Strong Committed Relationships Can Buffer Military Suicides

Can being in a strong committed relationship reduce the risk of suicide? Researchers at Michigan State University believe so, especially among members of the National Guard.

Suicide rates for members of the military are disproportionally higher than for civilians, and around the holidays the number of reported suicides often increases, for service members and civilians alike. What’s more alarming is the risk of suicide among National Guard and reserve members is even greater than the risk among active duty members.

When returning from a deployment, National Guard members in particular are expected to immediately jump back into their civilian lives, which many find difficult to do, especially after combat missions. Some suffer from post-traumatic stress disorder, depression or high anxiety in the months following their return. These mental health conditions are considered at-risk symptoms for higher rates of suicide.

The researchers wanted to know what factors can buffer suicide risk, specifically the role that a strong intimate relationship plays. They discovered that when the severity of mental health symptoms increase, better relationship satisfaction reduces the risk of suicide.

“A strong relationship provides a critical sense of belonging and motivation for living – the stronger a relationship, the more of a buffer it affords to prevent suicides,” said Adrian Blow, family studies professor, and lead author. “If the relationship is satisfying and going well, the lower the risk. National Guard members don’t typically have the same type of support system full-time soldiers receive upon returning home, so it’s important that the family and relationships they return to are as satisfying and strong as possible.”

The researchers surveyed 712 National Guard members who lived in Michigan, had been deployed to Iraq or Afghanistan between 2010-2013 and reported being in a committed relationship. The study measured three main variables – mental health symptoms, suicide risk and relationship satisfaction – each on a separate ranking scale. The soldiers were asked questions such as how enjoyable the relationship is, if they ever thought about or attempted suicide, how often they have been bothered by symptoms of depressive disorder, etc.

Results showed significant associations between each of the mental health variables (PTSD, depression and anxiety) and suicide risk, indicating that higher symptoms were predictive of greater risk.

However, once couple satisfaction and its interaction with mental health was factored in, the association between mental health symptoms and suicide risk was changed. Specifically, for those with higher couple satisfaction, the increased symptoms of PTSD, depression and anxiety were no longer a risk for suicide.

“Our findings show that more needs to be done to enhance the quality of relationships to improve the satisfaction level and through this decrease the suicide risk,” Blow said. “Having a partner who understands your symptoms may help the service member feel understood and valued. There are family support programs available, but we need to do more to enhance relationships post deployment. Relationships do not get enough consideration in the role they play in preventing military suicides, and I would love to see more attention devoted to this issue.”

Other co-authors included Adam Farero from MSU; Heather Walters and Marcia Valenstein from University of Michigan; and Dara Ganoczy from the Veterans Health Administration. The study was funded by the Veterans Administration. The study was published in the official journal of the American Association of Suicidology.

Operation Surf Uses Surfing to Help Veterans

Photo Credit: ESPN

Every day roughly twenty veterans commit suicide. It is estimated that 22% of all suicide deaths in the US are veterans. Former professional surfer Van Curaza wants to change that.

Curaza originally founded the nonprofit Amazing Surf Adventures (ASA) as a way to help at-risk youth by getting them into the ocean and off the streets. He expanded ASA to help veterans overcome the challenges caused by war with surfing – a program dubbed Operation Surf.

Operation Surf is a free program “that offers week-long adaptive surfing trips for wounded-veteran and active-duty military men and women.” They pair veterans “with their own individual surf instructor and develop a goal-based curriculum around their unique abilities. Operation Surf offers an environment of camaraderie and healing to its participants by giving them a shared experience in the water each day.”

Curaza and Operation Surf are featured in the award-winning Netflix documentary “Resurface.” The film is about Marine Corps veteran Bobby Lane. Bobby was planning on committing suicide, but he wanted to check surfing off his bucket list first. He ended up participating in Operation Surf and it changed his life. Not only did Bobby decide he wanted to keep living, but he decided he wanted to work with Operation Surf to help other veterans.

