Month: May 2017

 

·         1. You improve your concentration.

• We live in a hectic world these days. Our concentration is often incredibly split between work, home, electronics, and other stimuli. When you sit down and focus on one thing, like colouring, it improves your ability to focus elsewhere.

·         2. You unleash your inner creativity.

• Colouring inside or outside the lines does wonders to unleash your inner creativity. Adults who colour are more likely to approach problems more creatively and find better solutions.

·         3. Your brain treats it like meditation.

• When you colour, the same things happen inside of your brain as when you meditate.

·         4. You can chill out anywhere any time.

• Bored on a plane? Colour. Feeling stressed at work? Colour (on your break). Nothing to do at home? Colour. It’s awesome. You can do it wherever.

·         5. You improve your motor skills.

• All that colouring inside of the lines improves hand-eye coordination and your overall motor skills.

·         6. You release negative thoughts.

• It’s like with meditation. When you colour, you focus on what you’re doing and you just sort of naturally release a lot of tension and negative thinking.

 

Work by Pat

In therapy group this week we talked about forgiveness. It is often very hard for people to forgive the pain that has been caused, but without forgiveness the process of healing cannot begin. The easiest way to invoke a genuine forgiveness is to try to understand why people do the things they do and it is often because the perpetrator of harm has not come to terms with the harm that has been caused to them. As a humanity we need to all work together to break this cycle. No easy task! But we can make a start as individuals to espouse forgiveness and understanding and thus encourage others to do the same.

Psychoanalysis is a lifestyle that involves a different way of acknowledging and interpreting the world and our place in it. Psychoanalysis examines culture, pain, sexuality, drama, art, philosophies, human behaviour and all forms of thinking and activity.  Psychoanalysis is also a clinical practice predicated on a theory that the human condition  allows for self-improvement by way of monitoring human thoughts, feelings, emotions and their outcomes. Psychoanalysis gives focus to the unconscious mind as well to its cognitive and conscious implications.

Unlike many other therapies psychoanalysis does not pathologize the individual, it treats everyone as unique, purposeful and deserving of a full and creative life.  Psychoanalysis teaches the recipient to analyze dreams, fantasies, humour, images, memories and internal conversations and to determine  how these narratives action the body in symptoms, pain and sometimes chronic illness, all of which the psychoanalyst takes to be caused by repressed emotions and a lack of outward communication.   In this respect, the psychoanalyst understands the burden of that which cannot be otherwise spoken or shared.  To this end, psychoanalysis gives primary focus to the unconscious and how it drives the many decisions and events in our everyday lives. The practice of psychoanalysis comes from a place of empathy, acceptance and personal experience.   Every psychoanalyst has gone through a process of self-development and the aim is to use this to interact with the person(s) at the deepest and most spiritual level.

Rainbow Angel: Junitta Valak. 2008. Australian Artist Junitta Vallak has kindly offered her work for inclusion in my new book. Junitta has been a long standing member of the Peace Chamber Movement, which reached its height in the 1970s in light of the nuclear arms race and the threat of a total global destruction.   In discussions with Junitta we both agreed that this kind of global threat has had a profound psychological impact on the security and stability of individuals, whereby it reveals another aspect of the ever  increasing post-traumatic stress disorder.

Trauma seriously affects psychological and biological development. There have been many studies over the past three decades that have helped in our understanding of how the brain works and how trauma hinders the developmental processes. Trauma is a global problem that impacts the health and well-being of millions of people and it underscores a lot of negative human behaviour that perpetuates pain on a world scale. Today, the study of psychological trauma is accompanied by an explosion of knowledge about how experience shapes the central nervous system and the formation of identity, or what we call the self.  The developments in the neurosciences, developmental psychopathology and information processing have contributed to our understanding of how brain function is shaped by experience and that life in and of itself can continually transform the body and mind.  The study of trauma has probably been the most important area of study for helping to develop a deeper understanding of the relationship between the emotional, cognitive, social and biological forces that have shaped our human evolution and there is still a long way to go and much more to be explored.

So far, many of the studies have been around the high incidence of post-traumatic stress disorder (PTSD) and these have been extended into  early experiences in childhood. We know for instance, that certain experiences can put in place psychological narratives that have an impact in physiology and decision making. We know that most experience is automatically processed beyond our awareness.  In other words, behaviours generally arise from the unconscious and rational thinking has only a limited influence on the operation of these unconscious (sub-cortical) processes.  We know that most of the problems of traumatized people are caused by replaying the traumatic events of the past.  Drugs and therapy have only limited prospects in assisting these preconditioned scenarios and there is a high level of relapse from current therapeutic practices.  The suicide rates have soared.

