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The Lifelong Impacts of Child Sexual Abuse
Over 300,000 children are sexually abused each year in the United States, but that number is thought to be much larger as it is estimated that 90% of all child sexual abuse is never reported (“CSA Statistics, n.d.”). Child sexual abuse is defined as any sexual activity between an adult and a child; and it can also occur between children (Rousseau, 2018). The trauma that the child suffers mentally and physically has an impact on them for the rest of their lives. Right after the abuse occurs, they may feel powerless, ashamed and distrustful of others ("Effects of Child Sexual Abuse,” n.d.). Other short-term effects many include exhibiting regressive behaviors, such as thumb-sucking, and bed-wetting; sleep disturbances; eating problems; behavior or performance problems at school; and an unwillingness to participate in activities ("Effects of Child Sexual Abuse,” 2018). Long-term effects include depression, anxiety-related behaviors, eating disorders, obesity, anxiety, repression, sexual and relationship problems (Hall, 2011).
In Dr. Van der Kolk’s The Body Keeps the Score, he revealed that child sexual abuse victims, specifically those of incest, can even be impacted by autoimmune diseases (Van der Kolk, 2014). He did a study at Mass General that recruited twelve women who had histories of incest and twelve women who had never been sexually abused. Their results confirmed his findings - that the incest victims had abnormalities in their CD45 RA-to-RO ratio (Van der Kolk, 2014). Unfortunately, incest has been found to be the most common form of sexual abuse; with impacts even more detrimental (Hall, 2011). A study compared women who had histories of incest and women who experienced non-familial abuse. It found that “women who experienced incest reported higher current levels of depression and anxiety when thinking about the abuse (Hall, 2011).”
Other aspects of the abuse that increased feelings of distress were cases where the sexual abuse was extensive, a higher number of cases and a younger age during the first abuse experience (Hall, 2011). Child sexual abuse has detrimental impacts that can last throughout adulthood. It’s of the utmost importance for further research to be conducted on preventative measures. No child should have to experience anything like this.
References
“Child Sex Abuse Statistics.” (n.d.). Retrieved from http://riseaboveabuse.org/child-sex-abuse-statistics/
“Effects of Child Sexual Abuse.” (n.d.). Retrieved from http://victimsofcrime.org/media/reporting-on-child-sexual-abuse/effects-of-csa-on-the-victim
Hall, M., & Hall, J. (2011). The Long-Term Effects of Childhood Sexual Abuse: Counseling Implications. Retrieved from http://counselingoutfitters.com/vistas/vistas11/Article_19.pdf
Rousseau, D. Dr. (2018). Trauma and Crisis Intervention: Module 1. Boston University.
Van Der Kolk, B. M.D. (2014). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. New York, NY: Penguin Books.
The Effectiveness of EMDR
Eye Movement Desensitization and Reprocessing (EMDR) has been shown to be an effective method in treating those exposed to traumatic events. Discovered unintentionally by Psychologist Francine Shapiro in 1987, she observed that as her eyes moved rapidly, it "produced a dramatic relief from her distress" (Van Der Kolk, p. 253). Through the use of EMDR, patients are able to revisit past traumatic experiences without painful re-creations which could otherwise result in re-traumatization. EMDR consists of eight phases: history taking, preparation, assessment, desensitization, body scan, closure, and reevaluation (Rousseau, 2018). EDMR treatment is minimally invasive to the patient as it does not require them to talk about their traumatic experience. Instead, EMDR focuses on stimulating and opening up the associative process as "therapists ask their clients to hold the memories of anxiety-provoking stimuli—for example, the painful memories of a frightening accident—in their minds. While doing so, clients track the therapist's back-and-forth finger movements with their eyes" (Arkowitz, 2012). This process helps take loosely associated memories and images from a patient's past and piece them together to a more comprehensive perspective of the traumatic experience. Through studies, it has been shown that rapid eye movement (REM) sleep "reshapes memory by increasing the imprint of emotionally relevant information while helping irrelevant material fade away" and "make(s) sense out of information whose relevance is unclear while we are awake and integrate it into the larger memory system" (Van Der Kolk, p. 262). By large, those affected by PTSD have difficulty getting to and remaining in REM sleep. Because EMDR mimics REM sleep through the moving of the eyes back and forth in a rapid manner, "EMDR should be able to take advantage of sleep-dependent processes, which may be blocked or ineffective in PTSD sufferers, to allow effective memory processing and trauma resolution" (Van Der Kolk, p. 263). By becoming in-tune with the context of the emotions and sensations related to traumatic events, patients can learn to overcome physical reactions that were previously dictated by the imprint of the past.
Many who experience traumatic events attempt to suppress their memories by shutting down "the brain areas that transmit the visceral feelings and emotions that accompany and define terror" (Van Der Kolk, p. 94). In an attempt to protect themselves from the hurtful past, trauma victims can unintentionally prevent themselves from feeling fully alive in the present. As a result, the traumatic memory remains stuck in the patient's mind, "undigested and raw" (Van Der Kolk, p. 258). To be able to recover from trauma, its crucial that patients are able to feel present and be aware of what is going on within them. "The core of our self-awareness rests on the physical sensations that convey the inner states of the body" (Van Der Kolk, p. 95). EMDR helps to restore a trauma victim's broken "self-sensing system" and reactive it by integrating the traumatic material into a "coherent event in the past, instead of experiencing sensations and images divorced from any context" (Van Der Kolk, p. 257). EMDR allows the brain to activate new images, feelings, and thoughts from seemingly unrelated events while simultaneously restoring the patients sense of agency, engagement, and ownership of mind and body.
EMDR therapy can also be used to help those who are grieving over the loss of a loved one and those suffering from debilitating medical conditions. Family members are "often unable to retrieve positive memories of the deceased, which further exacerbates and complicates the grieving process" (Shapiro, 2014). Similarly, those who experience a tragic medical condition such as a burn victims or amputees may benefit from EMDR. In both examples, EMDR treatment helps the individual to focus on pleasant past experiences rather than the emotional present. The individual can then mark their grief as a specific point in time and begin to understand that their tragic event is not what defines them as a person and start to heal emotionally.
