 2019). Some juvenile detention centers require the assessment of incoming adolescents to determine if they suffer from PTSD or need mental health services (Rousseau, 2019). Knowing if a delinquent behavior was a result of post-traumatic stress is important because it points to which adolescents in the center need treatment, are at risk for suicide and have high probabilities of rehabilitation.

It is important for juvenile detention centers to know who to offer treatments to and which individuals need to be closely monitored. While it would be ideal to offer these services to all teens in the criminal justice system, it is not financially realistic. Teens in juvenile detention centers are more likely to commit suicide and it is imperative that they receive treatment and monitoring. Chapman states that, incarcerated youths with traumatic stress history or PTSD could be exposed to conditions that exacerbate the risk of suicide, like the use of restraints for discipline, and locked cells (Chapman, 2008). Data is needed to guide juvenile detention programs in early identification of youths who are at risk for suicide (Chapman, 2008). To avoid wasting resources, these services should only be offered to individuals experiencing trauma. There are two ways to determine who needs treatment, Screening and Assessment (Rousseau, 2019). It is more effective and important for juvenile detention centers to use assessment. A screening is a brief evaluation for safety; they are of short duration and can be applied universally (Rousseau, 2019). Assessment evaluates people in depth; it is a clinical evaluation designed to establish whether a youth meets criteria for a diagnosis or needs mental health services (Rousseau, 2019). Assessing incoming adolescents and providing treatment for those experiencing post-traumatic stress can save and change lives. Treatment can prevent adolescents from becoming repeat offenders, teach them how to forgive and give them the tools needed for coping and self-regulating. A juvenile detention center that exemplifies the policies and programs described is, Woodfield Detention Cottage in Westchester, New York.

Woodfield Detention Cottage uses assessments to test for childhood trauma and determine whether or not individuals need assistance from Rising Ground. Rising Ground is an organization that offers many different programs throughout New York City; the program that works with Woodfield Detention Cottage is called Justice for Youth & Families. It focuses on giving youth who have suffered childhood trauma a second chance. They believe that these individuals performed crimes due to unresolved problems associated with trauma, not because they are bad people. Their website states, “Life can throw up roadblocks that seem insurmountable. Abuse, neglect, or serious trauma may lead young people to make poor choices and to involvement with the juvenile justice system. Both our residential and our community-based juvenile justice programs give them a chance to rise above the obstacles they face so they can change the trajectory of their lives” (risingground.org). This program aims to teach individuals how to cope with their trauma correctly, examine their choices and prepare them for re-entry.

Woodfield Detention Cottage tries to adjust behavior but takes into consideration the fact that some children were stuck in toxic situations that deeply impacted their behavior. As pointed on in the lecture notes, the development of the prefrontal cortex is sensitive to psychological environments, and children who have experienced severe trauma may have developmental issues with their prefrontal cortex. This can lead to hypersensitivity towards stress and make it more difficult to self-regulate emotion (Rousseau, 2019).  In an article written about the Woodfield Detention Cottage and other similar Juvenile Detention Centers, a psychiatrist working in these facilities stated that, “It was not unusual to see a 200-pound, 16-year-old who was deeply enraged because he was deprived of parental care but who had only ‘the emotional maturity of the terrible 2's’” (Brenner, 1997). The Rising Ground organization also takes into consideration how damaging family issues can be for children. Van der Kolk explains that sometimes parents are so preoccupied with their own traumas, that they are too emotionally unstable and unreliable to offer comfort and protection to their children (Van der Kolk, 2015). Rising Ground tries to help children understand their relatives and rebuild relationships. This is clearly indicated in their mission statement, “Many of the youth we support come from families and communities that face challenges with poverty, violence and lack of educational resources. But the cycle doesn’t have to continue. Youth in our juvenile justice programs discover their inner strengths and demonstrate tremendous resilience” (risingground.org). Woodfield Detention Cottage’s procedures have been working for many years. Rocco Pozzi, Probation Commissioner for Westchester County even stated that, ''Most kids in trouble with the law never graduate upstairs. Most of them, we won't see again. A lot of them do respond to rehabilitation efforts, and they don't go on to become adult criminals” (Brenner). This shows how effective an assessment and treatment policy is for adolescents with childhood trauma. It is important that this policy be incorporated into as many juvenile detention centers as possible, it has a positive effect on adolescents and changes their life.

Resources

Brenner, E. (1997, August 03). Trying to Avoid Giving Up on Young Offenders. Retrieved from https://www.nytimes.com/1997/08/03/nyregion/trying-to-avoid-giving-up-on-young-offenders.html

Chapman, J. F., & Ford, J. D. (2008). Relationships between suicide risk, traumatic experiences, and substance use among juvenile detainees. Archives of Suicide Research, 12(1), 50-61. http://dx.doi.org/10.1080/13811110701800830

Our Juvenile Justice programs mean better solutions for youth. (n.d.). Retrieved from https://www.risingground.org/program/juvenile-justice-programs/

Rousseau, D. (2019). Lesson 2.1: The Minds of Children [PDF]. Retrieved from Boston University MET CJ 720 Online Campus Dashboard.

Van Der Kolk, B. (2015). The Body Keeps the Score. New York: Penguin.