Data from the National Vital Statistics System, (a collaboration between the National Centre for Health Statistics of the U.S. Department of Health and Human Services and each US state), provides the best estimate of suicides for United States and it can be used as a guide for all western nations whose lifestyle is based on a continued expansion of economic productivity over and above human well-being.

Suicide. Considerable debate exists about the reason for the heightened risk of suicide in trauma survivors. Whereas some studies suggest that suicide risk is higher among those who experienced trauma due to the symptoms of PTSD (8-10), others claim that suicide risk is higher in these individuals because of related psychiatric conditions (11,12). However, a study analyzing data from the National Co-morbidity Survey, a nationally representative sample, showed that PTSD alone out of six anxiety diagnoses was significantly associated with suicidal ideation or attempts (13). While the study also found an association between suicidal behaviours and both mood disorders and antisocial personality disorder, the findings pointed to a robust relationship between PTSD and suicide after controlling for co-morbid disorders. A later study using the Canadian Community Health Survey data also found that respondents with PTSD were at higher risk for suicide attempts after controlling for physical illness and other mental disorders. https://www.ptsd.va.gov/professional/co-occurring/ptsd-suicide.asp

Overall, men have significantly higher rates of suicide than women and there is an extraordinarily high rate of suicide for veterans.  From 1999-2010, the suicide rate in the US population among males was 19.4 per 100,000, compared to 4.9 per 100,000 in females. Based on the most recent US data available, in the fiscal year 2009, the suicide rate among male Veteran VA users was 38.3 per 100,000, compared to 12.8 per 100,000 in females. [i]

Many suicides are not reported and it can be very difficult to determine whether or not a particular individual’s death was intentional. For a suicide to be recognized, examiners must be able to say that the deceased meant to die. Other factors that contribute to the difficulty are differences among states as to who is mandated to report a death, as well as changes over time in the coding of mortality data.[ii]

Importance of combat exposure in Veterans experience PTSD. Though considerable research has examined the relation between combat or war trauma and suicide, the relationship is not entirely clear. Some studies have shown a relationship while others have not (1). There is strong evidence, though, that among Veterans who experienced combat trauma, the highest relative suicide risk is observed in those who were wounded multiple times and/or hospitalized for a wound (7). This suggests that the intensity of the combat trauma, and the number of times it occurred, may influence suicide risk in Veterans. This study assessed only combat trauma, not a diagnosis of PTSD, as a factor in the suicidal behaviour. https://www.ptsd.va.gov/professional/co-occurring/ptsd-suicide.asp

A body of research indicates that there is a correlation between many types of trauma and suicidal behaviours. For example, there is evidence that traumatic events such as childhood abuse may increase a person’s suicide risk.[iii]   A history of military sexual trauma (MST) also increases the risk for suicide and intentional self-harm, suggesting a need to screen for suicide risk in this population.[iv] There is no one cure for these problems.

The incidence of post-traumatic stress disorder (PTSD) can be related to a number of stressful situations, PTSD is regarded as a mental disorder that may occur in people who experience first-hand, or witness any form of intense violence, shock, or serious accident, or a life-threatening situation, which causes the fight and flight areas of the brain to be activated (the amygdala). PTSD often involves situations that will make people feel unworthy, hopeless, fearful, horrified, and overwhelmed when attempting to carry out the simplest of tasks or when they find themselves in a social situation and unable to relate to the people around them.

Symptoms of PTSD include: Reliving the traumatic event through thoughts, flashbacks, and nightmares. Experiencing a rapid heart-beat and sweating while reliving  the traumatic event. Feeling numb. Feeling emotionally detached from other people. Sleep disturbances. Irritability. Avoidance of anything associated with the trauma. Anger. Difficulty concentrating. Amnesia. A strong response when shocked. Extreme vigilance, always feeling on guard. Difficulty working. Difficulty with social situations. Inability to properly care for loved ones. The onset of symptoms usually occurs within three months of the incident, but may not occur for several years. PTSD can affect people of any age, including children. About 7.5 percent of Americans will experience PTSD in their lifetime. About 5 million Americans will suffer from PTSD during any year. Women are twice as likely to experience PTSD as men. People with PTSD oftentimes also suffer from depression or other mental disorders. War veterans, law enforcement officers, firefighters, and EMT workers are particularly vulnerable to PTSD. Anyone with PTSD is at a high risk for suicide. www.suicide.org.

Possible causes for PTSD.   Military combat, rape, domestic violence, assault, sexual molestation, sexual abuse, a kidnapping, child abuse, severe verbal abuse, torture, airplane accident, fire, hurricane, tornado, earthquake, animal attack, threatening individual with a gun, a knife or other weapon, stalking, constant pressure to achieve. www.suicide.org.