The first time I volunteered for Operation Surf I briefly met a young man named Tommy Counihan. He was learning how to kiteboard. With his long blonde hair and slender build, he looked more like a surf hippie than a veteran.

In 2011, while on deployment in Afghanistan the armored vehicle Tommy was in drove over an IED. It exploded directly under Tommy’s feet. His right foot ended up needing to be amputated. But it was more than a physical injury, “I felt like when I made that decision that day to amputate my foot that I lost more than just a physical part of myself,” he said. “It plays tricks on your head. It brings you to a really dark place that’s almost impossible to get out of on your own. I remember the times when I would sit there by myself and contemplate whether or not I should commit suicide.”

On the advice of his therapist, Tommy participated in Operation Surf. Even though Tommy had surfed when he was a teenager, he was skeptical that it would help him now. Then he caught his first wave, “I was just so ecstatic that I was able to stand up on that board because in that one instant I knew that everything that I thought I had lost was just something I was creating in my head. That I was going to be able to do it all. I just had to push myself to overcome these barriers that I placed in front of myself.” Tommy won the wounded warriors division at the Hawaii Adaptive Surfing Championship last year.

Surfing can have a profound impact on veterans’ mental health. Dr. Russell Crawford, Air Force veteran and licensed therapist, conducted a research study on Operation Surf participants and found that surfing decreased PTSD symptoms by 36%, decreased depression by 47%, and increased self-efficacy by 68%.

Surfing can help veterans overcome the challenges caused by war. It has given Bobby, Tommy, and hundreds of other veterans a new lease on life. You can show your support by volunteering or donating to Amazing Surf Adventures and Operation Surf by visiting their website.

Will Veteran Suicide and Mental Illness Rate Improve?

Even in Afghanistan, I will seek pet therapy! – Rick Rogers (pictured above)

It was about 9 years ago.  I decided to put down the rifle and pick up the DSM. You see, I was an infantryman since I was age 17.  That means, since I was a child, I was literally trained to kill people.  Looking back at it, that sounds like a profound concept.

I am proud of my time in the military.  I am proud of my brothers and sisters who have ever answered the call.  But…  I am also worried.

As I said, 9 years ago, I decided to change my path.  I didn’t realize where that path would lead.  I seen multiple traumas and death happen to my fellow comrades.  I went through some trauma myself, but I still worried about others more than myself.  So, I decided to become a Mental Health Specialist in the military.

It’s been a long road going from Infantryman to Social Worker. There are a lot of learned attitudes and behaviors I had to change. Can you believe it? I literally had to learn empathy.  And that took a long time.

Just about anyone in the military knows that drinking alcohol is a part of the lifestyle. Everyone I looked up to drank and considered me a p**sy if I didn’t.  So… when I was sent to Germany back in the early 2000’s as a 19 year old kid, you better believe I drank. It was legal!

Looking back at my adventures between then and now, I don’t regret a thing. Yes, there were many embarrassing moments, and I have lost many friends along the way.  I also met some great people.  My alcohol use made my path rockier than anything else.

Many others have had this experience as well.  Between 1998 and 2008, binge drinking went from 35% to 47% of veterans, and 27% of that 47% experienced combat. 

Between 2002 and 2008, misuse of opiate prescriptions went from 2 percent to 11 percent in the military.  These prescriptions were mostly due to injuries sustained in combat, as well as the strain of carrying heavy equipment.

This concerns me. When I was young, I had a good time. Looking back, maybe it wasn’t.This might not be every veteran’s experience, but the culture encouraged substance use and discouraged getting help. There are others that would agree with me.

This could explain why 20 veterans a day on average commit suicide. This is actually down from 22 a day before the 2014 study from the VA.  However, it is a 32% increase since 2001. In 2014, veteran suicides accounted for 8.5% of U.S.’s adult suicides, and the rates were especially high among 19-29 year old compared to the older generation.

Let’s not forget about the infamy of PTSD. Up to twenty percent of veterans have suffered from this. Of course, those who suffer are more likely to admit their distress to a computer program than a battle buddy or their superior.  This, again, goes with the constant culture that causes our military to fear judgment.