Patients showed dramatic improvements with very few EMDR treatments. In a study of twelve individuals, Dr. Van Der Kolk found that after only three EMDR sessions, "eight of the twelve had shown a significant decrease in their PTSD scores" (Van Der Kolk, p. 256). It was also found that patient's PTSD scores improved substantially better than those who used pharmaceuticals (Prozac) for treatment. After several EMDR treatments, patients were able to integrate their traumatic memories and continue to improve to the point where many were cured of their ailments and remained cured months after treatment, unlike those who relapsed once off the medication. Further, Dr. Francine Shapiro found, "Twenty-four randomized controlled trials support the positive effects of EMDR therapy in the treatment of emotional trauma and other adverse life experiences relevant to clinical practice. Seven of 10 studies reported EMDR therapy to be more rapid and/or more effective than trauma-focused cognitive behavioral therapy. Twelve randomized studies of the eye movement component noted rapid decreases in negative emotions and/or vividness of disturbing images, with an additional 8 reporting a variety of other memory effects. Numerous other evaluations document that EMDR therapy provides relief from a variety of somatic complaints" (Shaprio, 2014). EMDR has proven to be an effective, minimally invasive, and long lasting treatment option for victims of trauma. This holistic approach may prove to be more beneficial to trauma victims than other more invasive or pharmaceutical dependent treatments that may not have as long lasting results.
Although much EMDR treatment research has shown "that processing memories of such (adverse life) experiences results in the rapid amelioration of negative emotions, beliefs, and physical sensations (Shapiro, 2014), there is one glaring limitation to EMDR. It has been found to be not as effective in patients who have experience childhood trauma. Dr. Van Der Kolk suggests EMDR doesn't work as well in children because of the mental and biological changes that occur in children who experience chronic child abuse. Because an abused child's life can have a variety of "triggers", they may not be able to distinguish their trauma as being a past isolated event that they can move on from, as EMDR attempts to do. Abused children often lack a secure base and secure attachment with loving caregivers. "A secure attachment combined with the cultivation of competency builds an internal locus of control" (Van Der Kolk, p. 115). Without these primitive skills, the physiological changes in children after experiencing a traumatic event can make it harder from them to break free from the past as it could be harder from them to look within and realize they're not the cause of their own trauma. Nevertheless, EMDR is an extremely useful tool that can be used in the medical field for both patients and family members alike. This treatment can help mental health professionals pinpoint what adverse experiences are effecting an individual so psychological and physical resolution can occur.
References:
Van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. New York: Viking Penguin
Protecting the Sheepdog: Resource Allocation during Budget Restrictions
Nationally, law enforcement agencies are recruiting and screening citizens to ensure qualified applicant have the moral and psychological aptitude to protect their communities. While the agencies are striving to provide transparency in policing practices and allowing only the most qualified candidates a chance at serving, there is little discussion outside scholarly channels about the challenges law enforcement officers face. Many departments are being forced to do more with less and often times officers are the ones who are shortchanged.
Memphis police officers make on average 43 percent less base salary than Austin police officers after their first year and also face cuts to their medical benefits, time off, and other benefits (Thompson, 2014). It is reasonable to suggests police officers and other emergency service providers experience higher rates of psychological trauma and stress leading to earlier morbidity and mortality than premature death by gunshots or other physical trauma. The daily experience of increased stressors on law enforcement officers place the sympathetic nervous system into a constant rollercoaster ride of fight or flight responses that place excessive where on the cardiovascular and central nervous systems. In an effort to resolve the conflict of maintaining homeostasis and to cope with the stress and trauma of work, officers may experience adverse health conditions such as insomnia, alcohol use disorder, depression, chronic fatigue, and hypertension (Stevens, 2008). Van Der Kolk (2014) identifies the unbearable and intolerable nature of trauma, which has the potential to have primary and secondary effects on those who experience the trauma and others indirectly exposed to it such as spouses and children. In order to care for the community, law enforcement officers need to have assistance afforded and guaranteed to them.
Elvin Semrad discouraged scholarly textbook readings for his residents during their first year in an effort to prevent perceptions of reality from becoming obscured by psychiatric diagnosis (Van Der Kolk, 2014, p. 26). Law enforcement agencies can benefit from putting scholarly literature down for a brief time and look around without trying to assign labels and categories of their officers and see that many face stressors daily and should be afforded the upmost care. Psychology has expanded greatly in modern times and new pharmacological treatments are available that many often may seek out for help instead of talking through stressors. Encouraging support groups for traumatic events and stress debriefings with avenues to gain time off work to recover psychologically without stigmatization is necessary with the events officers face on a routine and daily basis. Health insurance should provide adequate coverage for mental health care and physical conditioning. Cardiovascular exercise has great potential to lower stress levels in officers and to burn off hormones from heightened calls. With departments being requested to do more with less it is imperative that officers do not face the brunt of budget restrictions and instead be afforded every opportunity to succeed without worrying about overtime to pay bills or second jobs to gain better medical coverage.
References
Stevens, D. (2008). Police Officer Stress Sources and Solutions. Upper Saddle River, NJ: Pearson,
Prentice Hall.
Thompson, A. (2014). You won’t believe what Austin Texas is offering Memphis officers. WREG
Memphis. Retrieved from http://www.wreg.com
Van Der Kolk, B. (2014). The Body Keeps the Score: Brain, Mind, and Body in the Healing of
Trauma. New York, NY: Penguin Random House Publishing.
Stress and Law Enforcement
As people, we all have the chance to experience some type of stress or traumatic event in our lives. How our minds and bodies react to the stress and trauma determines if we will live as we always have with positive or negative responses. This is extremely evident in the field of law enforcement. Those like myself, who choose to be part of law enforcement, recognize that stress is a part of the job and assume it will not affect us. Prior to this class, when I would hear the terms trauma, stress, and PTSD my thoughts would always turn to our military, feeling as if they were the ones who were susceptible to these terms because it’s a wartime exposure and response. Little did I know, we are all susceptible to the effects of trauma and stress, which can lead to PTSD and all of the responses that may come along with it.