Many people repress their trauma and it would appear that the severity and length of time the trauma is experienced the more likely the details of the trauma will be repressed.  Finding one’s voice to speak the truth of experience, and the transformative potential of writing, art and meditation is  a significant aid to alleviating the problems of trauma, but it is not an easy road, it takes time and commitment.  We now know how trauma occurs and how the damage caused can be successfully managed and in some cases repaired when sufficient resources are available.   However, trauma is a societal problem and  alleviating the trauma in the first place seems like an impossible task so the next best thing  must be preparing people for the possible onset of trauma at any stage in their lifetime.   If this kind of preparation is going to happen it needs to start at an early age.

[i] Knox, K.L. (2008). Epidemiology of the relationship between traumatic experience and suicidal behaviors. PTSD Research Quarterly, 19(4). www.ptsd.va.gov/professional/newsletters/research-quarterly/V19N4.pdf (PDF)

[ii] Ibid.

[iii] Afifi, T.O., Enns, M.W., Cox, B.J., Asmundson, G.J.G., Stein, M.B., & Sareen, J. (2008). Population attributable fractions of psychiatric disorders and suicide ideation and attempts associated with adverse childhood experiences. American Journal of Public Health, 98, 946-952. doi: 10.2105/AJPH.2007.120253

[iv] Kimerling, R., Gima, K., Smith, M. W., Street, A., & Frayne, S. (2007). The Veterans Health Administration and military sexual trauma. American Journal of Public Health, 97, 2160-2166. doi: 10.2105/AJPH.2006.092999

 

Symbolism.

In psychoanalysis symbolism is associated with ego formation. Sigmund Freud described ego formation in his Introductory Lectures on Psychoanalysis (1916-1917). Freud wrote: There can be no doubt that the source [of the fantasies] lie in the instincts; but it still has to be explained why the same fantasies with the same content are created on every occasion. I am prepared with an answer that I know will seem daring to you. I believe that…primal fantasies, and no doubt a few others as well, are a phylogenetic endowment. Freud’s suggestion that primal fantasies are a residue of specific memories of prehistoric experiences follows his interest in archetypes, which he withdrew from after his split with Carl Jung.  It was Jung who developed the notion of archetypes as an influential component in human behaviour.   Laplanehe and Pontalis point out that all the so-called primal fantasies relate to the origins and that  like collective myths they claim to provide a representation of and a ‘solution’ to whatever constitutes an enigma for the (developing) child.[i]

According to Melanie Klein not only does symbolism come to be the foundation of all fantasy and sublimation, but more than that, it is the basis of the subject’s relation to the outside world and to reality in general.[ii]  For Klein trauma is associated with an internal rage that serves as an antidote for the preservation of the good object. Klein argued that the introjection and identification with a stable good object is crucial to the ego’s construction.

The concept of introjected objects‘, or the term ‘internal object’ means a mental and emotional image of an external object that has been taken inside the self. A complex interaction continues in the mind between the internalized world and its figures and objects  and their replicates in the real world.   According to Klein, this happens in repeated cycles of projection and introjection. The primary internal objects are those derived from the parents, in particular from the mother. The main component is the bodily contact, which allows the infant to feel and project a loving instinct or a disparaging (death) instinct.   These objects, when taken into the self, are thought to be experienced by the infant concretely as physically present within the body, causing pleasure (good internal part-object…) or pain (bad internal part-object…). The processes involved in these early experiences are believed to colour the ongoing outlook the infant has of the world as well as the fluctuations between pain and pleasure.

Kleinian theory suggests the introjection of and identification with a stable good object is crucial to the ego’s capacity to cohere and integrate experience. Damaged or dead internal objects (sometimes referred to as the dead mother) causes enormous anxiety and can lead to personality disintegration, whereas objects felt to be in a good state promote confidence and well-being.  Internal objects can exist on several levels. They are generally unconscious and  primitive. Infantile internal objects are experienced initially concretely within the body and mind and constitute a primitive level of the adult psyche, adding emotional influence and force to later perceptions, feelings and thoughts. Internal objects may be represented to the self in dreams, fantasies and in language. [iii]

The term ‘symbol formation’ is used in psychoanalysis to denote a mode of indirect or figurative representation of a significant idea, conflict or wish. The ability to move on from relating concretely to archaic objects to relating symbolically to substitute objects (symbols) is both a developmental achievement and a move made because of the anxieties involved in relating to primal objects. Klein extended the ideas of both Freud and Jones on symbols, showing in particular the symbolic significance of play and how sublimation depends on the capacity to symbolize.  Others further developed Klein’s theory of symbols, distinguishing between the symbol proper formed in the depressive position and a more primitive version, the symbolic equation, belonging to paranoid-schizoid functioning. In the symbolic equation, the symbol is equated with the thing symbolized.[iv]