These wars have been a constant the last two decades, and have cost all U.S. citizens a pretty penny. According to one report, the VA spends $59 billion a year on health care.  This number is 3 times as much as it was since before 2002.

And let’s not forget the cost this country has incurred for being in war for this long.  Well, we don’t really know an exact number.  The cost is estimated by many to be in the billions or even trillions.  This isn’t including the interest from borrowed money.

So, after looking at all these figures, I am overwhelmed.  How can I even make a dent in helping our nation’s veterans? The current administration is planning on increasing our presence in war zones.  I am expecting the rate of PTSD and suicide to increase once again.  Also, our country will continue to spend.  It seems to me that we are all participating in a death and mental illness factory.   The thing is, I didn’t even get to the physical injuries many of our combatants have suffered from.

I love our nation’s military.  I want every one of them to know that I am here to support them.  But most of all, we all need to be here to support each other.

The Struggles After a Miscarriage

During pregnancy, many mothers imagine the face of their future child and start planning the ways they will raise them. After your baby’s arrival in the world you implement those plans. You nourish your child, protect it from harm and encourage it to becoming a contributing member of the society.

But sometimes, life is not that perfect. It does not turn out the way you intended it to be, and you end up losing your child, before you even get to see it alive, healthy and breathing. As reported by American Pregnancy Association as much as 25% pregnancies end up in miscarriage, in USA.  This is perhaps the most traumatic experience any mother can face. Although the father is also understandably hurt by the loss, but somehow mothers are usually the more affected of the two.  It is because the mother has been the closest to the child than the father or any other human being could ever be. The baby has been fed through the mother’s spinal cord, the same food that the woman has been eating. There is no bond closer than that.

Mothers who have lost their children can have the tendency to develop Post traumatic Stress disorder (PTSD) or Post-Partum disorder (PPD). PTSD is usually attributed with people who have had their or some dear ones’ lives threatened. It can also happen when the person’s integrity or their physical body is exposed to a risk at any event. So it is understandable if a mother who has had a miscarriage is suffering through these conditions. The woman who has had this traumatic experience is in need of support and someone to bring back her courage.

A mother who has suffered through the spontaneous abortion of the fetus can have flashbacks of the horrific experience through dreams. It can also shatter her confidence of bearing another life in her womb. There is always a fear left in the heart of women such as these that they might have to go through these type of losses again. It is the job of the people who are close to her to assure her that everything is going to be alright. She must learn to be compassionate and self-loving and not feel guilty about what happened.

Therapists can guide a grieving woman to come over the loss in a better way. It’s a therapist’s job to acknowledge that and help comfort the affected person. Spouses or parents of the woman can support her in a group session therapy to help the mother from felling uneasy. Although the Affordable Care act does not cover the insurance for such therapeutic procedures, but therapy is a necessity rather than a luxury in your case. If you don’t have enough finance for a therapist, then have your family members come as often as possible so as to talk and share anything that can help lower the sufferer’s pain.

Any person suffering through depression may have a hard time keeping their appetite. It is vital to a person’s health that they eat correctly and supply their body with proper nutrition. In this case, the spouse should be the more responsible one and keep track of their partner’s eating habits. It is true that being busy might keep a person’s mind away from grievance, but human interaction is always needed. For this reason the spouse needs to take share of the responsibilities that were required from the woman.  When working together the mother would have someone to interact with and talk to when she needs to.  If she feels too depressed, it is better for the husband to take few days off from work and spend his time with her as much as possible.

A child’s death can leave any person in a shock and have a huge emotional impact. All the mothers who have gone through this experience must know that there will always be hope for them. They must take their time to grief, but should also be able to comprehend that their life doesn’t stop there. It is also important for them to realize that they need their family’s and friends’ support as much as possible. So isolation should never be considered as an option for anyone.