As Law Enforcement Officers, we respond to calls where most people are at their worst and in need of help. The chronic exposure to such traumatic events can affect individuals differently and can come in many different forms either mentally or physically or both. This is on top of the current social climate where not everyone sees the Police as allies and protectors. As we might not even be aware of the effect the stressors of the job are having on us, we are still tasked, every day, with making life or death decisions, in split seconds, all while maintaining the ability to think like a counselor, social worker and lawyer. To perform the job day to day, the men and women need to make sure they remain in healthy mind and body to combat the negative effects of stress and trauma such as PTSD, anxiety, depression and even health problems (Hinkman, Fricas, Strom, & Pope, 2011). If these conditions are not treated they can lead to numerous underlying responses such as cynicism, emotional detachment, reduced efficiency, absenteeism, aggressiveness, substance abuse, personal relationship problems, PTSD, health problems and even suicide (Beshears, 2017).
The first step in managing and treating the effects of stress and trauma, before it is too late, is identifying the causes of stress which are not only the job-related functions but can also be internal and individual causes. Internal factors can include poor management, long and constant hours and even poor equipment, while individual factors can include family, financial and personal relationships (Beshears, 2017). By identifying these causes officers can find a method to address and discover a personalized approach to self-care before it goes too far. For this to be effective, Law Enforcement Organizations first need to remove the overall belief that seeking help for chronic exposure is a sign of being weak or vulnerable. I feel that, if this was accomplished, those who are in the high-risk field of law enforcement would be able to access therapy or help without fear of professional or coworker ridicule from embarrassment. There are many methods an officer can care for themselves physically and mentally, but the methods need to be made known, all the while removing the negativizes stress and trauma has on everyone especially those in the Law Enforcement field.
Police One, put together a great article on how police can reduce and manage stress, outlining ways to reduce and manage stressors among police officers. The highlighted ways in managing and reducing stress are healthy eating, taking scheduled time off, a realistic exercise program, getting away from the job and having conversations about something other than work and plan to achieve balance in one’s life (Beshears, 2017). By the use of these methods officers are less susceptible to the effects of chronic exposure but, not immune. To increase these chances, I feel that organization could implement an annual psych evaluation with an employed professional. By integrating this evaluation as part of the annual performance review, and not only when a tragic even occurs, this will provide individuals with the opportunity to speak with a professional and it will be applicable to all, making it required for everyone, and not just singling one person out. Also, by performing these annually, there will be a base line and progressive observations for officers that can be monitored and hopefully alleviate complications in the future. As a result of these reviews officers can talk to a knowledgeable person regarding ways to effectively self-care to reduce and manage the effects of stress and trauma creating a long and healthy career. By doing this, the officer, co-workers, society and the organization will benefit from the healthy well-being of those who are serving.
Works Cited
Beshears, M. (2017, March 30). How Police Can Reduce and Manage Stress. Retrieved August 5, 2018, from PoliceOne.
Hinkman, M. J., Fricas, J., Strom, K. J., & Pope, M. W. (2011). Mapping Police Stress.Police Quaterly, 14(3), 227-250.
Therapeutic Approaches, What is the Baseline?
Humans are made to communicate and be in community. Using words is how we make connections, learn, express our feelings and needs, how we reveal our fears, and how any form of healing from trauma can begin.
While there are multitudes of approaches to choose from and each trauma victims will have individual needs (and therefore individual plans to adjust their healing process) talking, specially talk therapy, is pivotal and foundational to any healing.
That said, it can be argued that talk therapy could be used as the baseline or a supplemental to other therapeutic approaches. At times talk therapy may need to be used alone, but it can also be used in conjunction with other therapeutic approaches in order to bring the fullest healing to a victim. (Fritscher, 2018). It may be best to take a deeper look into talk therapy to grasp how it can integrated or supplemental to other forms of therapy and yet completely necessary for healing.
To begin, author Van Deer Kolk (2014) offers this quote: “nobody can ‘treat’ a war, or abuse, rape, molestation, or any other horrendous event, for that matter; what has happened cannot be undone. But what can be dealt with are the imprints of trauma on body, mind, and soul” (p. 205). However, “the challenge of recovery is to reestablish ownership of your body and your mind - of yourself” (p. 205).
Due to the challenge of recovery those in the mental health field have developed numerous ways of attempting to assist victims in establishing ownership of themselves. One to the foundational remedy developments, and what I believe to be the most effective, is analytical talk therapy.
Van Der Kolk (2014) insists that therapists have an undying faith in the capacity of talk to resolve trauma (p. 233). While not easy, talking and communicating about an event is one of the most healing things a person can do. This can be said because no one can heal from anything until they name it. Meaning, no one can heal from trauma until the know what they need healing from. Analytic talk therapy can accomplish this.
It accomplishes the above goals by helping clients “break the silence” (Van Der Kolk, 2014, p. 235). Trauma and traumatic events present a difficult task when it comes to communication, though, they are almost impossible to put into words. Therapist can and will attempt to help clients break their silence through a few avenues.
One way is that a therapist will help, ask, and enable clients to become aware of their bodies while speaking or listening. The therapist will ask the client to tell them their stories or experiences and tell them to be aware of visceral sensations while talking or being asked questions. Being aware of these sensations is the key emotional awareness (Van Der Kolk, 2014, p. 240). Once emotional awareness is achieved, clients can begin to put words to what they are feeling and discover what made them feel this way. Once this is identified with words, a story can be pieced together that can offer an object to blame and give words to pain, which can effectively reduce the effects of trauma
A second method is asking clients to write to themselves. This is one of the most effective ways to access your inner world of feeling (Van Der Kolk, 2014, p. 240). One of the specific exercises therapists will engage clients with is the practice of free writing. This is where a client will use any object as their own “Rorschach test” and begin writing the first things that come to mind as they look at the object. The client then continues to write without stopping or rereading and soon finds that there is a string of memories, thoughts, and associations that are uniquely theirs (Van Der Kolk, 2014, p. 241). Using this exercise gets the clients into conversation with him or herself and positively reinforces the use of words to discover themselves and find healing from trauma.
To show how effective analytical talk therapy is we can look at the first systematic test of the use of language and talk therapy done by James Pennebaker in 1986. Pennebaker was a professor at the University of Texas and turned one of his classes into a experiment. He asked students to think about a deeply traumatizing event in their lives and divided the class into three groups.
One would write about what was currently going on in their lives, another would write about the details of the traumatic event, and the third would write about the facts of event, their feelings/emotions about it, and what impact they felt it had on their lives. The students wrote continuously for 15 minutes on four consecutive days. As time went on the students would reveal secrets they had never verbalized, were emotional as they wrote and all of the students agreed that it increased their self-awareness and ability to articulate their pain (Van Der Kolk, 2014, p. 242).