Melanie Klein believed in the idea of unconscious phantasy, which is closely related to Carl Jung’s archetype  as Both involve the notion of an a priori  mental construction composed of images and patterns based on real and mythological experience.   For Jung these experiences form a universal collective unconsciousness that extends over time and many lifetimes. The manifestation of these archetypes are counterpart to instincts. They are autonomous inherited potentials rather than inherited types, which can be transformed and/or expressed in the ideas, behaviours and cultures of individuals.  History, culture and personal context shape these manifest representations thereby giving them their specific content. These images and motifs are more precisely called archetypal images. However, it is common for the term archetype to be used interchangeably to refer to both archetypes-as-such and archetypal images.[v]

Following the Jungian view it would appear that the internal objects, good and bad, can be inherited, whereby they present a subtle underlying current in the care-giver’s emotions to which the primitive, instinctual infant displays an acute sensitivity.

[i] Andrew Samuels, Jung and the Post-Jungians ISBN 0415059046, Routledge (1986)

[ii] M Klein 1930 The importance of symbol formation in the development of the ego. In Contributions to Psycho-Analysis 1921-1945 London Hogarth, p238. Also in Gerard Fromm 2012 Lost in Transmission UK. Karnac, p52.

[iii] Internal Objects Melany Klein Trust. http://www.melanie-klein-trust.org.uk/internal-objects and The New Dictionary of Kleinian Thought  Elizabeth Bott Spillius, Jane Milton, Penelope Garvey, Cyril Couve and Deborah Steiner.

[iv] Internal Objects Melany Klein Trust. http://www.melanie-klein-trust.org.uk/internal-objects and The New Dictionary of Kleinian Thought  Elizabeth Bott Spillius, Jane Milton, Penelope Garvey, Cyril Couve and Deborah Steiner.http://www.melanie-klein-trust.org.uk/symbol-formation

[v] Stevens, Anthony in “The archetypes” (Chapter 3.) Ed. Papadopoulos, Renos. The Handbook of Jungian Psychology (2006)

Dreams.

Much of the work carried out on Holocaust survivors has been focused on dreams.

Natan P.F. Kellerman describes a dream experienced by one of his clients.

      I am hiding in the cellar from soldiers who are searching for me. Overwhelmed by anxiety I know that if they find me they will kill me on the spot…Then I am standing in line for selection, the smell of burning flesh is in the air and I can hear shots fired. Faceless and undernourished people with striped uniforms march away to the crematoriums. Then I am in a pit with dead skeletal bodies. I struggle desperately to bury the cadavers in the mud, but limbs keep sticking up from the wet soil and keep floating up to the surface. I feel guilty for what has happened, though I do not know why I wake up in a sweat and immediately remember that these are the kinds of nightmares that I had ever since I was a child. During a lifelong journey of mourning I have been travelling back to the dead: to the corpses and graveyards of the Second World War with a prevailing sense of numb grief for all those anonymously gone. [i]

This man was not a Holocaust survivor, but the son of a survivor.  As Kellerman points out the story is not unique, over three decades more than 300 papers have been written on the transmission of trauma from Holocaust survivors to their children.[ii]

Kellerman’s example made a lot of sense to me and we now know that this kind of intergenerational transmission is not unique to Holocaust survivors, it forms the basis of many second generation traumas.   I was able to resonate with the dream because I had experienced similar dreams.

I was born east of London just after the Second World War ended, yet my life and that of my immediate family was dominated by the events of war.   After the war and by the time I was born in January 1948 (the War ended in 1945) my parents and grandmother had acquired a two-story terraced house as part of the government’s reconstruction program, but it was a far cry from the space and comfort they were used to.  My grandmother had rescued some of her Victorian furniture and works of art and they were crammed into a front bedroom on the upstairs floor. She would spend hours conveying the stories that each of these objects represented to willing listeners.  I was always fascinated by these grand and romantic tales, but they also seemed to be associated with my bad dreams.   For some reason I had a strange fear of staircases.

I used to dream about my grandparent’s beautiful house being bombed in the Blitz.  I pictured the grand hallway staircase as the only thing left intact in the entrance after the bombing had ended.    I would see myself walking to the top of the staircase, but having reached the top of the stairs there was nothing except a long drop into the bomb crater below.  Later, I recalled my mother telling me how she had been stuck on the top of a staircase when a bomb hit the surrounding buildings and how the explosion had taken out the main wall of the house.  No one was hurt, but the shock would not go away. My mother also had some trepidation over buying a house with a staircase.  It is hard to say who truly owned these memories, but the emotional impacts between two generations were clearly a reality.

