Serious Mental Illness Blog

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Posts tagged trauma

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More similar than we know: When animals go madBy Laurel Braitman, ideas.ted.com
Author of the book Animal Madness, TED Fellow Laurel Braitman shares 5 ways in which animals and humans suffer from similar mental illnesses. Anthropomorphism run amok? You decide.
A golden retriever chases his tail every morning for hours on end. In the evening he compulsively licks his paws till they’re bare and oozy. When he’s given Prozac, he calms down and stops injuring himself … After the death of her mate, a scarlet macaw plucks out every last one of her feathers and doesn’t stop until she’s befriended by a cockatoo … A tabby cat who grew listless and stopped eating after his favorite human went off to college is cheered by the arrival of the family’s new pet rabbit, whom he likes to follow around the house.
Is the dog obsessive-compulsive? The parrot struggling with trichotillomania? The cat, once depressed, now recovered?
Making sense of animal emotional states and behavior, especially when they are doing things that seem abnormal, has always involved a certain amount of projection. The diagnoses that many of these animals receive reflect shifting ideas about human mental health, since people use the concepts, language and diagnostic tools they are comfortable with to puzzle out what may be wrong with the animals around them.
This isn’t to say that the creatures aren’t suffering, but the labels we give to their suffering reflect not only our beliefs about animals’ capacity for emotional expression, but also our own, most popular, ideas about mental illness and recovery. Where, for example, earlier generations saw madness, homesickness and heartbreak in themselves and other animals, veterinarians and physicians now diagnose anxiety, impulse control and obsessive-compulsive disorders in humans, dogs, gorillas, whales and many animals in between.
Looking at instances of purported animal madness is like holding up a mirror to the history of mental illness in people. It’s not always flattering — but it’s always interesting. Here are five classic examples of animal insanity, as diagnosed by arguably the craziest creatures of all, humans:
1. Heartbreak
Well into the 20th century, brokenheartedness was considered a potentially lethal medical problem that affected both humans and other animals alike, from jilted lovers who were thought to have died of shock after being left at the altar to loyal dogs that died immediately after their masters. In 1937, a German shepherd named Teddy stopped eating when his horse companion died; he stayed in the horse’s stall for three days until he died himself. These cases still pop up from time to time. In 2010, two elderly male otters that had been inseparable for 15 years died within an hour of each other at a New Zealand zoo. Only one had been ill; their keepers believed that the second otter died of a broken heart. In March 2011 another heartbreak story pinged around the web. A British soldier, Lance Corporal Tasker, was killed in a firefight in Helmand, Afghanistan. His dog, Theo, a Springer spaniel mix trained to sniff out explosives, watched the whole thing. Theo wasn’t injured in the firefight, but hours after Tasker died, she suffered a fatal seizure, brought on, according to witnesses, by stress and grief over the loss of her companion.
2. Madness
It wasn’t until Louis Pasteur successfully inoculated the first person against rabies in 1885 that people began to understand the disease as a matter of contagion. Before Pasteur, rabies symptoms were often seen as a form of insanity that could be passed between people and other animals. How and why animals could catch madness was a confusing business. Creatures could go mad from a lifetime of abuse, such as Smiles, the Central Park rhinoceros, who reportedly did so in 1903. Maddened horses, as they were known, could simply take off running, still attached to their carriages or dragging their riders behind, often with fatal consequences. Mad monkeys bit small children at the circus, and dogs could sometimes go mad with loneliness. Looking back, it’s likely that more than a few of these animals were not actually rabid. Instead, madness was a catch-all term for lots of different kinds of emotional suffering and other forms of insanity.
3. OCD
Obsessive-compulsive disorders are now relatively common diagnoses in humans and other animals. Many of these behaviors are actually healthy animal activities gone awry. People, mice and dogs, for example, can develop hand- or paw-washing habits that are so extreme as to keep them from playing, eating their meals, going on walks or sleeping. Parrots can develop feather-plucking compulsions that leave them bald as roasting chickens; rodents, cats, humans and other primates can compulsively pluck their hair to the point of baldness, a disorder known as trichotillomania. Other OCD spectrum behaviors, like rituals, can also be seen in nonhumans, as for instance this dog that spins every time he sees a car.
4. Phobias
Some animals, like some people, develop extremely specific fears of particular things in their environment, such as escalators, the beeps of an electronic alarm clock, shadows, even toaster ovens. One of the most common phobias, at least in dogs, iscrippling fear of thunderstorms, but cats can develop fears too, like this one whose owners believe is scared of measuring spoons. Horses can develop fears of plastic bags or umbrellas, among many other things. Thankfully, both people and other animals can learn to overcome their phobias, often with a mixture of behavior therapy and training, time, and psychopharmaceutical drugs such as Valium or Xanax.
5. PTSD
Traumatic stress disorders have been documented in a variety of animal species — from great ape veterans of pharmaceutical testing and elephants rescued from brutal circus training to canine veterans of armed conflict. How similar is PTSD in different animal species? It’s hard to know, but there are many shared symptoms, from changes in temperament and mood, difficulty sleeping and more sensitive startle responses to possible flashbacks of traumatizing events. In his book Second Nature,the ethologist Jonathan Balcombe shares an account of PTSD at the Fauna Sanctuary in Quebec, Canada, a refuge for chimps who’d been used in research. One afternoon, keepers loaded a shipment of materials onto a metal trolley they pushed past the enclosure of two chimps, Tom and Pablo. As soon as the chimps caught sight of it they let out frightened shrieks and became inconsolable. The staff later realized that the same brand of trolley, or one that looked like it, had been used to transport unconscious chimps to the surgery room at a research facility where Tom and Pablo had lived, and been experimented upon, two years earlier.
Laurel Braitman’s book, Animal Madness: How Anxious Dogs, Compulsive Parrots and Elephants in Recovery Help Us Understand Ourselves, is out now.
For more mental health resources, Click Here to access the Serious Mental Illness Blog.
Click Here to access original SMI Blog content

