Humans are relatively adaptable beings which is why we are thriving and not dying out like other species. Horrendous disasters such as the Philippines typhoon, the Boxing Day Tsunami, the nuclear disaster in Japan, the major wars of our time, and horrific famines see great suffering, but these events also inspire survival through adaptation. It turns out we possess a strong survival mechanism in our brains directly linked to our bodies, fight, flight, freeze, flop and friend (fffff).
In fact, the survival part of our brain, which is primitive yet effective, is the first to develop in utero starting at around 7 weeks. It regulates our breathing, digestive system, heart rate and temperature, along with the ‘fffff’ system which operates to preserve our life.
If we have to dodge a falling object, jump out of the path of a speeding car, keep very still to avoid being seen, run for the hills from a predator, or get someone potentially threatening ‘onside’ we need this to happen fast. If a baby is scared, cold, hungry, lonely, or in any way overwhelmed, this triggers their survival system and they cry to bring an adult to them to help them survive.
If a baby is repeatedly scared and emotionally overwhelmed and they do not get their survival brain soothed, so they can cope, they begin to develop a brain and bodily system which is on hyper alert and the World seems to be a scary place. Sadly, this is not something they can ‘just grow out of’. Far from it as what neuroscience is showing us from all the recent findings. An early experience has a profound effect on the way in which a child’s brain forms and operates as the survival brain is on over drive and senses threat everywhere so works too hard, too often, for too long.
Babies and young children systems are flooded with potent stress hormones which help in the event of needing the 5 fffff’s, but they are not good to have at high levels for too long. Imagine the feeling when you truly believe you have lost your wallet with all your cards and money in. You feel a bit faint, your brain is whirring, your heart racing, breathing is shallow, and you may get the urge to empty your bowels or bladder. Hopefully, this may only last for the usual 45 minute cycle for those who are not traumatised.
Then, stress hormone levels drop and you can think more clearly and resume your day fairly unscathed. What if you are 4, 9 or 15 years old? How will you cope if your repetitive early childhood trauma of living with domestic violence, unavailable or rough carers, chaos and unpredictability has left you traumatised?
As I referred to at the start, humans are amazingly adaptable in order to survive, although not necessarily thrive. So a child’s system adapts to get whatever basic needs met it can and to live to the next moment, think the soldier in a war zone kind of survival. In an abusive environment, this will make sense but it is not something a child can just stop doing as their survival brain is in charge and has to do what it has learnt to keep them alive.
The kinds of survival behaviours they commonly develop are:
Presenting as helpless may have made carers frustrated, even angry and rough with them but will mean they sometimes had to touch a child who presented as unable to say get dressed or wipe their bottom or feed themselves – this can look like immaturity and ‘babyish’ behaviour in an 8 year old but it has previously served a purpose
Being held and touched kindly is a basic human need and tragically children in Romanian orphanages who were not, died. Almost ‘pathetically’ children often devise ways which can seem strange, given their age and previous capabilities, to get some physical contact, even if it’s unpleasant
Children often learn to survive by being ‘like a baby’ as they have either learnt how babies get more kindness and attention or have some in-built ‘memory’ of this. However, ‘acting like a baby’ can be negatively viewed as regression, yet it is often an expression of trust in carers as they feel safe enough post abuse to seek out kindness from them. These behaviours need to be handled gently until the child is ready to move on. Imagine you had never experienced physical closeness and gentle touch, but you were driven to seek it out which requires real courage.
When a child is in the ‘I’ve lost my keys’ panic state most of the day, it’s like a pan boiling on the stove and the smallest extra heat causes it to boil over
The survival brain leaps into action at the slightest thing, an accidental shove from another child, a small scratch on the arm, a lost pencil, a ‘look’ from another child and the 5 fffff’s are triggered, for most children that’s flight but if cornered and unable to escape, or previously over used, it will be fight
Children may cry more readily and for much longer and louder as they do not have the ability to self soothe or to be soothed easily as their brain has not been exposed to this and is not wired that way so telling them to ‘calm down’ is of no use
They are feeling things as deeply as they seem to be at this point and are not just ‘attention seeking’
Disassociation or ‘zoning out’ is another way the brain and body cope with high levels of potentially toxic stress hormones for overly long periods. It can also be a learnt survival strategy, submit, switch off and wait for the frightening, painful, incomprehensible act to be over. This ability to switch off can look like defiance or non-compliance as a child may just stare ahead and not respond to requests from adults
Children cannot continuously cope with the muscle tension, nausea, thudding heart, racing thoughts so finding something to fixate on to soothe them can become a great coping strategy and again will look as if they are being non-compliant whereas they are escaping from their trauma the only way they know how.