What I remember most about the aftermath of the War was that most people did not wish to talk about it, the pain and details were repressed.  This left a new generation struggling to understand their psychic fears and emotions when there seemed nothing tangible to attach them to.   My parents had a false sense of victory, which served to cover all the superficial effects of painful experiences, but it would take its toll over the years and manifest in physical illness.  My mother became a hypochondriac who was obsessed with reading medical journals.  My father contracted tuberculosis and spent much of his life in sanatoriums.  I remember visiting my father in the hospital, but it was not until I was an adult that I began to wonder if there was something other than infection behind this man’s poor health.  Many stories of pain and trauma were bound to arise after the war with details that were often kept secret due to pain, shame and/or a fear of being ostracized by the community.

My school friend Daphne and her younger brother were adopted after their parents were killed in the Second World War.  Neither Daphne nor her brother were told they were the children of Jewish parents or that they had been    adopted by a Gentile family.  The children went to a State Christian school and had no contact with the Jewish community.   Daphne only discovered that she was Jewish after meeting a young Jewish man whom she eventually married.  Daphne struggled through her education because she always felt she was different.  She also suffered from physical pains, mainly in her muscles and joints and complained of burning sensations and an inability to breathe, a condition which no doctor could explain.   Daphne was  generally quite distant, she had little trust in people and was reluctant to make close friends.    It was as if her outward self was lived on a periphery of existence, while her inner life was the reality she wished to embrace.  Daphne saw her inner life as a protection from the harshness of school life and the world in general.  After Daphne left school she and her boyfriend went to see a Rabbi as they planned to get married, it was then that Daphne discovered that she was the child of Holocaust victims.

Daphne’s feelings are not an unusual manifestation of trauma.  The events of trauma cause distinct absences in the mental framework.  Distance separates us from the atrocities and painful memories that might otherwise penetrate consciousness.  Today, we have come to know a little about this process.  In the words of Gerard Fromm:

      To know something is to process new information, to assimilate and integrate an experience into one’s own inner world of representation. It is essentially to build a new construct inside ourselves…What, specifically overwhelms the process of construction, and, therefore, the constructor himself resulting in a total loss of capacity to participate in one’s own reality?

The answer is symbolization.  Freud saw the formation of the symbol as something created in the context of an internal narrative, which is replayed to ourselves as part of our inner world. We might call this our inner voice, Other or soul.   Reality, or the events of the external world can only be fully grasped when the inner world and the outer world are attuned.  Extreme trauma causes this process to be interrupted, both at the external and internal levels.  The inner world, which is generally focused on one’s needs is faced with an emptiness and a terror of the abyss.  It is this state of fear or loss that causes the subject to internalize the only other object available, that of the external other, often the perpetrator/representative/object of the fear being experienced by the subject.

[i] Transmission of holocaust trauma–an integrative view Natan P F Kellermann Psychiatry; Fall 2001; 64, 3; ProQuest Social Science Journals pg. 256

[ii] Natan Kellerman (1999a)Bibliography. Children of Holocaust Survivors AMCHA The National Israeli Centre for Psychological Support of Holocaust Survivors and the Second Generation.

The Holocaust.

Historically, much of the attention surrounding incidents of trauma was given to Holocaust survivors and their offspring, this gave rise to the notion of trauma transmission, or to put it differently the probability that trauma in the parent would be manifest in the offspring, albeit with attachments to new realities, scenarios and circumstances. Nonetheless, the children of Holocaust survivors were shown to have a deep identification with the damage that had been caused to their parents. The question then was, what happened to these offspring when they faced trauma in their own lives?  Case studies revealed that the impact of past traumas experienced by parents could unwittingly have a direct influence on current lives leading to personal traumas and distress.[i]  Researcher Ilany Kogan describes two mechanisms by which the generational transmission of trauma occurs, first is where the child’s unconscious introjection and assimilation of the damaged parent’s self-images occurs through interaction with that parent, which then leads to the loss of the child’s separate sense of self and an inability to differentiate between the self and the damaged parent. Second, is where the parent forces aspects of him or herself onto the child, consciously or unconsciously. Kogan goes on to say:

      Life threatening reality does not reactivate only a simple recollection of traumatic events, but also reactivates in the children the mental representation…that they share with their parents. These include real events of a traumatic nature, conscious and unconscious fantasies regarding these events, intense feelings…and defences against unacceptable feelings such as shame, guilt or aggression.[ii]