More similar than we know: When animals go mad
By Laurel Braitman, ideas.ted.com

Author of the book Animal Madness, TED Fellow Laurel Braitman shares 5 ways in which animals and humans suffer from similar mental illnesses. Anthropomorphism run amok? You decide.

A golden retriever chases his tail every morning for hours on end. In the evening he compulsively licks his paws till they’re bare and oozy. When he’s given Prozac, he calms down and stops injuring himself … After the death of her mate, a scarlet macaw plucks out every last one of her feathers and doesn’t stop until she’s befriended by a cockatoo … A tabby cat who grew listless and stopped eating after his favorite human went off to college is cheered by the arrival of the family’s new pet rabbit, whom he likes to follow around the house.

Is the dog obsessive-compulsive? The parrot struggling with trichotillomania? The cat, once depressed, now recovered?

Making sense of animal emotional states and behavior, especially when they are doing things that seem abnormal, has always involved a certain amount of projection. The diagnoses that many of these animals receive reflect shifting ideas about human mental health, since people use the concepts, language and diagnostic tools they are comfortable with to puzzle out what may be wrong with the animals around them.

This isn’t to say that the creatures aren’t suffering, but the labels we give to their suffering reflect not only our beliefs about animals’ capacity for emotional expression, but also our own, most popular, ideas about mental illness and recovery. Where, for example, earlier generations saw madness, homesickness and heartbreak in themselves and other animals, veterinarians and physicians now diagnose anxiety, impulse control and obsessive-compulsive disorders in humans, dogs, gorillas, whales and many animals in between.