How long until they do ‘get over it?’
It’s a fair question as to why it’s so hard for traumatised children to trust caring adults. If they were removed from the abuse and trauma as a baby or even directly after birth, surely they should not be having these dramatic reactions?
Going back to our survival part of our brain, this is not designed to be the dominant part of anyone’s brain as we also have an emotional memories part and a thinking, reasoning, socially able cognitive part which should mostly be ‘in charge’. All three areas are interlinked and share info back and forth all the time but mostly we need to think before we act and then we do better. However, if your start in life has made your survival brain ‘hyper alert’ then to manage this is like repeatedly trying to get a squirrel into a matchbox!
Children need us to be calm, kind, to use rhythm, patience and to try to step into their world and emotional state and show empathy. As practitioners, it can be helpful to research ways of supporting traumatised children, pushing for appropriate training and most importantly being very aware of the extra strain that comes with working with and caring for traumatised children. However, with the right long term acceptance, kindness and support children can get a better chance at eventually being able to manage their reactive survival brain which has, after all, got them this far.
Trigger Warning: A Chinese Father Saved More Than 300 People at Nanjing Yangtze River Bridge
“I understand these people. I know they are tired of living here. They have had difficulties. They have no one to help them.” – Chen Si
Since the Nanjing Yangtze River Bridge was first built in 1968, an estimated 2,000 people have died from suicide involving the bridge. According to data from 1995-99, in China’s first national survey in 2002, death from suicide accounted for 3.6 percent of the country’s total deaths. During that period of time, 287,000 Chinese people died from suicide every year, putting the average suicide rate at 23 per 100,000 people.
Chen Si, also known as The Angel of Nanjing, has been patrolling this bridge every Saturday for more than 20 years and has managed to save more than 300 people from death by suicide. He is a 52-year-old father from Nanjing, the capital of Jiangsu province of the People’s Republic of China. Following the loss of a close relative to suicide, Chen Si has taken up this cause because someone needs to.
A Long History
The relationship between mental illness and suicide is controversial in China. Those who follow traditional Chinese philosophy are not encouraged to express their feelings, nor are they encouraged to expect their environment to change to suit their needs. Therefore, intense misery and feelings of despair may go unrecognized, and suicidal symptoms are not easily detected by Chinese medical professionals. In fact, many doctors working in rural areas do not understand the symptoms of depression and often receive low salaries, which discourages more doctors from entering the mental-health field.
According to the World Health Organization (WHO) statistics, China’s suicide rate in the 1990s was 20 per 100,000 people. In the 1990s, female suicides were higher than male suicides by a factor of three. While China remains one of the few countries with a higher suicide rate among women than men, recent data shows that these disparities have evened out. In 2016, suicide rates among Chinese men and women came up almost even at 9.1 per 100,000 men and 10.3 per 100,000 women. Overall, China’s suicide rate in 2016 was 9.7 per 100,000 people, which was among the lowest globally.
A 2002 survey also revealed that 88 percent of females who died from suicide used agricultural pesticides or rat poison. Although China initially eliminated highly toxic pesticides to improve the safety of its farm produce, the elimination also had a substantial impact on the reduction of deaths from suicide among women. Research shows that men tend to attempt suicide through violent means such as hanging, whereas women tend to attempt suicide with medication. Overall, most studies indicate a decline in suicide rates among all gender and regional categories in China. The studies also recommended targeted suicide prevention programs, particularly for people in rural areas.