5 Ways a PTSD Service Dog Can Help

U.S. Navy Hospital Corpsman 3rd Class Sean Stevenson takes a knee while on a security patrol in Sangin, Afghanistan, June 6, 2011. Stevenson is a corpsman with Combined Anti-Armor Team 2, Weapons Company, 1st Battalion, 5th Marines, Regimental Combat Team 8. The U.S. Marines conduct frequent patrols through the area to show a presence and interact with the community to find ways to help the populace. (U.S. Marine Corps photo by Cpl. Nathan McCord/Released)
U.S. Navy Hospital Corpsman 3rd Class Sean Stevenson takes a knee while on a security patrol in Sangin, Afghanistan, June 6, 2011. Stevenson is a corpsman with Combined Anti-Armor Team 2, Weapons Company, 1st Battalion, 5th Marines, Regimental Combat Team 8. The U.S. Marines conduct frequent patrols through the area to show a presence and interact with the community to find ways to help the populace. (U.S. Marine Corps photo by Cpl. Nathan McCord/Released)

Post-traumatic Stress Disorder (PTSD) is a mental disorder that results from a traumatic experience. Common symptoms are nightmares, flashbacks, intrusive memories, depression, and anxiety following a traumatic event. Living with PTSD can be very difficult. Public outings may result in flashbacks while depression can become overwhelming if the person stays at home.

The risk of depression is high as well as the risk of suicide. While there are very effective treatments available for people with PTSD, a service dog can be a very useful support. Here are a few reasons you might want to consider getting a PTSD service dog.

They Encourage Exercise

Any dog needs someone to play with them and take them for walks. This physical activity is a very beneficial way to help treat PTSD. The positive endorphins that are produced during exercise can help combat depression and anxiety as well as improving physical fitness. Even on bad days, it’s hard to say no to a dog begging for a walk.

They Prevent Social Isolation

0-4Dogs are a wonderful way to cushion social interactions. They attract friendly people who want to pet them while providing something for you to talk about. Walks or trips to the dog park will force you to get out and see other people rather than isolate yourself in your home.

They Can Make Public Outings More Feasible

A trained service dog will be able to recognize when you have an episode and either comfort you or lead you to safety. They can also be trained to lead you to the nearest entrance in anticipation of an episode. These specialized skills can make going out in public safer, easier, and more comfortable for their handler.

They Can Recognize and Act Upon Nightmares

For at-home assistance, service dogs may be trained to fetch medication or even interrupt nightmares. When you are having a nightmare, the dog may be able to wake you and halt the nightmare, making it easier to recover and go back to sleep. If you have woken up from a nightmare, the dog will be able to provide comfort in the form of pressure or affection, also helping to prevent insomnia.

They Make Therapy Sessions Easier

Attending therapy for PTSD can be very difficult. You will need to discuss your trauma, the symptoms you are experiencing, and other potentially painful subject matter. With a dog by your side to stroke and seek comfort from, talking about these topics can become easier. The dog can also become part of your treatment plan, whether that means taking it to a new destination each week or simply spending a few hours a day on training sessions.

Though a dog is certainly a financial responsibility and a well-trained service dog can be expensive, the benefits a service dog has to offer are worth it. Even an untrained dog can be a wonderful addition to your home if you are suffering from PTSD. The unconditional love, encouragement to exercise, and help in social situations might even be all you need to start recovering.

https://www.youtube.com/watch?v=nZOaR1vnBik

Telemental Health: Improving Access to Veterans’ Mental Healthcare

By Brian Neese

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Photo Credit: Dublin VA

Military members comprise less than 1 percent of the U.S. population, yet veterans represent 20 percent of suicides nationally, according to the National Alliance on Mental Illness. Each day, about 22 veterans die from suicide.

An issue affecting mental healthcare for veterans is accessibility. In the spring of 2014, the U.S. Department of Veterans Affairs (VA) wait time scandal emerged when allegations surfaced of veterans dying while waiting for care at the Phoenix VA Health Care System, according to Military Times. Wait time issues and manipulated appointment scheduling highlighted a nationwide problem and resulted in several top officials resigning or retiring.