      Two examples are offered by Kogan, one where a female high school teacher decides to demonstrate against Israel’s treatment of the Palestinians, which Kogan suggests was a way of unconsciously mitigating the burden of guilt she felt towards her parents when her needs overshadowed the pain experienced by her mother and father, this also became transferred to other close relationships making them difficult to sustain.   The second example is a man who sought counselling to control his anger. His father, also a Holocaust survivor, had committed suicide.   Here the client projected his anger onto others having introjected the pain of his father’s experience as a Holocaust victim.  In my own therapy practice I could think of many incidents where anger was a manifestation of anxiety that stemmed from the actions (or non-actions) of parents, thus the question arose, how far back could one trace this introjection of emotions and actions (or non-action) and to what avail. Was it truly possible for a child to experience an inner world of pain and trauma due to the painful experiences of parents, grandparents or great grand-parents etcetera?   Further, was this implicated in an epigenetics?

[i] M. Gerard Fromm (2012) Lost in Transmission: Studies of Trauma Across Generations. Introduction. London, Karnac Publishing.

[ii] Ilany Kogan (2012) The Second Generation in the Shadow of Terror Lost in Transmission: Studies of Trauma Across Generations. Introduction. London, Karnac Publishing., p6.

 

 

The Anti-Psychiatry Movement of the 1960s and in particular R.D. Liang attempted to link all mental illness to various expectations and inequities within society said to cause anxiety and trauma.  All mental illness has strong components of fear and anxiety, which in turn alters the brain chemistry, whereby it can cause long term damage to the brain’s neurological structure, but the brain also has plasticity and in some cases the brain can repair itself or supplement the damage by using other areas. The neurological elements of mental illness have become the core focus of treatments for mental disorder, generally by matching the condition with anti-depressant or anti-psychotic drugs. However, while trauma studies became increasingly popular in the 1970s there has been a decline in the deeper understanding of trauma in favour of a quick fix for aberrations and it is only recently that the notion of generational trauma has arisen as a probability rather than a possibility.

There has been a significant philosophical and medical divide between the notion of  mental illness and the incidence of trauma.   Mental illness is partly seen as a social problem and it carries a social stigma.   Moreover, the etiology of generational trauma as a cause of mental dysfunction has received little efficacy in the realms of organic diagnostics.  The word ‘trauma’ conveys an extreme condition of immediate pain and urgency, yet, while the many other names attributed to psychiatric conditions, such as depression, stress or forms of neuroses are generally implicated in the condition, they receive a softer alliteration, whereby the softer meaning can serve to undermine the importance and urgency of the circumstance or its severe experiential ramifications for a quality life, as well as for its long term consequences.

For example,  complex post-traumatic stress disorder (C-PTSD; also known as complex trauma),[i]  is a psychological disorder which is hardly spoken of in society at large, albeit, its counterpart, post-traumatic disorder has become well known, but only because of its high incidence amidst soldiers currently returning from wars. The diagnosis of PTSD was originally developed for adults who had suffered from a single event trauma, such as rape, or a traumatic experience during a war.[ii]   However, the situation for many traumatized children is quite different. Children can suffer chronic trauma such as maltreatment, family violence, and a disruption in attachment to their primary caregiver,[iii]  which exceed the diagnosis of PTSD because it does not account for the child’s development.  Currently there is no proper diagnosis for this condition, but the term developmental trauma disorder has been suggested.[iv]

Post-traumatic stress disorder (PTSD) was included in the Diagnostic Statistical Manual Vol III (DSM-III,1980), when it was shown that American combat veterans of the Vietnam War were experiencing combat stress.   In the 1980s various researchers and clinicians suggested that PTSD might also accurately describe the long term effects of child sexual abuse and domestic violence. This prompted the suggestion that PTSD failed to account for the cluster of symptoms that were often observed in cases of prolonged abuse, particularly when perpetrated during multiple developmental stages.  This gave rise to the notion of complex post traumatic stress disorder (C-PTSD), which was characterized by additional symptoms such as psychological fragmentation, the loss of a sense of safety, trust, and self-worth, as well as the tendency to become an ongoing victim.  In addition, this condition was shown to include a loss of a coherent sense of self: it is this loss, and the ensuing symptom profile, that most pointedly differentiates C-PTSD from PTSD.[v]

C-PTSD is also characterized by attachment disorder, particularly the pervasive insecure, or disorganized-type attachment.[vi] In the DSM-IV (1994) dissociative disorders and PTSD do not include insecure attachment in their criteria. As a consequence of this aspect of C-PTSD, when some adults with C-PTSD become parents and confront their own children’s attachment needs, they may have particular difficulty in responding sensitively especially to their infant’s and young children’s routine distress despite constant efforts to do so.[vii]  This situation is exacerbated if the parent is a single parent lacking adequate support.   Although the great majority of survivors do not abuse others,  difficulties in parenting may have adverse repercussions for their children’s social and emotional development. [viii]