One specific thing that is interesting to note is that the group that wrote about both the facts of the experience, their feelings/emotions about it, and how they thought it was affecting their lives were said to benefit the most. Van Der Kolk (2014) explained that those who wrote about their deepest thoughts and feelings about their trauma had improved moods, a more optimistic outlook on life, and even better physical health (p. 242).
The study above reveals that talk therapy is effective because it uses the body as a bridge to overcome the inability to put words to trauma. It provides a passage for understanding ourselves and enables us the ability to express how we feel. When we are able to express this we can then begin to piece together the timeline of our experiences and bring the chaos into focus. Once this can happen, healing can take its full effect.
Hence, talk therapy can be seen as necessary for any healing (Fritscher, 2018) and as such, a need to incorporate this into any therapeutic approach may not only be possible but may be necessary.
For instance, Cognitive Behavioral Therapy or CBT would not be possible without talking and analyzing through why an individual perceives a certain traumatic event and how it may govern how they feel or act (Rousseau, 2018, p. 13). A client must become aware of how they act or feel in certain situations and connect it to why they perceive the traumatizing event as they do. How is this done? Through talking and naming their trauma and their feelings/actions. This could not be done without incorporating analytic talk therapy tactics with CBT.
Even using medications as a therapeutic approach needs talk therapy. Here it may be best to use it after a medical diagnosis for medication is used. Once the correct medication is found and a victim expresses interest in further healing, talk therapy may be the next best step.
The examples of the necessity and baseline of talk therapy could go on and on. The need for basic human interaction and communication is necessary for any therapeutic approach to fully work (Fritscher, 2018).
Hence, the power of words and speaking out fears, alienations, perceptions, feelings, confusion, victories, and praises can make or break a therapeutic approach. Without talk therapy and its foundational practices, most therapeutic approaches run the risk of falling short in the quest to heal trauma victims.
As the post began with a quote, let it end with another relevant insight from Van Der Kolk (2014). Even though trauma can keep us “dumbfounded, the path out of it is paved with words, carefully assembled, piece by piece, until the whole story can be revealed” and thus healing from traumatic events takes place (p. 234).
Reference:
Fritscher, L. (2018). Talk Therapy. New York, NY: Well Mind.
Rousseau, D. PhD. (2018). Trauma and Crisis Intervention. Boston, MA: Boston University.
Van Der Kolk, B. M.D. (2014) The Body Keeps the Score: The Brain, Mind, and Body In the
Healing of Trauma. New York, NY: Penguin Books.
Growing Up in a PTSD Household
While Post Traumatic Stress Disorder (PTSD) is a personal struggle between the person affected by trauma and how their body responds, the affects do not stop at the trauma victim. By virtue of being children, growing up in a household that has at least one parent suffering from PTSD has the ability to affect how they function later in life as adults. In most situations, there is at least one parent who is in the household to play a barrier between the parent struggling with PTSD and the child, but that may not always be the case in situations such as divorce and single parents. Growing up with PTSD in their household, children may be expected to not have grumpy moods, bad days, disrespectful tones, or bad attitudes. Depending on when the PTSD started, the child may have been born into a household where PTSD was already located.
In the film, Trauma and Dissociation in Children I: Behavioral Impacts, the viewer is met with the number one public health issue, trauma and abuse in children. Multiple experts regarding the issue of traumatized children relate how children’s bodies are affected from the trauma and the struggle within their bodies. More times than not, children who experience traumatic stress or events are exposed to it on numerous levels. The sum of the impact of stress will determine the long-term effects that it has on the child’s memory and their development. There is a noticeable difference in the size of a traumatized child’s brain. How the brain functions and the structures of the brain are visibly smaller. (Trauma, 2007)
A child who is a victim of abuse and trauma will develop on the premise that they need to survive. Long term affects could be that they struggle to keep from bouncing off the walls, unable to retain information, withdrawal, avoidance, escape, freeze, or have no emotional expression. The coping styles that a child will develop will mirror what actually took place during the trauma itself. (Trauma, 2007) The brain development is not complete until the early 30s. A child who experiences trauma early in life may have issues with the development of the frontal lobe responsible for the executive functions, specifically emotional regulation, flexibility, and inhibitory control. (Rousseau, 2018, Module 3) The trauma becomes ingrained in the emotional brain that is the heart of the body’s central nervous system. The responses have a huge impact on any decision made in life. (Van Der Kolk, 2014, page 57) It is in this location where trauma stress is stored and will impact sleep, breathing, chemical balance, and basic functions. (Rousseau, 2018, Module 3)
Parents who dissociate because of PTSD can leave a child neglected or ignored. The parent suffering from PTSD may be self-absorbed and not providing the child in their household with the proper emotional support, which could lead to further psychological harm. A child may believe that they are the cause of the parent’s behavior, become depressed, copy the parent’s aggressive and violent behavior, bully their siblings as an expression of frustration, feel unwanted or unloved, become hostile towards the parents, and grow up feeling worthless, leading to a low self-esteem. (Hozier, 2014)
There are particular symptoms that a parent with PTSD suffers from that can be particularly damaging to a child. Due to their nature, children are noisy. Excessive noise can be a trigger for some PTSD sufferers who are sensitive to noise. Also, fluctuating moods can leave a child feeling inconsistency in their environment, leading to feelings of confusion. A child could also become affected with the parent’s negative view on life, which could lead to cynicism. (Hozier, 2014) When children are exposed to the behavior of a parent, they are going to mimic their parent’s behavior and actions. A child may not realize that what their parent is doing is not normal. Particularly so because a child may not even grasp what PTSD is or know that their parent is suffering. The PTSD trauma may have been caused prior to the child’s birth.