Months later, Congress passed a $15 billion bill allowing more veterans to seek care in the private sector through the VA Choice program. Meanwhile, the VA continued focusing efforts on telemental health, or the use of telecommunications technology to provide behavioral health services, to try to improve veterans’ access to mental health services, National Psychologist reports.

Accessibility

Nearly one in four active duty military members show signs of a mental health condition, based on a study in JAMA Psychiatry. With 44 percent of veterans returning home from Iraq and Afghanistan to rural zip codes, accessibility becomes an important topic for veterans’ mental healthcare. This is a natural strength of telemental health services, which can include clinical assessment, individual and group therapy, educational intervention, cognitive testing and general psychiatric treatment.

The first telemental health program funded by the VA’s Office of Rural Health is at the Portland VA Center in Oregon. Through telemental health sessions, veterans saved 826,290 miles driven and $161,126 worth of gasoline in 2013, program director Mark Ward said. Some veterans who live far from Portland and lack high-speed internet are given electronic tablets and notebooks for videoconferencing.

Telemental health can increase veterans’ access to services and eliminate travel. Another benefit is that telemental health can help veterans overcome the perceived stigma sometimes associated with seeking mental health treatment. Veterans who might feel embarrassed or ashamed to get help in person can receive care in their home.

The VA delivered a total of more than 650,000 telemental health sessions nationally from the program’s inception in 2004 through 2014. The VA anticipated delivering 300,000 telemental health visits for 115,000 veterans in 2014, an increase from more than 200,000 telemental health visits for 80,000 veterans the previous year. Additionally, the VA has created free smartphone apps that veterans can use to help with post-traumatic stress disorder (PTSD), such as the PTSD Coach application developed by the VA and the Department of Defense.

Telemental health has made progress in improving accessibility for veterans’ healthcare, and it will be needed to make further ground. The Government Accountability Office found that 18 months after the wait time scandal, the VA still struggled with wait times and patients’ schedules.

Effectiveness

The first large-scale assessment of telemental health services was published in Psychiatric Services. This study assessed clinical outcomes of 98,609 mental health patients before and after enrollment in telemental health services of the VA between 2006 and 2010. During this time, psychiatric admissions of telemental health patients decreased by an average of about 24 percent, and patients’ hospitalization lengths decreased by an average of nearly 27 percent.

A survey of veterans found high levels of satisfaction and perceived safety with home-based telemental health provided by the VA pilot program in Portland, according to the International Journal of Psychiatry in Medicine. Findings support the feasibility and safety of using technology in the home for the delivery of mental health services. Additionally, results suggest fewer no-show appointments in home-based telemental health compared to clinic-based telemental health.

Currently, telemental health is regarded as appropriate for general clinical use. Yet, the VA cautions that more needs to be known about using telemental health services for conditions such as PTSD, which Jama Psychiatry says is 15 times higher for those in the military than civilians. “While preliminary research has clearly established that a variety of telemental health modalities are feasible, reliable, and satisfactory for general clinical assessments and care, less is known about the clinical application and general effectiveness of telemental health modalities employed in the assessment or treatment of PTSD,” the VA says.

The Need for Behavioral Health Professionals

Approaches such as telemental health can support better access to behavioral healthcare and are expected to grow as a result. Yet, more professionals are needed for rising populations of veterans, children and others in need of services.

The online B.A. in Behavioral Health from Alvernia University enables students to meet this need. Some graduates enter fields such as addiction counseling, long-term care and child welfare, while others enter graduate studies. The program takes place in a convenient online format to accommodate students’ work and personal schedules.

First Responder Mental Health: It’s Not All In The Mind

IN THE MIND web2

Our police, paramedics, firefighters and rescue personnel help keep our communities safe. However, the general public does not view this population group as vulnerable. While in the mental health field, doctors, psychologists and social workers are seeing a very different picture with alarming suicide rates and a high incidence of Post Traumatic Stress Disorder (PTSD). Emergency services responders are trained to look after others, but not themselves. It’s a global issue, one that is being increasingly brought to light by the courage of those who suffer and their supporters speaking out.