Looking at instances of purported animal madness is like holding up a mirror to the history of mental illness in people. It’s not always flattering — but it’s always interesting. Here are five classic examples of animal insanity, as diagnosed by arguably the craziest creatures of all, humans:

1. Heartbreak

Well into the 20th century, brokenheartedness was considered a potentially lethal medical problem that affected both humans and other animals alike, from jilted lovers who were thought to have died of shock after being left at the altar to loyal dogs that died immediately after their masters. In 1937, a German shepherd named Teddy stopped eating when his horse companion died; he stayed in the horse’s stall for three days until he died himself. These cases still pop up from time to time. In 2010, two elderly male otters that had been inseparable for 15 years died within an hour of each other at a New Zealand zoo. Only one had been ill; their keepers believed that the second otter died of a broken heart. In March 2011 another heartbreak story pinged around the web. A British soldier, Lance Corporal Tasker, was killed in a firefight in Helmand, Afghanistan. His dog, Theo, a Springer spaniel mix trained to sniff out explosives, watched the whole thing. Theo wasn’t injured in the firefight, but hours after Tasker died, she suffered a fatal seizure, brought on, according to witnesses, by stress and grief over the loss of her companion.

2. Madness

It wasn’t until Louis Pasteur successfully inoculated the first person against rabies in 1885 that people began to understand the disease as a matter of contagion. Before Pasteur, rabies symptoms were often seen as a form of insanity that could be passed between people and other animals. How and why animals could catch madness was a confusing business. Creatures could go mad from a lifetime of abuse, such as Smiles, the Central Park rhinoceros, who reportedly did so in 1903. Maddened horses, as they were known, could simply take off running, still attached to their carriages or dragging their riders behind, often with fatal consequences. Mad monkeys bit small children at the circus, and dogs could sometimes go mad with loneliness. Looking back, it’s likely that more than a few of these animals were not actually rabid. Instead, madness was a catch-all term for lots of different kinds of emotional suffering and other forms of insanity.

3. OCD

Obsessive-compulsive disorders are now relatively common diagnoses in humans and other animals. Many of these behaviors are actually healthy animal activities gone awry. People, mice and dogs, for example, can develop hand- or paw-washing habits that are so extreme as to keep them from playing, eating their meals, going on walks or sleeping. Parrots can develop feather-plucking compulsions that leave them bald as roasting chickens; rodents, cats, humans and other primates can compulsively pluck their hair to the point of baldness, a disorder known as trichotillomania. Other OCD spectrum behaviors, like rituals, can also be seen in nonhumans, as for instance this dog that spins every time he sees a car.

4. Phobias

Some animals, like some people, develop extremely specific fears of particular things in their environment, such as escalators, the beeps of an electronic alarm clock, shadows, even toaster ovens. One of the most common phobias, at least in dogs, iscrippling fear of thunderstorms, but cats can develop fears too, like this one whose owners believe is scared of measuring spoons. Horses can develop fears of plastic bags or umbrellas, among many other things. Thankfully, both people and other animals can learn to overcome their phobias, often with a mixture of behavior therapy and training, time, and psychopharmaceutical drugs such as Valium or Xanax.

5. PTSD

Traumatic stress disorders have been documented in a variety of animal species — from great ape veterans of pharmaceutical testing and elephants rescued from brutal circus training to canine veterans of armed conflict. How similar is PTSD in different animal species? It’s hard to know, but there are many shared symptoms, from changes in temperament and mood, difficulty sleeping and more sensitive startle responses to possible flashbacks of traumatizing events. In his book Second Nature,the ethologist Jonathan Balcombe shares an account of PTSD at the Fauna Sanctuary in Quebec, Canada, a refuge for chimps who’d been used in research. One afternoon, keepers loaded a shipment of materials onto a metal trolley they pushed past the enclosure of two chimps, Tom and Pablo. As soon as the chimps caught sight of it they let out frightened shrieks and became inconsolable. The staff later realized that the same brand of trolley, or one that looked like it, had been used to transport unconscious chimps to the surgery room at a research facility where Tom and Pablo had lived, and been experimented upon, two years earlier.