In the cases of abuse, triggers can point a child into a dissociative state. The job of a parent or caregiver is to put the child at ease and safely bring the child back to reality. The documentary explained for warning signs for child protective service workers to look for regarding abused children. For example, being overly protective of their parent. When a child is immediately defensive regarding their parents, it may be because they fear the unknown of being removed from their parents’ custody. The fact that they know what life is like with that parent, while it may not be great, it could be worse somewhere else. Essentially, the child would not want anyone to jeopardize them being removed from the only stable thing they have in their life, which is their parent. A child is born loving their parent and will essentially not known any better if the abusive relationship is all they know. (Trauma, 2007)
Children growing up with a parent who suffers from PTSD may be traumatized because children learn their development from their parents through imitation. When the parent suffering from PTSD is unable to deal with stressors or has unhealthy reactions, the child may develop adverse reactions to stimulus, which in turn develops problems with social and interpersonal skills. The continued exposure of a child to dysfunctional behavior may lead the child to consider that behavior “normal.” (Hosier, 2014)
A child surrounded by PTSD may respond in one of three ways. A child may “over identify,” which means the child will act and feel just like their parent in order to connect with their parent, a child may become the “rescuer,” taking on the role of the adult, or the child may become “emotionally uninvolved” because they get little or no emotional help, causing problems later in life. Feeling overburdened from what their parent is experiencing could lead to increased anxiety levels. (Price, 2016) In any of these situations, children are not responding at their age level. A parent who suffers from PTSD may expect more from their child than they would have if they were not suffering. For example, keeping noise levels down or understanding sudden mood changes or outbursts. All things that are somewhat easier for adults to handle, are a huge burden for a child to conquer.
Parents living in a household with a child can provide help to the child understanding the symptoms of PTSD. Preventative interventions are also helpful to the entire family. A first step is to explain to the child the reason that the parent has PTSD, without providing graphic details. The child needs to know that they are not in any way responsible. (Price, 2016) While not all reasons for PTSD are appropriate for children to know, the child has a right to know what happened to their parents. Explaining the situation in terms that a child will be able to understand is important to solidify that the child is not the cause.
There are other options to assist the parents help their child cope with living in a PTSD household. Treatment can be focused on the person suffering from PTSD, family therapy, and individual therapy. The therapy that a child is placed in can be based on their age – play therapy or talk therapy. Each family will need to determine what type of treatment option is the right fit for their situation. (Price, 2016) Therapy can provide a meaningful way for a child to speak with a neutral third party to express what bothers them. It provides an outlet to the child and a non-judgmental arena to state their feelings and receive feedback.
There is not a human being on Earth who is perfect. PTSD does not just affect the person living with the symptoms, it affects the entire family. How that person functions as a parent can be undermined by PTSD. Part of being a child is having the ability to bounce back from traumatic experiences and still live what is considered to be a normal, fulfilling life. However, when trauma is repeated over and over again to children, particularly those of younger ages, this will alter their behavior for the remaining course of their life. Understanding the signs and symptoms of PTSD can allow children in the household to be able to cope. Providing a nurturing environment for the child to grow up will give them the tools that they need to become functioning adults. The parents in the situation will make or break how the child deals with growing up surrounded by PTSD. The actions of the parent and how they help their child understand and cope with their surroundings will be a deciding factor in how that child develops and whether there is any lasting impact.
References:
(2007). Trauma & Dissociation in Children I: Behavioral Impacts [Video file]. Cavalcade
Productions. Retrieved July 17, 2018, from Kanopy.
Hozier, David. (November 26, 2014) “Effects of Parents with PTSD on Children.” Childhood
Trauma Recovery. Retrieved from: https://childhoodtraumarecovery.com/2014/11/26/effects-parents-ptsd-children/
Price, Jennifer L, PhD. (February 23, 2016) “When a Child’s Parent has PTSD” PTSD:
National Center for PTSD, U.S. Department of Veterans Affairs. Retrieved from: https://www.ptsd.va.gov/professional/treatment/children/pro_child_parent_ptsd.asp
Rousseau, D. (2018). Module 3 Lecture Notes. Trauma and Crisis Intervention (MET CJ 720),
Boston University, Boston, MA.
Van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of
trauma. New York: Viking.
PTSD Diagnosis versus Right to Bear Arms
For my blog post, I have chosen to take a stand on a topic. For those who know me, you can now collectively say “Figures…”
I have opinions, and while they are not always right, I can always make them sound as though they are.
First and foremost, I would not take a stand on a topic which does not personally affect me. I must feel as though I have a right to an opinion in the matter, or else I would have to ask myself “who are you advocating for?”
My topic is the notion of the Department of Veterans Affairs (VA) potentially providing medical information in violation of Health Insurance Portability and Accountability Act of 1996 (HIPAA) laws to other federal agencies in order to compile a list of Veterans suffering from mental health issues, and especially Post-Traumatic Stress Disorder (PTSD), so that these other agencies can then confiscate our privately owned firearms, in violation of the 2nd Amendment to the U.S. Constitution (part of the Bill of Rights, or the first 10 amendments), or the right to bear arms. My opinion is that this would also violate the 4th Amendment as an unreasonable search and seizure. If no crime has been committed, the government would in essence be attempting to thwart future possible crimes, which is frighteningly similar to Orwell’s novel entitled 1984, where the notion of Thought Police was first introduced.
This has NOT occurred yet, but it seems to be something that is constantly buzzing in the background, like so much white noise, just enough to make Veterans like myself nervous.
First of all, not all PTSD sufferers are Veterans. So, discriminating against Veterans by only capturing Veterans suffering from PTSD, as opposed to the entire population suffering from PTSD, is actionable under Equal Opportunity laws to begin with. In this case, it would be discrimination against a protected class, or disabled persons, as well as all of the other laws that discriminating against disabled persons violates.
That being said, many Veterans ARE PTSD sufferers. And there are certainly ranges of this disease to the extent that one cookie-cutter image cannot be presented as “all” sufferers. Depending upon the individual, their support system, and their circumstances, there are highly functioning Veteran PTSD sufferers, and poorly functioning ones as well. Now that America has finally broken the silence regarding PTSD, a notion brought forward by Bessel Van der Kolk (2014) in the New York Times Bestseller book entitled The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma (p.234), and many positive inroads have been laid recently towards providing treatment for this ancient, yet previously secretive disease which is a bedfellow of combat and war, it would be a shame to penalize Veterans who have to muster a great deal of courage just to come out and admit that they may have been adversely affected by witnessing and causing and receiving unspeakable acts of horror on the battlefields that the U.S. government has chosen them to serve on.