Adults with C-PTSD have sometimes experienced prolonged interpersonal traumatization as children as well as prolonged trauma as adults. This early injury interrupts the development of a robust sense of self and of others. Because physical and emotional pain or neglect was often inflicted by attachment figures such as caregivers, older siblings or partners, these individuals may develop a sense that they are fundamentally flawed and that others cannot be relied upon.[ix]

C-PTSD also differs from continuous traumatic stress disorder (CTSD), which was introduced into the trauma literature by Gill Straker (1987). It was originally used by South African clinicians to describe the effects of exposure to frequent, high levels of violence usually associated with civil conflict and political repression. The term is also applicable to the effects of exposure to contexts in which gang violence and crime are endemic as well as to the effects of ongoing exposure to life threats in high-risk occupations such as police, fire and emergency services. [x]

C-PTSD can become a pervasive way of relating to others in adult life and six clusters of symptoms have been suggested for diagnosis of C-PTSD.  These are

(1) alterations in regulation of affect and impulses;

(2) alterations in attention or consciousness;

(3) alterations in self-perception;

(4) alterations in relations with others;

(5) somatization,

(6) alterations in systems of meaning.

Experiences in these areas may include: [xi]

• Difficulties regulating emotions, including symptoms such as persistent dysphoria, chronic suicidal preoccupation, self-injury, explosive or extremely inhibited anger (may alternate), or compulsive or extremely inhibited sexuality (may alternate).
• Variations in consciousness, including forgetting traumatic events (i.e., psychogenic amnesia), reliving experiences (either in the form of intrusive PTSD symptoms or in ruminative preoccupation), or having episodes of dissociation.
• Changes in self-perception, such as a chronic and pervasive sense of helplessness, paralysis of initiative, shame, guilt, self-blame, a sense of defilement or stigma, and a sense of being completely different from other human beings
• Varied changes in the perception of the perpetrator, such as attributing total power to the perpetrator, becoming preoccupied with the relationship to the perpetrator, including a preoccupation with revenge, idealization or paradoxical gratitude, a sense of a special relationship with the perpetrator or acceptance of the perpetrator’s belief system or rationalizations.
• Alterations in relations with others, including isolation and withdrawal, persistent distrust, a repeated search for a rescuer, disruption in intimate relationships and repeated failures of self-protection.
• Loss of, or changes in, one’s system of meanings, which may include a loss of sustaining faith or a sense of hopelessness and despair.
• Loss of a sense of reality accompanied by feelings of terror and confusion (psychosis).

Complex trauma is said to results from repetitive, prolonged trauma, often unintended or inflicted discursively via the perpetrators own history of trauma, which in turn can set up uneven power dynamics. C-PTSD is associated with intimate partner violence (unwanted and painful sexual acts) bondage, kidnap, hostages, indentured servants, slaves, sweatshop workers, prisoners of war, concentration camp survivors, and defectors of cults or cult-like organizations[xii].  Situations involving captivity/entrapment (a situation lacking a viable escape route for the victim or a perception of such) can lead to C-PTSD-like symptoms, which include prolonged feelings of terror, worthlessness, helplessness, and deformation of one’s identity and sense of self.[xiii]

[i] Cook, A., et. al.,(2005) Complex Trauma in Children and Adolescents,Psychiatric Annals, 35:5, pp-398

[ii] Complex Trauma And Developmental Trauma Disorder” (PDF). National Child Traumatic Stress Network. Retrieved 14 November 2013.

[iii] Ford, Grasso, Greene, Levine, Spinazzola & van der Kolk; Grasso; Greene; Levine; Spinazzola; Van Der Kolk (August 2013). “Clinical Significance of a Proposed Developmental Trauma Disorder Diagnosis: Results of an International Survey of Clinicians”. Journal of Clinical Psychiatry. 74 (8): 841–9. doi:10.4088/JCP.12m08030. PMID 24021504, and Wikipedia Retrieved 8^th May 2017.

[iv] Ford, Grasso, Greene, Levine, Spinazzola & van der Kolk; Grasso; Greene; Levine; Spinazzola; Van Der Kolk (August 2013). “Clinical Significance of a Proposed Developmental Trauma Disorder Diagnosis: Results of an International Survey of Clinicians”. Journal of Clinical Psychiatry. 74 (8): 841–9. doi:10.4088/JCP.12m08030. PMID 24021504, and Wikipedia Retrieved 8^th May 2017.