Laurel Braitman’s book, Animal Madness: How Anxious Dogs, Compulsive Parrots and Elephants in Recovery Help Us Understand Ourselves, is out now.

For more mental health resources, Click Here to access the Serious Mental Illness Blog.

Filed under animal animals pet pets dog cat dogs cats heartbreak sad sadness depressed depression madness mad ocd phobia scared ptsd trauma traumatized mind body brain wellness health healthy mental mental health mental illness

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Why is Institutional Betrayal so Traumatic?By Linda Hatch, Ph.D., PsychCentral
Since the posting on PsychCentral a year ago of the article called “Organizational Infidelity Amplifies Sexual Trauma” there has been a great deal of attention paid to the poor handling of sexual trauma by institutions such as universities, the military and the church. That article cited a study showing that victims of sexual trauma who also reported having a sense of institutional betrayal showed more severe symptoms of post-traumatic stress such as anxiety, sexual dysfunction and dissociation.
Recently there have been legislative efforts to impose guidelines in the handling of sexual assaults on campuses as well as efforts to find the best ways to address problems in the reporting, investigation and prosecution of sexual misconduct within the military, universities, and the church. These efforts were prompted by the low rate at which sexual assaults were reported and if reported the low rate at which those cases were acted upon. For example, although 20% of students were sexually assaulted at college, only 12% of the victims actually reported the assault. And although rape in the military  had increase 50% over the previous year, only one in 100 was prosecuted.
Attempts to address institutional betrayal have focused on prevention, changing the institutional culture, structural changes in investigation and prosecution, adding necessary resources and policies for following up on reports, and the interface between the institution and law enforcement.
Institutional betrayal and family betrayal
Many factors play into a person’s response to trauma including some having to do with the psychology of the individual and their own history and resiliency. Being betrayed by your organization or institution seems to me to involve a number of other psychological layers all of which exacerbate the sexual trauma and make the recovery from it more difficult. All of these aspects have parallels to what happens or doesn’t happen in a family in which a child is abused or traumatized.
Safety and the failure to protect
It makes sense on the face of it that sexual trauma in a supposedly safe environment would be more traumatic. The expectation of protection and the betrayal of that expectation would add an element of traumatic stress. In the past I have done extensive work with families in which a child is abused by a family member. In the handling of such cases by the child protection agencies and by the law, the parent who fails to protect the child or even who knowingly exposes the child to abuse is seen as being abusive in their own right. The non-offending parent is supposed to be the caregiver, the protector. The violation of the expectation of security shakes the child’s or adult’s reality. Rocking the foundations of someone’s sense of reality is a highly traumatic form of mental abuse. When used in brainwashing it often involves committing unthinkable acts in front of the person in order to make then so mentally shaken that they become malleable. This is sometimes called “ritual abuse.”
So the contrast between what victims expect from the institution (safety from harm or exploitation) and what actually happens renders the person more shaken and less able to rely on their own mental processes to help them cope. It jars loose their sense of reality above and beyond the impact of the actual assault. For children in a family this kind of betrayal is an attachment injury or relational trauma which has lasting effects on emotional development.
Failure of support after the fact and complex PTSD
Among the key factors that affect how well a child can cope with a traumatic event of any kind is the response of the parent or caregiver, the way the child is handled after the event occurs. Other things being equal, the child who receives a lot of support, comforting, sympathy validation and help after a traumatic experience will bounce back faster and have fewer long terms effects. The child who is not appropriately comforted and validated will likely be more damaged.
In the case of institutional betrayal– the experience of betrayal by the church, the school, the military– the failure after the fact is much like the betrayal by parents who fail to adequately support a child following a traumatic event. Adults, like children, may be better able to quickly recuperate following and event like sexual assault if they are able to go to someone in charge, be believed, get appropriate supports and be vindicated. If they are sent away or ignored and if the person who assaulted them is not held to account, their recovery is bound to be compromised and lead to symptoms akin to complex PTSD.
Of the two aspects of organizational betrayal, I am inclined to think that the failure after the fact may be potentially more damaging than the failure to prevent or protect in the first place. The healthy person can recover from trauma in the right context. We are all able to understand that there are people in the world who are up to no good. And as adults most people can even understand what it is like to be in a “culture” in which the norms are pretty rough, as long as the powers that be are willing to take a stand when a line is crossed. So although someone may be deeply shaken, they can also be very resilient if they get the right emotional supports at the right time. The failure to prevent a trauma can be understood and accepted, as long as the institution or organization does not look the other way or abandon the victim.
Find Dr. Hatch on Facebook at Sex Addictions Counseling or Twitter@SAResource
For more mental health resources, Click Here to access the Serious Mental Illness Blog.Click Here to access original SMI Blog content