Second, not all PTSD sufferers are a danger to themselves or others. In fact, most aren’t. Of course, when a PTSD suffering Veteran harms others, that’s the news story we remember. What is not newsworthy is the thousands of PTSD suffering Veterans who do not do anything to get on the news for each one who does. It’s sort of like plane crashes. We hear about planes crashing, and we remember that, but for every crash, there are literally millions of flights that land perfectly safely, that we never hear about because that’s not newsworthy. We tend to hear about and remember the sensational, and then it’s not much of a leap before people start indicating that these rarities are actually the norm. You’d think that many planes crash. Or that many Veterans go nuts and shoot up a work site. They say it only takes one bad apple to ruin the bunch. But I disagree. One bad apple amongst a barrel full of good apples does not make a barrel full of bad apples. It remains a barrel full of good apples with one bad one. To indicate anything else is a lie.
Third, I suffer from PTSD, and I am not a danger to anyone who isn’t trying to seriously harm others. If somebody is trying to seriously harm others, I can and will be very dangerous. With or without my legally owned firearms.
Fourth, and perhaps most importantly, punishing Veterans with PTSD by taking away their rights is counterintuitive, because they volunteered to go and give of themselves, up to and including their lives and their sanity, so that the rest of the nation could continue to enjoy their democracy. So, they go to war, get traumatized, end up with a debilitating disease, and the same government that they served turns around and steals their private arms in violation of the Constitution? I can think of few things as egregious…
There is a camp in the arms arena which seems incredibly logical to me. IF the government takes the guns away from “good guys”, the bad guys will still get the guns they need/want, so the only thing they are doing, in essence, is removing people’s ability to defend themselves. A black market will appear, of which only criminals will exploit, further arming bad guys and further causing good guys to be more outgunned.
One might be tempted to quote statistics from countries where guns have been outlawed. The fatal flaw with this being used as a catalyst towards de-arming Americans is that it is much, much too late to try and do that. Unless law enforcement is willing to enter every American home and tear it apart like is sometimes done during search warrant raids, requiring people to turn in their guns may yield a slim percentage of the gun owners in America actually complying with such an order.
Back to the U.S. Constitution. While the Constitution (U.S. Const. art. I, § 8) allows the forming of militias, to wit: “To provide for organizing, arming, and disciplining, the Militia, and for governing such Part of them as may be employed in the Service of the United States, reserving to the States respectively, the Appointment of the Officers, and the Authority of training the Militia according to the discipline prescribed by Congress”, and the aforementioned right to bear arms, many Americans misunderstood why these were written into the contract. A lot of people believe these rights are there to allow citizenry to protect themselves from foreign enemies. The Constitution indicates their mission is “To provide for calling forth the Militia to execute the Laws of the Union, suppress Insurrections and repel Invasions.” SUPPRESS INSURRECTIONS. Key words. These were actually included to allow U.S. Citizens to protect themselves against the U.S. government, should the government ever turn into a dictatorship akin to the one we left during our revolution. History has a funny way of repeating itself, and the founding fathers, having just spilled blood with England in order to leave behind a tyrannical foreign leader, were rightfully afraid that down the line, what’s to stop the U.S. from turning into its own tyrannical country? And if it does, the authors of our Constitution wrote into the script the ability of the nation’s people to bear arms, form militias, and overthrow the U.S. government should it come down to that. So, the notion of the U.S. government forcefully removing arms from any population groups seems like a very good first step towards that tyrannical government that we are supposed to be able to overthrow.
As has become a common phrase, but a truism to many of us warrior-poet gun owners, they can have my guns when they pry them from my cold, dead hands. (And even then, I will resist!)
As an afterword of reasonableness, I do understand that there are some mental health diseases that would make a sufferer dangerous to themselves and others, especially more so if they were armed. And for those SPECIFIC cases, I support ensuring, on a CASE-BY-CASE basis, and only with certain diagnoses, that all sufferers therein be prevented, as much as is legally possible, to own weapons. My cautionary statement is that the U.S. government paint with fine brushstrokes here, not broad ones.
And while I am certainly not endorsing or advertising for them, I found a law firm who specializes in this very issue – Veterans having their arms confiscated. A direct quote from Mr. Berry is very inciteful into this issue: “There are also prohibitions against owning a gun under certain conditions as laid forth in 18 U.S.C. § 922, such as that the applicant “has not been adjudicated as a mental defective or been committed to a mental institution,” but there is not a direct prohibition against ownership simply on the grounds of having a mental health diagnosis.” (I emboldened part of that for effect – Mr. Berry didn’t…). Having not realized this firm existed before this research, I may just need to call them for some help with my ongoing feud with the Department of Veterans Affairs (VA), and their Pension and Compensation (P&C) branch, who (horrifically) adjudicate Veterans’ disability compensation claims…
Please take a side on this subject, and do not make Veterans regret the great sacrifices they made to ensure that ALL Americans, including THEMSELVES, are forever granted the rights created through our Constitution.
References:
Berry Law Firm - Veterans Law Attorneys. (2017, December 1). Mental health: PTSD veterans gun ownership. Berry Law Firm website [HTML]. Retrieved from https://ptsdlawyers.com/blog/can-veteran-ptsd-gun/
Office for Civil Rights (OCR). (2013, July 26). HHS.gov health information privacy: Summary of the HIPAA security rule. U.S. Department of Health & Human Services website [HTML]. Retrieved from https://www.hhs.gov/hipaa/for-professionals/security/laws-regulations/index.html
U.S. Const. art. I, § 8. Retrieved from https://usconstitution.net/xconst_A1Sec8.html
Van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. New York: Viking.
Does our over use of the anxiety label take away from the real trauma sufferers?
Throughout our course, with the examples of patients and others, whose stories have been shared, you can’t help but feel deep sympathy for their difficult struggles. As we have learned through the readings trauma creates a plethora of symptoms and hole body effects, that can be treated with a number of conventional and unconventional methods. No one reaction to a traumatic event is the same, and diagnosing the symptoms and marrying them to the proper treatments can be daunting. “This description suggests a clear story line: A person is suddenly and unexpectedly devastated by an atrocious event and is never the same again. The trauma may be over, but it keeps being replayed in continually recycling memories and in a reorganized nervous system.” (Van Der Kolk, 2014, p. 159). Therapists and researchers have devoted themselves just to get PTSD and other diagnoses published and accepted by the medical field, yet so many times we continue to see those suffering debased and shrunken down to descriptions like, “crazy” or “nuts”.
