Posts tagged abuse
Posts tagged abuse
Trigger warning: This article is about sexual abuse. Please exercise caution in deciding whether, when, and where to read this piece. This advice isn’t going to apply to everyone, and I unfortunately can’t address every aspect of the healing process. I strongly recommend seeking personalized support if that’s an option for you.
Understandably, those who have experienced the dark side of sex can sometimes forget that sex does have the potential to be incredibly joyful and pleasurable.
I love being a sex therapist because I get to help people discover how much fun sex can be. Unfortunately, sex also has some really dark shadow sides. Human beings are capable of hurting each other in the most unimaginably awful ways. What’s even worse is how frequently abuse occurs. We’ve all heard the numbers — one in every three or four women will experience sexual abuse in her lifetime. I’ve worked with a lot of sexual abuse survivors.
Sexual abuse of any kind or degree has the potential to dramatically affect your sex life. Being sexually abused can lead to fearful response patterns, chronic pain conditions and health issues, a low or nonexistent sex drive, and a feeling of disconnect from your body. It can eradicate your ability to enjoy sex altogether.
Understandably, those who have experienced the dark side of sex can sometimes forget that sex does have the potential to be incredibly joyful and pleasurable. See if you can tap into even the slightest ounce of hope that you could develop a better relationship with your sex life. Think about possible goals. How do you want your sex life to be different from what it is now? What do you want sex or intimacy to feel like for you? Some of your goals may feel obvious, but the simple process of setting them can be an act of reasserting yourself.
One of the ways I start working with a new survivor is to talk about the messages that get sent to your body when you’re being sexually abused. The messages vary based on your particular situation, but many of the underlying themes are the same:
●You’re not in control
●Your desires aren’t important
●Sex is emotionally and/or physically painful
●You’re not safe
I see my job as helping women acknowledge the particular messages they received, and working on sending their bodies and minds a new and improved set of beliefs about sex. Here are four of the most common dynamics that I’ve seen, and what you can do to regain control of your sex life:
You may have developed triggers around sex.
Triggers are words, experiences, actions, sounds, gestures, or even smells that can send you into a heightened state of agitation. The effects of triggers can range from making you feel emotional to making you feel like you’re back in the abuse.
One of the most helpful things you can do is to start to identify your triggers. What makes you scared, nervous, upset, or uncomfortable? Is it when your partner touches a certain part of your body? Is it when you’re having sex in specific locations or positions? Is it a particular sexual act?
Once you identify some of your triggers, you can start taking active steps to avoid those situations. My clients have reported that even the act of brainstorming a game plan or declaring certain things off-limits helps them feel more in control. For example, you can tell your boyfriend, “it’s really important for me to be able to make eye contact with you during sex. Can you help support me with that?”
You can also identify a trigger in the moment, like reminding yourself that you tend to feel jittery when someone whispers in your ear. Being able to say to yourself, “OK, this is a trigger” takes away some of the intensity and helps you feel more present.
You may have learned to dissociate during sex.
Dissociation is the experience of feeling separate from your body. Many women report feeling dissociated during their abuse. You may have felt like you were floating up by the ceiling, standing right next to yourself, or far, far away. I tell my clients that dissociation is actually an amazing defense mechanism. Your psyche knew that it was unsafe to be in your body during the abuse, so it got the hell out of there. Unfortunately, dissociation persists long after the abuse is over, and makes it difficult to be present enough to enjoy having sex.
To start reversing your dissociative tendencies, first learn more about how you dissociate. Which triggers cause you to leave your body? Where do you go? What does it feel like to dissociate?
Once you start building up awareness of your dissociation patterns, you can start slowly building tolerance for being in your body. Focus on breathing slowly and deeply during intimate moments. Get up and shake out when you feel yourself starting to disconnect; movement can counteract the feelings of paralysis. You can also try touching your body, to remind you that you’re in your own skin. Put your hand on a part of your body that feels safe, and practice remaining present for increasing periods of time.
You may have learned to hate your body.
When you learn that your body is not a safe place to be, it’s hard to feel a lot of love for it. It takes a while to change your relationship with your body, but one way to start improving it is to try finding your body’s happy places and safe spaces. Perhaps you feel very present in your own skin after taking a walk on the beach, or maybe you feel safe and snuggly in your bed. Learn the things that feel good for your body, and do them on a regular basis.
You may have learned that you don’t have a choice when it comes to sex.