Women’s freedom, urbanization, and decreased access to toxic pesticides are key reasons behind the decline in suicide rates. According to Jing Jun, a professor at Tsinghua University in Beijing, “female independence has saved a lot of women.” The founding of New China in 1949 in combination with the opening-up policy in the late 1970s and the continuous growth of China’s economy has led to more equitable opportunities for women. Additionally, urbanization removed certain social constraints leading to more freedom for women. For instance, escaping an abusive partner or household may be easier in a city than in a small village.
Despite a decline in death by suicide rates in China, this is an area that we should pay more attention to. Chen Si acts as an angel, but he cannot do this work alone. He hopes that officials consider building a net across the Nanjing Yangtze River Bridge to prevent deaths by suicide.
The Crisis Intervention Centre, the first of its kind in China, was established by Nanjing Brain Hospital to provide psychological advice and support to Chinese people. The Centre also has a hotline, which can be reached at 862583712977.
The Lifeline Shanghai at (400) 821 1215 is a free, confidential, and anonymous support service that is open 365 days a year from 10am-10pm GMT+8.
Facebook and other social media platforms also offer many virtual support groups for individuals experiencing hardship. The National Suicide Prevention Lifeline at 1-800-273-8255 is a 27/4, free and confidential resource to support people in distress, prevention, or in an active crisis. Users should utilize the translate function on these web pages to adjust for language barriers, if necessary.
Can I Ask My Therapist About My Diagnosis?
“I don’t know if I did the right thing. Maybe I shouldn’t have.”
Power differentials are present within the helping profession and may cause the helpee to feel inferior to the helper, particularly in a client-therapist relationship. Oftentimes, clients are in a position where they feel reliant on guidance from their therapist. If there is a significant power imbalance, clients may be hesitant to ask questions and unsure of their role in the reciprocal helping relationship.
On a Reddit social media post, a female client with obsessive-compulsive disorder (OCD) posed this question: “Can I ask my therapist about my diagnosis?” The client has been working with her therapist who is a psychiatrist. The relationship between the therapist and client is fairly new. During one of their sessions, the therapist mentioned that the client might be autistic but they were unsure. The client was previously tested as a child, but the results did not confirm autism or autistic traits. Because the therapist has not confirmed the client’s diagnosis, the lack of uncertainty is creating terrible chaos in the client’s head, as she would like to know if she is or is not autistic. The client is thinking about repeating this question in her next session but is unsure whether it would be rude, pointless, or wrong. Unsure whether or not her therapist is capable of diagnosing autism, the client has tried to persuade her therapist into revealing a diagnosis, but the therapist redirected the conversation.
“This is something I’ve brought up with reluctant therapists as well. I understand the reasons they may not want to disclose that info to a client, but at a certain point it’s like if you had to go to the doctor every week to get an MRI and they just told you they’re just concerned with working on your symptoms.” – u/HyaAlphard
An article on Informed Consent written by Annette Johns discusses how the Canadian Association of Social Workers (CASW) Code of Ethics (2005) defines informed consent as “a voluntary agreement reached by a capable client based on information about foreseeable risks and benefits associated with the agreement.” Social workers have an ethical responsibility to seek informed consent from their clients at the beginning of the therapist-client relationship. Clients also have the right to refuse or withdraw consent and to have an opportunity to ask questions.
It is also important for clients to be engaged in the decision-making processes throughout the duration of the therapist-client relationship. In fact, informed consent and full transparency are integral to the relationship between a client and therapist and ensures the client’s right to self-determination, autonomy, dignity, and confidentiality. Social workers should use clear and understandable language to inform clients of the purpose, risks, limits, and reasonable alternatives to services.
Receiving a Diagnosis
Clients should be a part of the decision about whether to be assessed for a diagnosis. If the client is willing, the therapist has a responsibility to disclose the advantages and disadvantages of receiving a diagnosis. One advantage is that receiving a diagnosis can be comforting to clients who have been struggling with symptoms. Some clients find relief and feelings of validation when they can put a name to it, as well as decreased guilt, shame, and feelings of isolation. Receiving a diagnosis can also open up resources for the client and strengthen the relationship between the therapist and the client. However, clients should also be informed that diagnoses can stick with people, following them to and beyond adulthood even if they were misdiagnosed.