Why is it then that as a society, we continue to embrace with open arms the over arching diagnosis of anxiety, and allow people to hide behind it in one form or another? Does this use of the word, that gets thrown around all too often, take away from those really suffering? “Anxiety disorders are the most common mental health illness in the U.S., affecting 40 million adults in the United States age 18 and older, or 18/1% of the population every year.” (Anxiety and Depression Association of America) How do we accept anxiety disorders as an ever increasing and acceptable explanation for everything under the sun, yet debase those with significant trauma to crazy? Not to take anything away from those with serious anxiety, as I know it is a legitimate diagnosis for some, but in my line of work I have become a skeptic. As a police officer I to often run into people 18 and older who consistently tell me they don’t work because they collect disability and would rather collect from the system. When you ask what their disability is they are quick and proud to say “anxiety”.
What really made me more skeptical, annoyed and a bit angry is when I saw the headline, “Report: US Therapists See Increase in Patients With ‘Trump Anxiety Disorder’” (Fox News, 2018). In no way do I wish to make any political stance or point, the part that made me more upset is that people, Therapists and leaders in the mental health world, are putting time and value into issues like this, over important efforts of PTSD and significant trauma’s that effect people in real ways. “Elisabeth LaMotte, founder of the D.C. Counseling and Psychotherapy Center in Washington, D.C., said that some of her patients feel “on edge” about Trump’s decisions. “It’s very disorienting and constantly unsettling,” LaMotte said.” (Fox News, 2018). How are people’s lives allowed to be consumed and overwhelmed by the decisions and words of another person, so significantly? We take the time to diagnose and offer explanation for those who do not agree with political decisions yet do not take the time to understand those with greater underlying issues of trauma that might make a person seem “crazy”, only because they are so different from us. Do we make diagnoses like “Trump Anxiety Order” because there are so many people that are similar and because it plays better to the media and the general public, when in actuality PTSD is still never at the forefront of the discussion?
“How can doctors, police officers, or social workers recognize that someone is suffering from traumatic stress as long as he reenacts rather than remembers? How can patients themselves identify the source of their behavior? If their history is not known, they are likely to be labeled as crazy or punished as criminals rather than helped to integrate the past.” (Van Der Kolk, 2014, p. 184). Those suffering from PTSD or other horrific traumas are at such a disadvantage because they are unable to talk about the underlying issues and have a hard time themselves indentifying the source of their behavior. For these reasons we as an instant gratification society are quick to label them as “crazy” instead of taking the time to try and better understand. Yet we are quick to label someone with anxiety and offer them disability, encouraging them for quickly diagnosing themselves, without trying to help them. “According to an essay written by psychologist Jennifer Panning, the symptoms of “Trump Anxiety Disorder” include “feeling a loss of control and helplessness, and fretting about what’s happening in the country and spending excessive time on social media.” (Fox News). While I admittedly do not know enough about all anxiety disorders or the diagnosis of anxiety, working as a police officer and seeing the numbers of people collecting disability for anxiety, and hearing about psychologists and other mental health professionals lend time and effort to a diagnosis such as “Trump Anxiety Disorder” with symptoms such as excessive social media use, make me more mad and sympathetic for those suffering from real issues of trauma. What will it take to make PTSD come to the forefront, and make people stop and question underlying issues that make someone “nuts” or “crazy”? If you ask me the people suffering from a diagnosis of excessive social media, are more “crazy” then anyone with real issues of trauma and abuse. We need to stop using these overarching descriptors or diagnoses of anxiety or ADHD and focus mental health efforts on what really matters, the unexplainable complicated issues of trauma.
-Pete
References:
Anxiety and Depression Association of America. (2018). Understanding The Facts. From https://adaa.org/about-adaa/press-room/facts-statistics. retrieved on July 29, 2018.
Fox News Insider. (July 29th, 2018). Report: US Therapists See Increase in Patients With ‘Trump Anxiety Disorder’. From http://insider.foxnews.com/2018/07/29/us-therapists-see-increase-patients-trump-anxiety-disorder retrieved on July 29, 2018.
Van Der Kolk, B. M.D. (2014). The Body Keeps the Score. Brain, Mind, and Body In the Healing of Trauma. New York, NY. Penguin Books.
Girls’ Juvenile Justice Involvement
Girls’ Juvenile Justice Involvement
By Juliann Nicolson
Over the last several decades a pipeline has clearly developed in the United States, connecting girls’ experiences with trauma to their juvenile justice involvement. At the core of this problem is American girls’ widespread exposure to physical, emotional and sexual abuse, which sets them up for an array of negative outcomes throughout childhood, adolescence and adulthood. A growing body of research has shown that trauma experiences among justice-involved girls are nearly universal (Rousseau, 2018). A 2014 Department of Justice study found that among girls who were confined nearly one third had been sexually abused and 45% had experienced complex trauma, as measured by five or more adverse childhood experiences (ACEs) (Baglivio et al., 2014). In particular, sexual abuse has been shown to be one of the strongest predictors of girls’ involvement with the juvenile justice system (Marston et al., 2012), as well as a leading predictor of reentry into the system (Conrad et al., 2014). This is unsurprising in light of research that has shown the profound negative effects of sexual abuse on girls, from cognitive deficits and mental illness to abnormal stress hormone responses (Van der Kolk, 2014).
While the prevalence of trauma histories among girls involved in juvenile justice is increasingly understood, there is still ambiguity around the question of why the proportion of girls involved in juvenile justice is growing. As the National Center for Juvenile Justice points out (2014), the rising proportion of girls’ arrests is either due to changes in the “volume and nature of law-violating behaviors” of girls and boys, or “differential responses by law enforcement” to the behaviors leading to arrests. In support of the former theory, some in the popular media and press have suggested that the primary cause is that girls are increasingly engaging in delinquent behavior. According to the gender convergence hypothesis, as traditional gender roles erode and violence becomes more widely accepted in mainstream culture, girls have become more inclined toward traditionally male social behaviors, including violence and other forms of aggression (Goodkind et al., 2010). On the other hand, those who support the latter theory argue that girls’ increasing rates of arrest and confinement are not caused by increasing criminal activity or violence, but rather by the increasingly aggressive enforcement and prosecution of non-serious offences such as misdemeanors and status offenses, which have become the leading cause of girls’ arrest in recent years (Zahn et al., 2008).