This is one of the biggest struggles for my clients. Even if your partner knows about the abuse, you may still find yourself feeling like you’re obligated to have sex with him. A lot of my clients report having a hard time saying no, either because they feel like they’re not allowed to, or because they never learned how to feel comfortable saying it.
The first step is to start getting in touch with your authentic desires. You have to stop forcing yourself to engage in sexual behaviors that you don’t actually want, and start sending yourself the message that your desires are important. You get to decide what you do and don’t want to do.
If you’re in a relationship, I suggest taking a temporary break from intercourse. This can be a difficult thing to ask your partner for, but it gives your body the opportunity to relax and start learning what it actually wants. You can also create a period of time where you get to do all of the sexual initiation. Knowing that all contact will be on your terms helps promote a sense of safety and agency.
Next, you’re going to want to practice getting more comfortable saying no. Try saying “no” more confidently in your life outside the bedroom. Reread the part of my first article where I discussed good rejection technique. Practice touching your body and trying to sense when it’s saying “no” or “yes” to touch.
When you start having sex again, it’s important to keep emphasizing your agency. Make the conscious decision about what you want to do in the moment, and use a little self-talk to remind yourself. For example, “I want to kiss him right now, so I am going to kiss him,” or, “I’m choosing to give a hand job because I want to bring my partner pleasure.”
Perhaps the single most important piece of advice I can give you is to be kind to yourself as you work towards rebuilding your sex life. You’ve gone through a horribly traumatic experience that no one should EVER have to go through. Take care of yourself as best you can.
Trigger warning: Descriptions of self-harm
Given how dangerous and common self-harm is worldwide, it is very important for anyone to try to learn as much as possible about it. This will help us give the most informed and respectful support and advice possible to those who engage in it. This article outlines some of the challenges we face in trying to understand, explain and reduce self-harm behaviors, as well as some current understandings of its meanings and functions.
Many people engage in self-harm; they cut or burn themselves, they overdose on medications, they burn themselves, they pull their hair out, they jump from high places, they insert things into their bodies, they ingest poisonous substances, or they strangle themselves. Although it is very difficult to gauge exactly how many people self-harm –mainly because most individuals who do it do not seek out help from hospitals or clinics– it is clearly extremely common worldwide. One study recently showed that about one in 130 people engage in self-harm, while another one found that 11% of females and 3% of males aged 15 and 16 have engaged in it. Some people have self-harmed once or twice in their lives, while others will engage in it many times over long periods of time.
It has been shown that taken together, self-harm and suicide make up the second most common cause of death in young people. Although self-harm serves as a coping mechanism to many, people who engage in it are not only at an increased risk of dying accidentally from the self-harm or to actually commit suicide, they are also more likely to die young from natural causes. This close relationship between self-harm and death makes self-harm an extremely scary and difficult topic for everyone involved, from the individuals who engage in it to those who try to help them live without doing so.
Nevertheless, it is imperative for us to learn as much as we can about it and to move away from the harmful myths that surround self-harm, including “self-harm is a form of manipulation,” “if you engage in self-harm, you must be borderline,” and “self-harm is always a failed suicide attempt”. This will help us give the most informed and respectful support and advice possible to our loved ones, family members, friends, or patients who engage in it.
It is common for teenagers and adults who experienced sexual abuse, physical abuse, and/or neglect in childhood to hurt themselves, but these are certainly not the only kinds of life experiences associated with self-harm. It has been frequently observed in people experiencing or having experienced such common and varied life situations as difficult experiences of acculturation, financial difficulties, intense alcohol dependence, obesity, and bullying.
This begs the question of what exactly does self-harm do for those who engage in it?
Self-harm as emotion regulation
Some therapists and researchers –namely psychoanalysts and those who practice Dialectical Behavior Therapy– have a theory that links self-harm to emotion regulation. According to them, many people find themselves emotionally overwhelmed at some point in their lives, by experiences like relationship problems, financial difficulties, life transitions (e.g., having a baby), or sleep deprivation. Feeling overwhelmed makes some individuals experience intense emotional pain and vulnerability to this pain, and it overpowers their ability to think and act rationally. This makes them desperately try to reduce their emotional vulnerability and suffering in unhelpful ways, including self-harm. According to this theory, the pain produced by self-harm “resets” one’s emotional balance through the production of pain-relieving chemicals in the brain. This provides the self-harming individual with an intense and short-lived sense of relief that overcomes their negative feelings and allows for a moment of respite. Proponents of the emotion regulation theory of self-harm encourage people who engage in this kind of emotional coping to find other ways to manage their emotions. One of the ways to do this is to work to understand negative emotions as normal part of life, and that there are ways to acknowledge and then let go of these feelings, so that one is not forced to self-harm when overwhelmed.