With many helping professionals working from a traditional medical model, mental health issues among first responders tend to be identified primarily as a response to attending traumatic incidents. Treatment is inclined to be focused on therapies such as CBT, DBT, EMDR and mindfulness. These approaches focus on individual change and evidence certainly suggests that these types of treatments are invaluable in terms of strengthening the individual’s coping and resilience skills.

However, we must be mindful how the systems in which the individual functions will also have an impact on their mental health. When working with emergency services responders and their families, it is vital that therapists and health promotion workers understand ALL the factors which impact wellbeing, not just in response to mental health issues but also in developing prevention strategies.

So, what are some of these “other” factors, or determinants warranting attention when dealing with emergency services wellbeing?

1) Emergency services culture – historically emergency services culture has fostered the ‘toughen up’ attitude, deeming the admission of mental health issues as a ‘weakness’ . Admitting this weakness not only reflects on the individual but also on the ‘brotherhood’ which values pride and strength.

2) Organisational culture- whilst changes are being made in some organisations, there are ingrained fears (real or perceived) from responders that any admission of mental health issues will either deem them unfit for work, or will stop them from getting promoted.

3) Workplace Stigma– there are real and perceived fears of work colleagues judging a responder as ‘weak’, particularly if a number of them have been to the same call outs, but only one speaks out about struggling. A lack of understanding of stress responses and the individuality of conditions such as depression, anxiety and PTSD leads to judgement and alienation of the individual affected, rather than what is needed – support.

4) Societal Expectations – Let’s face it, we all grew up thinking of police, firefighters and paramedics as heroes. They’re the people who protect us, and save our lives! We’ve been taught to listen to their instructions, trust their judgement in crisis and look to them for guidance when in danger. Somehow it doesn’t make sense to acknowledge that these ’heroes’ are human just like us!

5) Lifestyle changes Whether the responder is full time, part time or a volunteer, from the moment of recruitment personal and family lifestyle require changes. Inconvenient rosters, critical incidents, unexpected call outs and changes in household roles and routines are just some of the challenges faced by emergency services responders and their families.

6) Family Support– families of first responders have unique stresses and unique expectations. But it’s difficult to discuss these stresses and expectations outside emergency services circles. Firstly there is this feeling that the general public won’t understand. More significantly, divulging that their responder family member is suffering in some way feels like they’re breaching an unwritten ‘confidentiality code’ such as don’t embarrass the organisation, the crew or the individual by speaking about individual or family mental health issues. What happens on the job stays on the job which extends to family members. There is also the old belief that telling your family about any incidents affecting you will adversely impact that family member’s mental health. Organisational confidentiality regulations support that notion – yet talking about and processing traumatic incidents is critical in any recovery process.

7) Relevant Social Support. When responders experience work related stress, they have a number of barriers to disclosing struggles to friends who are not part of the emergency services culture. One barrier is confidentiality – they are not supposed to discuss the details of their work with anyone from the general public. Secondly, there is the notion (real or perceived) that those who haven’t done the job could not possibly understand what they’ve experienced. Thirdly, there is the reluctance to ‘burden’ civilians with the graphic details of incidents for fear they may end up suffering vicariously as a result of the disclosures.

What advice can those in the helping professions take from this?

If you treat an emergency services person with depression, anxiety or PTSD without understanding the context in which their illness or injury occurred, then you are not only doing your client a disservice, but you could in fact be damaging their potential for an effective recovery. It is vital that you have a genuine understanding of emergency services culture both today and historically.

Secondly, should we as professionals not be advocating on behalf of this group? In Australia alone there are over 400,000 paid, part time and volunteer emergency services responders – add their family members and that’s a huge population group affected by unique stresses! To advocate effectively, helping professionals need to understand the systems their lives function in, and systems which impact on wellbeing and recovery.