Why is Institutional Betrayal so Traumatic?
By Linda Hatch, Ph.D., PsychCentral

Since the posting on PsychCentral a year ago of the article called “Organizational Infidelity Amplifies Sexual Trauma” there has been a great deal of attention paid to the poor handling of sexual trauma by institutions such as universities, the military and the church. That article cited a study showing that victims of sexual trauma who also reported having a sense of institutional betrayal showed more severe symptoms of post-traumatic stress such as anxiety, sexual dysfunction and dissociation.

Recently there have been legislative efforts to impose guidelines in the handling of sexual assaults on campuses as well as efforts to find the best ways to address problems in the reporting, investigation and prosecution of sexual misconduct within the military, universities, and the church. These efforts were prompted by the low rate at which sexual assaults were reported and if reported the low rate at which those cases were acted upon. For example, although 20% of students were sexually assaulted at college, only 12% of the victims actually reported the assault. And although rape in the military  had increase 50% over the previous year, only one in 100 was prosecuted.

Attempts to address institutional betrayal have focused on prevention, changing the institutional culture, structural changes in investigation and prosecution, adding necessary resources and policies for following up on reports, and the interface between the institution and law enforcement.

Institutional betrayal and family betrayal

Many factors play into a person’s response to trauma including some having to do with the psychology of the individual and their own history and resiliency. Being betrayed by your organization or institution seems to me to involve a number of other psychological layers all of which exacerbate the sexual trauma and make the recovery from it more difficult. All of these aspects have parallels to what happens or doesn’t happen in a family in which a child is abused or traumatized.

Safety and the failure to protect

It makes sense on the face of it that sexual trauma in a supposedly safe environment would be more traumatic. The expectation of protection and the betrayal of that expectation would add an element of traumatic stress. In the past I have done extensive work with families in which a child is abused by a family member. In the handling of such cases by the child protection agencies and by the law, the parent who fails to protect the child or even who knowingly exposes the child to abuse is seen as being abusive in their own right. The non-offending parent is supposed to be the caregiver, the protector. The violation of the expectation of security shakes the child’s or adult’s reality. Rocking the foundations of someone’s sense of reality is a highly traumatic form of mental abuse. When used in brainwashing it often involves committing unthinkable acts in front of the person in order to make then so mentally shaken that they become malleable. This is sometimes called “ritual abuse.”

So the contrast between what victims expect from the institution (safety from harm or exploitation) and what actually happens renders the person more shaken and less able to rely on their own mental processes to help them cope. It jars loose their sense of reality above and beyond the impact of the actual assault. For children in a family this kind of betrayal is an attachment injury or relational trauma which has lasting effects on emotional development.

Failure of support after the fact and complex PTSD

Among the key factors that affect how well a child can cope with a traumatic event of any kind is the response of the parent or caregiver, the way the child is handled after the event occurs. Other things being equal, the child who receives a lot of support, comforting, sympathy validation and help after a traumatic experience will bounce back faster and have fewer long terms effects. The child who is not appropriately comforted and validated will likely be more damaged.