[v]   Herman, J. L. (1992). “Complex PTSD: A syndrome in survivors of prolonged and repeated trauma” (PDF). Journal of Traumatic Stress. 5 (3): 377–391. doi:10.1007/BF00977235. and 1997 pp. 119–122.

[vi] Van Der Kolk, B. A.; Roth, S.; Pelcovitz, D.; Sunday, S.; Spinazzola, J. (2005). “Disorders of extreme stress: The empirical foundation of a complex adaptation to trauma” (PDF). Journal of Traumatic Stress. 18 (5): 389–399. doi:10.1002/jts.20047. PMID 16281237, and Wikipedia Retrieved 8^th May 2017.

[vii] Schechter, D. S.; Coates, S. W.; Kaminer, T.; Coots, T.; Zeanah, C. H.; Davies, M.; Schonfeld, I. S.; Marshall, R. D.; Liebowitz, M. R.; Trabka, K. A.; McCaw, J. E.; Myers, M. M. (2008). “Distorted Maternal Mental Representations and Atypical Behavior in a Clinical Sample of Violence-Exposed Mothers and Their Toddlers”. Journal of Trauma & Dissociation. 9 (2): 123–147. doi:10.1080/15299730802045666. PMC 2577290  . PMID 18985165., pp. 123-149 and Wikipedia Retrieved 8^th May 2017.

[viii] Kaufman, J.; Zigler, E. (1987). “Do abused children become abusive parents?”. The American journal of orthopsychiatry. 57 (2): 186–192, and Wikipedia Retrieved 8^th May 2017.

[ix] Herman, J. L. (1992). “Complex PTSD: A syndrome in survivors of prolonged and repeated trauma” (PDF). Journal of Traumatic Stress. 5 (3): 377–391. doi:10.1007/BF00977235, and Wikipedia Retrieved 8^th May 2017.

[x] Straker, Gillian (1987). “The Continuous Traumatic Stress Syndrome. The Single Therapeutic Interview”. Psychology in Society (8): 46–79., and Wikipedia Retrieved 8^th May 2017.

[xi] Zlotnick, C.; Zakriski, A. L.; Shea, M. T.; Costello, E.; Begin, A.; Pearlstein, T.; Simpson, E. (1996). “The long-term sequelae of sexual abuse: Support for a complex posttraumatic stress disorder”. Journal of Traumatic Stress. 9 (2): 195–205 and Wikipedia. Retrieved 18^th May 2017.

[xii] ibid

[xiii] Lewis Herman, Judith (1992). Trauma and Recovery. Basic Books and Wikipedia Retrieved 8^th May 2017.

 

 

Workshops have come a long way since this model was published, but it still remains the backbone of exploration.  I pulled the document from files recently because I am writing a new book on inter-generational trauma. This is a very challenging topic as none of us can choose the ancestry we were born into and there are always going to be surprises.  I will keep you posted.  In the meantime I invite you to explore the model above using any medium you like. If you want to email your drawings to me I will post them on the website.  No names or details required unless you have something you wish to share. doctorchrisjames@gmail.com

 

What if depression wasn’t an illness, it was a response to trauma? On the 3rd of May 2017 I posted this question on social media where it received massive attention from the public at large, as well as from some very prominent social identities.  The question is not entirely new the Anti-Psychiatry Movement of the 1960s and in particular R.D. Liang attempted to link mental illness to various expectations and inequities within society. Human behaviour runs along a axis of duality,  life/death, love/hate, rich/poor, happy/sad, loyalty/betrayal, expectation/disappointment and a host of accompanying emotions that underscore human values and behaviour.  As a result of these dualities a society can only mark its successes against those who are unable to succeed in a socially accepted way.   Those who do not match the necessary standards for societal normalcy are generally cast aside, treated as sick or unwelcome and in need of behaviour modification.  Often they are medicated and/or locked away in hospitals designed to alter their mental framework. The emphasis on changing behaviour far outweighs the need to explore what causes the behaviour in the first place and as society becomes more and more oriented towards material achievement, the numbers being left behind or locked away either mentally of physically grows exponentially, this in turn feeds its own industry of capitalist achievers who exist on the misery of those perceived as inadequate or misplaced. Further, those who complain are also at risk of being labelled the disorderly.  There is undoubtedly a lot of mental suffering that needs to be ethically and compassionately addressed.  While there are constant announcements of better medicines and therapies designed to cure mental disorders, they do not work for everyone and there are huge numbers of individuals falling through the  cracks.  What if  mental difference was caused by the repression of pain, how might we better resolve this problem?