Suggested Questions to Ask
The client should feel comfortable to ask their therapist questions and express their needs throughout the duration of the therapist-client relationship. When the therapist suggests a “working diagnosis,” it should also be understood that the client is the most important member of the diagnostic process and has the right to obtain clarity by asking questions, taking notes, and being actively involved. Although the questions below are based in the medical profession, they are relevant to all clients. Out of seven questions posed by Helene Epstein, here are four relatable key questions:
What kind of test(s) will I have?
It is important for the client to know what kind of tests the therapist plans to administer. There are many different types of tests and ways to identify the source of a client’s concern.
Why do you think I need this test?
It is important for the client to understand why their therapist is even recommending the test in the first place, as not every test is essential, and some may be invasive or expensive. The client has the right to ask whether there’s an alternative, if it is costly, or if the test is necessary.
What do I need to do to prepare for this test?
While not every test requires specific planning, some might. If this is not communicated in advance, the client may have to reschedule.
When will I get the results?
Depending on the test and other extenuating factors, waiting times for results may vary. Clients should consult with their therapist for more details.
Clients have the right to be fully informed and fully engaged. Although asking questions may seem rude or wrong, it is not. It is important for clients to be informed about decisions being made on their behalf.
Start with these questions and see if they help give you the answers you need. It’s important you use your voice in client-therapist relationships and prioritize your needs. At the end of the day, the treatment your seeking is for you, so do what feels right.
Trigger Warning: Holistic Public Policy Can Save Lives From Suicide
At the age of 17, I lost my older brother, David, to suicide. As a gay man in his early 20s, David struggled with mental health conditions and social isolation. His loss affected my family, his friends, and me forever. It was then that I decided to dedicate my life to suicide prevention.
His loss, and the loss of so many others, makes the 2020 data showing that the suicide rate in the United States has increased by 1.4 percent even more upsetting. Michigan’s suicide rate has increased by over 33 percent since 1999, and among young people ages 10 to 24, the rate has climbed by 56 percent since 2007, making it the second leading cause of death for that age group.
Despite these sobering statistics, I’m confident that we can prevent suicide.
In the past couple of years, Michigan has taken great steps toward suicide prevention and mental health promotion. In a past legislative session, Senate Bill 228 established the State Suicide Prevention Commission, and House Bill 4051 established a statewide mental health crisis line. The passage of each of these bills highlights our legislators’ commitment to saving lives – but there is more we can do.
We need a holistic set of public policies that works to promote well-being and ensure safety across all contexts in which our young people live, learn, and play.
For example, in 2019 Sen. Curtis Hertel, Jr. introduced Senate Bill 532 to mandate suicide prevention instruction for K-12 students and professional development training for public school teachers and staff. As of the start of 2020, Michigan was one of only 15 states that encourages such training but does not require it. In comparison, 18 states mandate suicide prevention training but do not specify if it must be annual. Whereas 13 states have mandated annual suicide prevention training for school personnel.
In addition to training, 22 states also mandate comprehensive school policies on implementing suicide prevention education, responding to students in crisis, and handling suicide deaths. Again, Michigan has no such mandated policies.
The American Foundation for Suicide Prevention (AFSP), in partnership with The Trevor Project, the American School Counselor Association, and the National Association of School Psychologists has developed a Model School District Policy on suicide prevention. The document outlines policies and best practices that school districts can follow to protect the health and safety of all students.
Outside of the school, numerous other policies can help save young lives. For example, while federally mandated, Michigan is among a staggering number of states that currently have no laws guaranteeing mental health parity — the assurance that insurance companies will cover mental health care in the same way they cover physical health care.
In addition, 20 states now have laws banning conversion therapy – the practice of counseling or psychotherapy that attempts to change one’s sexual orientation or gender identity. The negative effects of such practices are well documented and include increased suicide risk, decreased self-esteem and well-being, disrupted healthy identity development, and increased social isolation. As it stands, Michigan only partially bans conversion therapy for minors, along with four other states. In total, 20 states ban the practice for minors outright, 3 are still settling the issue in court, and 22 states have no policy or mandate regarding the practice.
As a researcher, advocate, and brother, I know we need policies that are proactive rather than reactive, address multiple contexts, and dismantle the stigma around suicide. We can and must do more to save lives and bring hope to those affected by suicide.
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