In the case of institutional betrayal– the experience of betrayal by the church, the school, the military– the failure after the fact is much like the betrayal by parents who fail to adequately support a child following a traumatic event. Adults, like children, may be better able to quickly recuperate following and event like sexual assault if they are able to go to someone in charge, be believed, get appropriate supports and be vindicated. If they are sent away or ignored and if the person who assaulted them is not held to account, their recovery is bound to be compromised and lead to symptoms akin to complex PTSD.

Of the two aspects of organizational betrayal, I am inclined to think that the failure after the fact may be potentially more damaging than the failure to prevent or protect in the first place. The healthy person can recover from trauma in the right context. We are all able to understand that there are people in the world who are up to no good. And as adults most people can even understand what it is like to be in a “culture” in which the norms are pretty rough, as long as the powers that be are willing to take a stand when a line is crossed. So although someone may be deeply shaken, they can also be very resilient if they get the right emotional supports at the right time. The failure to prevent a trauma can be understood and accepted, as long as the institution or organization does not look the other way or abandon the victim.

Find Dr. Hatch on Facebook at Sex Addictions Counseling or Twitter@SAResource

For more mental health resources, Click Here to access the Serious Mental Illness Blog.
Click Here
 to access original SMI Blog content

Filed under trauma traumatized ptsd sexual trauma sex sexual mental health mental illness mental health illness healthy mind body brain wellness recovery hope psychology psychiatry counseling anxiety anxious depressed depression sad sadness dissociation dissociated sexual assault

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How to Regain Control of Your Sex Life after Sexual Abuse: A Sex Therapist’s GuideBy Vanessa Marin, XOJane.com
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. 
For more mental health resources, Click Here to access the Serious Mental Illness Blog.Click Here to access original SMI Blog content

How to Regain Control of Your Sex Life after Sexual Abuse: A Sex Therapist’s Guide
By Vanessa Marin, XOJane.com

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. 

For more mental health resources, Click Here to access the Serious Mental Illness Blog.
Click Here
 to access original SMI Blog content

Filed under sex sexual abuse rape raped trauma ptsd traumatized dissociation dissociated dissociate numb feelings emotions mind body brain wellness recovery hope treatment therapy pain fear scared sad sadness depressed depression health