Thirdly, there is a strong need to focus on prevention – on a global level the media are telling us there is a “mental health crisis among emergency services workers.” We’ve seen these sorts of reports for years. What is actually happening to prevent mental health issues among emergency services responders? What sorts of consultations are happening? Who is invited to these consultations? Who is the information from these consultations being disseminated to? And what are the results of these consultations “on the frontline”?

No matter what field of practice you are in, I urge you to educate yourself on ALL the factors impacting the mental health of those who keep us, our families and our communities safe.

Genocide Survivors: Contributors not Victims

Polish-born Holocaust survivor Meyer Hack shows his prisoner number tattooed on his arm during a news conference at the Yad Vashem Holocaust Museum in Jerusalem June 15, 2009. A 95-year-old Auschwitz survivor, Hack, donated jewellery he took from the clothing of Jews who were gassed to death at the Nazi camp to Yad Vashem on Monday. Hack, who now lives in Boston, found the gems while sorting the clothing of victims sent to die in the gas chambers, which was his job at the camp where his mother, brother and two sisters perished. REUTERS/Baz Ratner (JERUSALEM CONFLICT SOCIETY) - RTR24OVC
Polish-born Holocaust survivor Meyer Hack shows his prisoner number tattooed on his arm during a news conference at the Yad Vashem Holocaust Museum in Jerusalem June 15, 2009. A 95-year-old Auschwitz survivor, Hack, donated jewellery he took from the clothing of Jews who were gassed to death at the Nazi camp to Yad Vashem on Monday. Hack, who now lives in Boston, found the gems while sorting the clothing of victims sent to die in the gas chambers, which was his job at the camp where his mother, brother and two sisters perished. REUTERS/Baz Ratner (JERUSALEM CONFLICT SOCIETY) – RTR24OVC

Listening directly to survivors and learning from them have provided me with the most powerful, inspirational, and insightful lessons. Individuals who witness the dark side of humanity have much to teach us about coping and adaptation. In the words of Elie Wiesel, Auschwitz survivor and Nobel peace prizewinner, “Listen to survivors, listen to them well. They have more to teach you than you them!”

Unfortunately, genocide and war did not end with the Holocaust. People continue to be displaced by global armed conflict. The United Nations High Commission for Refugees (UNHCR) reports that in 2015, over 60 million people have been displaced. Holocaust survivors are among the oldest living survivor populations of genocide and war. Lessons learned from working with them as they recovered from and transcended victimization can benefit survivors of other mass atrocities around the world who are trying to recover from similar ordeals. It sends a message of hope to these communities that recovery is possible.

In my work, I focus on strengthening and leveraging their coping skills that have remained strong and intact and minimizing limitations and handicaps. Practicing from a strengths perspective begins with the premise that every individual, family, group, and community has strengths (positive attributes and abilities, knowledge, resources) that are mobilized to achieve their goals and visions (Saleebey, 2006). By changing our perceptions, and seeing them as survivors rather than scarred victims, we move away from the traditional deficit model of mental health to one that is competence and strengths based.

When I first started this program 18 years ago many survivors cried when we had entertainers and music. They missed their families during happy occasions. They were still grieving their losses and did not give themselves permission to experience joy because it was difficult to detach from their suffering. Some survivors felt that living with painful memories helped them keep memories of their murdered families and friends alive. They believed letting go of their pain and suffering would betray those who were murdered during the Holocaust.

In recent years, we noticed that group members were able to recover from the after-effects of their horrendous ordeals. They are able to laugh and give themselves permission to have a good time, demonstrating their detachment from their suffering. In fact, they request lighthearted and fun-filled programs so they can enjoy themselves. They are also aware of their needs and are able to modulate their emotions when these are triggered by an external event that reminds them of their war experiences, e.g. terror attacks in the media.

My approach led to the development of a Drop-in Centre for Holocaust Survivors that I refer to as a group trauma recovery model. This program provides a safe environment where survivors interact with their peers and learn coping strategies that include a holistic approach to well-being. They grieve their losses together by participating in commemorative events and creating mourning rituals. They also participate in activities that bring meaning and purpose to their lives such as publishing a book of memoirs and experiencing themselves as “witnesses to history” through intergenerational programs. This program takes place in a community setting and is run in partnership with survivors where they serve as the Board of Management.