Girls’ exposure to trauma, and to severe stressors within the home, is strongly associated with delinquency, risk-taking and mental health disorders such as depression, anxiety and PTSD (Teplin et al., 2002). The increasing proportion of justice-involved girls prompts the question of whether girls’ trauma exposure is increasing in frequency or severity. Dynamics at home also play an important role in girls’ well-being, so if family structures and norms have changed over the last several decades this might also be a contributing factor. The increasing arrests of girls may also be linked to changed enforcement, and increasing visibility, of domestic violence. Increased focus on domestic violence has led to more states and localities adopting mandatory arrest policies (or at least mandatory hold policies) in domestic violent assaults, which has had the effect of widening the net of people—including women and girls—classified as domestic violence perpetrators (Sherman, Mendel & Irvine, 2013). While these changes constitute progress for victims of intimate partner violence, one unintended consequence is the increased involvement of girls in the juvenile justice system. Prostitution is another area where current state laws are insufficient. While federal law considers commercial sex acts performed by minors as constituting “sex trafficking”—even in cases when no force, fraud or coercion has taken place—most state laws do not recognize minors as trafficking victims. This discrepancy leads to the widespread arrest of girls for prostitution, when in fact they have been victimized. So far only eleven states have decriminalized “prostitution” for minors, and only ten have laws granting children immunity from prosecution for that crime.
These possible explanations for the increasing proportion of justice-involved girls in the U.S. merit further study. In the meantime, however, what is currently known highlights the importance of trauma-informed care in the juvenile justice system, and several key areas for policy change.
Baglivio et al. (2014). The prevalence of adverse childhood experience (ACE) in the lives of juvenile offenders, Journal of Juvenile Justice 2(11).
Conrad, S. M., Tolou-Shams, M., Rizzo, C. J., Placella, N., & Brown, L. K. (2014). Gender differences in recidivism rates for juvenile justice youth: The impact of sexual abuse, Law & Human Behavior 4(38), 309-310.
Goodkind, S., Wallace, J. M., Shook, J. J., Bachman, J., & Omalley, P. (2009). Are girls really becoming more delinquent? Testing the gender convergence hypothesis by race and ethnicity, 1976–2005. Children and Youth Services Review, 31(8), 885-895.
Marston, E. G., Russell, M. A., Obsuth, I., & Watson, G. K. (2011). Dealing with Double Jeopardy: Mental Health Disorders Among Girls in the Juvenile Justice System. Delinquent Girls, 105-118.
National Center for Juvenile Justice (2014). Juvenile offenders and victims: 2014 national report.
Sherman, F., Mendel, R. & Irvine, A. (2013). Making detention reform work for girls. Report for The Annie E. Casey Foundation.
Teplin, L., Abram, K.M., McClelland, G., Dulcan, M., and Mericle, A. (2002). Psychiatric disorders in youth in juvenile detention. Archives of General Psychiatry 59, 1133-1143.
Van der Kolk, B.A. (2015). The body keeps the score: Brain, mind, and body in the healing of trauma. New York: Penguin Books.
Zahn, M., Hawkins, S., Chancone, J. & Whitworth, A. (2008). Understanding girls’ delinquency. Retrieved at https://www.ncjrs.gov/pdffiles1/ojjdp/223434.pdf
A letter to New Cops
Dear New Cop,
Many law enforcement officers are socialized to law enforcement by television shows. Shows like Adam-12, CHiPs, and Cops are watched as children. Law enforcement officers are attracted to the lights and sirens, the fast cars, and the ability to take someone else’s freedom away. It is obvious that people who grew up admiring this lifestyle desire to become law enforcement officers when they become older.
However, living this dream is much harder than imagining it. For example, in the police academy, first responder instructors will teach you how to save a life. They stress the importance of using the appropriate CPR technique. They explain to you that if you use this form, you will have a high likelihood of success. But, in reality, the person who you are responding to will most likely already be dead. And each time you respond to these types of calls, and you do CPR, you will feel like a failure. It will stress you out, until you realize that this is just how it is.
I write this letter to you because you are new, and you are graduating from the police academy soon. I am writing because I want you to know the things that I would have wanted to know. It’s not that your hand placement in CPR isn’t important if the guy is already dead, I want you to know more than that. I want you to know how important it is to take care of yourself. I want to introduce you to the concept of self-care, because I know that no one in the police academy explained it to you.
The truth is, that law enforcement is a fun job. You turn on your go-fast lights, people pull over, you ride down the yellow line in the middle of the road. You show up to a call that can be nothing, or it could be a call that gives you nightmares. But that’s the part that Hollywood doesn’t show; the blood, the crying, and the violence. That is the stuff that gives you nightmares. To add to these nightmares, you are new and the senior guy on days called out, so you’re going to be held at work for sixteen hours straight. In fact, he books off for two more days. He says he’s sick, but in roll call, you overhear someone say that he’s in Florida.
To increase your stress level, you are on probation, you can’t complain about anything, and the supervisor sends all your reports back because he doesn’t think you’re a good writer. Or, he just likes to bother you because your new. Who knows? These types of stresses will build throughout your career. But, there’s good news. You can learn to combat them by practicing self-care, even as a rook.
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), self-care is the ability to maintain physical, emotional, relational, and spiritual health in times of stress (David & Naturale, 2012). Among the steps to building a self-care system is making sure that you use your time off wisely. Other factors include simple things, such as eating a balanced meal, listening to music, exercising,
In conclusion, becoming a law enforcement officer is a dream come true for many people. It is a very unique profession. But the profession can also carry a burden. If you don’t take care of yourself, the profession can be a gift and a curse. So, my suggestion to you is to take care of yourself and practice self-care. If you don’t take care of yourself, no one else will.
Sincerely,
Old “New” Cop
REFERENCES
David, J. & Naturale, A. (2012). Self-Care for Disaster Behavioral Health Responders. [PowerPoint slides]. Retrieved from https://www.samhsa.gov/sites/default/files/podcasts-selfcare-dbhresponders-presentation.pdf