17 notes

What Does the Treatment for Complex Trauma Look Like?By Sara Staggs, LICSW, MPH, PsychCentral
Lack of research and exclusion of truly complex casesResearch for complex trauma and dissociation is severely underfunded relative to the numbers of individuals with these conditions. As such, there aren’t any randomized control trials that assess a specific protocol, like there are for other disorders. The few studies that claim to include survivors of complex trauma will include people who have been exposed to the traumatic events I described a couple of posts ago, but then exclude people who are suicidal, have self-harming behaviors, have comorbid disorders, have psychotic symptoms (people who are dissociative can appear to have psychotic symptoms) and/or have substance abuse. Since this describes individuals with dissociative disorders, the studies are excluding clients who have truly complex trauma. This study, for example, claims to study the efficacy of CBT and CPT, relatively short term evidence-based treatments for classic trauma. However, they exclude people with almost all of the symptoms listed above, so while the participants may have some features of complex trauma, they definitely don’t resemble the complex trauma clients that I work with, or that are described in case studies of extremely dissociative cases.
This study did show that when TF-CBT is adapted to be administered in a phase-based fashion (up to 30 sessions instead of 12, assessing for safety and stability throughout), it can be helpful in treating adolescents with complex trauma. Unfortunately, they say almost nothing about their participants except to note how difficult it is to assess youth for complex trauma, so we don’t know how severe their symptoms were when they started.
So what do we know?What does exist are some case studies and a large, international prospective study by Bethany Brand that examines what practitioners are currently doing and assesses how that is working. The good news is that practitioners who take on complex trauma clients (the suicidal, self-harming, addicted, dissociative ones with disorganized attachment) are doing solid clinical work that is consistent with complex trauma treatment guidelines and are unequivocally helping clients get better.
What is currently recommended to treat complex trauma and dissociation is a three phase treatment approach. Incidentally, if you’re seeking a therapist for complex trauma a great way to find out if they know what they’re doing is to ask if they use this (or if they even know what it is).
Phase I- Safety and Coping
in some cases, this phase can take months or even years
a great deal of attention is paid to rapport to address attachment phobia
emotion regulation and grounding are used to help the individual stay in the present and in their window of tolerance
safety and stability for individuals who have suicidal thoughts or self-harming behaviors
distress tolerance and coping to help
Evidence based practices that are helpful at this stage can include DBT, mindfulness, CBT skills (including those from ACTand CPT), and Resource Development and Installation from EMDR. Also there are several group treatments that can be helpful, particularly Seeking Safety.
Phase II-Trauma Processing
Prolonged exposure, by definition is not recommended. Instead, trauma exposure should be gradual. A significant feature of complex trauma is that clients experience frequent intrusions of the trauma, and they aren’t able to avoid it the way that many people with classic trauma can. Therefore, they are already experiencing flooded exposure to their trauma and more of that isn’t therapeutic. Instead, re-experiencing is done while within the window of tolerance and while the client has a dual awareness with the present so that they know they are safe.
Safety and coping interlaced throughout
May be interspersed with checkup/integrative sessions. Many of my clients experience a whole new perspective on their experience and need a session between memories to process this.
Techniques from EMDR, somatic work, and trauma narratives from CBT exposure-based therapies listed above are effective here
Phase III
Integrates new skills, insight and stability
Helps client develop sense of new normal
For clients with Dissociative Identity Disorder, final integration of parts into the whole takes place
For more mental health resources, Click Here to access the Serious Mental Illness Blog.Click Here to access original SMI Blog content

What Does the Treatment for Complex Trauma Look Like?
By Sara Staggs, LICSW, MPH, PsychCentral

Lack of research and exclusion of truly complex cases
Research for complex trauma and dissociation is severely underfunded relative to the numbers of individuals with these conditions. As such, there aren’t any randomized control trials that assess a specific protocol, like there are for other disorders. The few studies that claim to include survivors of complex trauma will include people who have been exposed to the traumatic events I described a couple of posts ago, but then exclude people who are suicidal, have self-harming behaviors, have comorbid disorders, have psychotic symptoms (people who are dissociative can appear to have psychotic symptoms) and/or have substance abuse. Since this describes individuals with dissociative disorders, the studies are excluding clients who have truly complex trauma. This study, for example, claims to study the efficacy of CBT and CPT, relatively short term evidence-based treatments for classic trauma. However, they exclude people with almost all of the symptoms listed above, so while the participants may have some features of complex trauma, they definitely don’t resemble the complex trauma clients that I work with, or that are described in case studies of extremely dissociative cases.

This study did show that when TF-CBT is adapted to be administered in a phase-based fashion (up to 30 sessions instead of 12, assessing for safety and stability throughout), it can be helpful in treating adolescents with complex trauma. Unfortunately, they say almost nothing about their participants except to note how difficult it is to assess youth for complex trauma, so we don’t know how severe their symptoms were when they started.

So what do we know?
What does exist are some case studies and a large, international prospective study by Bethany Brand that examines what practitioners are currently doing and assesses how that is working. The good news is that practitioners who take on complex trauma clients (the suicidal, self-harming, addicted, dissociative ones with disorganized attachment) are doing solid clinical work that is consistent with complex trauma treatment guidelines and are unequivocally helping clients get better.

What is currently recommended to treat complex trauma and dissociation is a three phase treatment approach. Incidentally, if you’re seeking a therapist for complex trauma a great way to find out if they know what they’re doing is to ask if they use this (or if they even know what it is).