Self-harm as communication
Anotherpopular theory describes self-harm as a means of communicating difficult emotions to others at times when identifying or describing these feelings is difficult or impossible. Seen in this way, self-harm happens when people intentionally or unintentionally compartmentalize and deny the emotional pain they are feeling because it causes them too much suffering. Because the pain continues to exist and to grow within them, it eventually finds its way back to the surface through the desire and impulse to physically attack their own bodies. The body literally becomes a means of communicating unconscious pain to others(whether these others are outside or have been internalized) using self-harm instead of words. The main way to help a person stop hurting him or herself in these situations is to work with them to read and understand these communications and to give words to the pain they are feeling. In other words, it helps to learn the language of emotions and use it instead of the language of action.
Ultimately, while self-harm should be considered a dangerous way of responding to difficult thoughts and emotions, there is no one perfect explanation or theory of it. It is for most people a means of coping with, and communicating difficult thoughts and emotions to others, all the while serving many other functions for those who engage in it. Talk therapy can help most people identify and manage underlying issues that trigger self-harm and it can help build skills to tolerate stress, regulate emotions, boost self-image, better relationships, and improve problem-solving skills. However, there is no one golden standard of recovery from self-harm, as everyone has different needs in regards to treatment or therapy style.
The following self-harm websites and organizations may be of help to you or someone who is struggling with self-harm:
A definitive analysis of the 41 best studies into the impact of childhood adversity on the risk of psychosis (mostly schizophrenia and bipolar disorder) was published in 2012. In order of impact, emotional abuse increased the risk of psychosis the most
We cannot be blamed for feeling nervous when this government talks of criminalising lack of parental love. There are uber-Thatcherites in its ranks who talk up the ‘big society’ but blame the individual. A wheeze for dumping their failure to support parents back on them would be no surprise.
However, in proposing to criminalize emotional abuse and neglect crimes, I am inclined to give them the benefit of the doubt. Many estimable campaigning groups, such as Action for Children, have advocated such legislation.
The case for it comes from the nature as well as nurture side of the child development debate. In an astonishing admission in the Guardian last month, Robert Plomin, the country’s leading genetic psychologist, admitted of the Human Genome Project’s quest for genes for psychological traits of all kinds: “I’ve been looking for these genes for 15 years and I don’t have any.”
On the other side of the equation, the evidence for the role of maltreatment in causing emotional distress in general, and emotional abuse and neglect in particular, has become overwhelming. This applies as much to the extreme disturbance of psychosis (mostly schizophrenia and bipolar disorder) as to more common problems such as depression and anxiety.
A definitive analysis of the 41 best studies into the impact of childhood adversity on the risk of psychosis (mostly schizophrenia and bipolar disorder) was published in 2012. It broke down the role of different kinds of maltreatment. Emotional abuse meant exposure to behavior such as harshness and name-calling from parents. Emotional neglect meant lack of love and responsiveness. Overall, in order of impact, emotional abuse increased the risk of psychosis the most (by 3.4 times, physical abuse and emotional neglect did so by 2.9, sexual abuse and bullying by peers by 2.4).
That emotional abuse is more damaging than sexual and physical abuse may seem surprising, although they tend to go together. One study found that the emotionally abused were 12 times more likely to be schizophrenic than the general population (compared with six times for the physically abused and twice as likely for the sexually abused). Another study followed adolescents for 15 years and found that over a third became schizophrenic if both parents were hostile, critical and intrusive, compared with none where only one parent was or neither were. In his definitive book, Models of Madness, John Read, a clinical psychologist at Liverpool University, shows that in the 10 studies testing the matter, the more extreme the childhood adversity, the greater the risk of adult psychosis. The results are similar for the number of adversities. In one large study, those subjected to five or more adversities were 193 times more likely to suffer psychosis than those with none.
Similar findings come from studies of less extreme emotional distress. In the definitive one, which followed 180 children from infancy to the age of 18, 90% of those who suffered early maltreatment qualified for a mental illness. Emotional neglect under the age of two was a critical predictor.
It is in light of this evidence that the government’s plans must be understood: the crucial role of early nurture seems to be accepted in a cross-party consensus.
The null hypothesis of the Human Genome Project will almost certainly have to be accepted: that genes play almost no role in explaining why one sibling is different from another. In the meantime, we need not fear Orwellian intrusion on parents by social workers measuring how much we love our children.