Phase I- Safety and Coping

  • in some cases, this phase can take months or even years
  • a great deal of attention is paid to rapport to address attachment phobia
  • emotion regulation and grounding are used to help the individual stay in the present and in their window of tolerance
  • safety and stability for individuals who have suicidal thoughts or self-harming behaviors
  • distress tolerance and coping to help
  • Evidence based practices that are helpful at this stage can include DBT, mindfulness, CBT skills (including those from ACTand CPT), and Resource Development and Installation from EMDR. Also there are several group treatments that can be helpful, particularly Seeking Safety.

Phase II-Trauma Processing

  • Prolonged exposure, by definition is not recommended. Instead, trauma exposure should be gradual. A significant feature of complex trauma is that clients experience frequent intrusions of the trauma, and they aren’t able to avoid it the way that many people with classic trauma can. Therefore, they are already experiencing flooded exposure to their trauma and more of that isn’t therapeutic. Instead, re-experiencing is done while within the window of tolerance and while the client has a dual awareness with the present so that they know they are safe.
  • Safety and coping interlaced throughout
  • May be interspersed with checkup/integrative sessions. Many of my clients experience a whole new perspective on their experience and need a session between memories to process this.
  • Techniques from EMDR, somatic work, and trauma narratives from CBT exposure-based therapies listed above are effective here

Phase III

  • Integrates new skills, insight and stability
  • Helps client develop sense of new normal
  • For clients with Dissociative Identity Disorder, final integration of parts into the whole takes place

For more mental health resources, Click Here to access the Serious Mental Illness Blog.
Click Here
 to access original SMI Blog content

Filed under trauma complex trauma dissociation dissociate dissociated ptsd traumatized fear scared psychology psychiatry counseling mental health mental illness mental health illness healthy mind body brain wellness recovery hope psychotic psychosis treatment therapy diagnosis disorder

228 notes

artfromtheedge:

HAVE YOU CREATED ART IN OR ABOUT AN EXTREME STATE?
The creators of the Serious Mental Illness blog invite you to submit your visual art, photography, video work, poetry, collage, or short fiction to Art from the Edge. All of the art shown on this flyer has been featured on the blog.
Art from the Edge, a virtual gallery and resource center, is 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.
Much like art, which exists in a multitude of mediums and forms of expression, there are a plurality of “edge” states that inspire the artists who harbor them. For this reason, we leave the term completely open to our community’s interpretation, knowing from research and experience that this state could be driven by psychosis or trauma, or an altered state induced by drugs. It could be the offshoot of extreme depression or grief, or the aftermath of a spiritual or mystical state of consciousness.
Ultimately, we are interested in the artist’s individual experience and in his or her sense of what it is that drove the creative act. 
submissions@artfromtheedge.net
artfromtheedge.net

artfromtheedge:

HAVE YOU CREATED ART IN OR ABOUT AN EXTREME STATE?

The creators of the Serious Mental Illness blog invite you to submit your visual art, photography, video work, poetry, collage, or short fiction to Art from the Edge. All of the art shown on this flyer has been featured on the blog.

Art from the Edge, a virtual gallery and resource center, is 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.

Much like art, which exists in a multitude of mediums and forms of expression, there are a plurality of “edge” states that inspire the artists who harbor them. For this reason, we leave the term completely open to our community’s interpretation, knowing from research and experience that this state could be driven by psychosis or trauma, or an altered state induced by drugs. It could be the offshoot of extreme depression or grief, or the aftermath of a spiritual or mystical state of consciousness.

Ultimately, we are interested in the artist’s individual experience and in his or her sense of what it is that drove the creative act. 

submissions@artfromtheedge.net

artfromtheedge.net

(via smiliu)

Filed under art artist artistic creative poem story write poetry poet writer visual visual art video mixed media collage digital art digital psychosis psychotic trauma drug drugs depressed depression mind body brain diagnosis disorder psychology