If there were laws against hitting children, as there should be, it would not result in many, or even any, convictions. It will be the same with this law. What is important is for the authorities to signal clearly that, as John Bowlby pointed out 60 years ago, love is as vital as vitamins for a child to flourish.
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[In the News] Insurers directed to treat mental health issues the same as physical ailments
By Sandhya Somashekhar and Juliet Eilperin, Washington Post Health and Science
The Obama administration issued a final rule Friday requiring insurers to treat mental health and substance-abuse problems the same way they do physical illnesses.
The rule provides long-awaited clarification on a mental health parity law that was enacted with much fanfare five years ago but had not been fully implemented as the federal government wrote and revised the regulations.
It also represents a fulfillment of a promise made by President Obama, who vowed to put the finishing touches on the regulations as part of a broader effort to address the problem of mass shootings, which have thrust mental health issues into the spotlight in recent years.
“For way too long, the health-care system has openly discriminated against Americans with behavioral health problems. In the past, it was legal for insurance companies to treat these disorders differently than medical and surgical needs,” Health and Human Services Secretary Kathleen Sebelius said in announcing the rule Friday.
Because of the 2008 mental health parity law, as well as the 2010 Affordable Care Act, “we are finally closing these gaps in coverage,” she said.
Mental health advocates lauded Friday’s news because they have been eagerly awaiting final regulations since the passage of the Mental Health Parity and Addiction Equity Act in 2008. Championed more than two decades ago by then-Sens. Paul D. Wellstone (D-Minn.) and Pete V. Domenici (R-N.M.), the law was hailed as a milestone for people with mental illness and substance-abuse problems.
The administration issued interim rules in 2010 meant to partially explain the nuances of the law, but it still left ambiguity in a number of areas, including how insurance companies were to cover the kind of intensive treatment that falls in the gray area between emergency inpatient care and a doctor’s office visit.
Friday’s rule clarifies that people are entitled to information about the standards used by health plans to determine what kind of treatment they cover — information that could be valuable if people want to file a complaint alleging that their mental health service was not treated comparably to a medical one.
It also confirms that the gray-area treatments — for example, intensive therapy after a psychotic break that does not require hospitalization — should be covered in a similar fashion as a medical condition, such as the rehabilitation that takes place after a heart attack.
But some mental health advocates said it fell short in at least one respect: It did not indicate that the rules apply to people in private health plans administered through Medicaid, the state-federal program for the poor.
They also noted that five years was a long time to wait for final rules. It was a period in which patients were somewhat reluctant to assert their rights under the law because of the lack of clarity, they said.
Still, they called Friday’s news historic and hailed it as a huge win for people who suffer from behavior problems.
“What a historic day this is, and what a difference it will make to families and individuals who have been discriminated against legally for many, many years,” said Debbie Plotnick, senior director of state policy for Mental Health America, an advocacy group.
By and large, insurance companies have already been abiding by the 2008 law, according to a federal study issued Friday in conjunction with the new rule.
Health plans “have worked to implement these requirements in a manner that is affordable, safe, and effective for patients,” Karen Ignagni, president of industry group America’s Health Insurance Plans, said in a statement Friday. “We appreciate that the final rule enables patients with mental and behavioral health conditions to continue to benefit from the innovative programs and services health plans have pioneered.”
The law applies only to health plans provided by employers with 50 workers or more. The Affordable Care Act, commonly referred to as Obamacare, extended the parity rules to the private health insurance market. The rules do not apply to people in government health insurance programs such as Medicaid or Medicare.
Finalizing the rule had been among the priorities outlined by Obama and Vice President Biden shortly after the attack in December at Sandy Hook Elementary School in Newtown, Conn., where a gunman opened fire, killing 20 first-graders and six school employees before taking his own life.
According to reports, the shooter, Adam Lanza, may have had a history of mental illness. Although studies show that people with mental disorders are more likely to be the victim of a crime than the perpetrator, Newtown and other mass shootings have prompted renewed interest in bolstering the nation’s mental health safety net.
That incident in particular led Obama and Biden to issue a plan to reduce gun violence through 23 proposed executive actions. With Friday’s announcement, all have now been fully or partially implemented.
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The creators of the Serious Mental Illness blog invite you to submit your visual art, poetry, or short fiction to Art from the Edge Now!!!
Art from the Edge, a virtual gallery and resource center by the creators of the Serious Mental Illness blog, is a blog dedicated to art created in and about extreme mental states. It is an open and public world wide forum for artists to share their visual and written works and their personal stories with all those interested in the connection between creativity and “edge” states.