As service providers, it is essential to have a theoretical framework for practice to guide our work with individuals and groups. It is imperative we acknowledge survivors’ coping abilities and resilience that co-exist with their post-traumatic symptoms such as intrusive recollections, sleeplessness, anxiety, and depression.

Reference

Saleebey, D. (2006). Introduction: Power in the people. In D. Saleebey (Ed.) The strengths perspective in social work practice 4th ed., 1-24). Boston: Pearson Education.

Changing Hearts, Changing Lives: How 5 Social Initiatives in Chicago Are Making a Difference

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Home to 9.5 million people, Chicago is the third-largest city in the United States and internationally recognized for its contributions to finance, transportation, commerce and culture. In the 2014 Global Cities Index, Chicago earned its fourth-consecutive top 10 ranking for its impact in business, information exchange, cultural experience and political dialogue. But despite all that Chicago is doing right, for some, life in the Windy City still presents challenges. Vulnerable populations, including children and adults, need the help of professionals.

Poverty affects 33 percent of children in Chicago, according to ThinkProgress, compared to 20 percent for all children in Illinois. And All Chicago, a nonprofit organization, reports that approximately half of all renters and homeowners arecost burdened, paying more than 30 percent of their income toward housing costs. Poverty has led to high figures for homelessness and hunger:

  • 138,575 Chicago residents were homeless in the 2013-14 school year, a 19.4 percent increase from the previous year (Chicago Coalition for the Homeless)
  • One in six (812,100) in Cook County receives food from a member agency grocery or meal program (Greater Chicago Food Depository)

And although Chicago has seen an overall improvement in violent crime, it has increased in certain areas of the city. “In the early 1990s, the most dangerous third of the city saw about six times more murders than the safest third,” Chicago writer Daniel Kay Hertz reports. “Over the last several years, the most dangerous third has seen between 12 and 16 times more homicides.”

Social workers are answering the call for help. By teaming up with initiatives and organizations, led by community leaders and professionals in education, psychology and more, social workers are truly making a difference for those in need.

Social workers are educated professionals trained to help at-risk populations. They can work in community centers, agencies, rehabilitation centers and other areas. A program such as the online Bachelor of Social Work from Aurora University gives those with a passion for changing lives the tools they need to succeed, including courses in how to work with groups, the special needs of children and adolescents, how to work with communities and groups, and more.

Val Starr, an Aurora University alumna who assisted homeless veterans as a social worker at Catholic Charities and now works for the Edward Hines Jr. VA Hospital, is just one example of how social workers are making a difference in Chicago.

“I have really found my passion working with this population and their unique needs,” Starr said. “It means so much to me to have the ability to help them.”

Education was the first step in Starr’s journey to change the lives of those who need help the most. “The education I received at AU was so beneficial to this position because it helped me understand and recognize mental health needs, taught me strategies for working with individuals from all walks of life and helping them cope with their daily struggles,” she said.

Learn how social workers like Val are making life in Chicago better, as we examine five initiatives that are helping make the city a safer, more accessible place to live.

1. Chicago Safe Start

Who it helps: According to the 2014 annual report for Safe From the Start (SFS), 4,350 children have sought treatment at the 11 Illinois sites since the program was launched, with a mean age of 4.7. Seventy-six percent of children had a single parent, while 58 percent of children came from families with annual household incomes of less than $15,000. On average, 22 percent of children were exposed to additional violence after services began.

In 1999, following the tragic deaths of 13 people at Columbine High School, President Bill Clinton called a national summit to address the subject of children and violence. The event included experts in childhood development and juvenile justice, and the findings shed light on the damage that exposure to violence can have on children.

The summit’s accompanying report said that “Being abused or neglected as a child increases the likelihood of arrest as a juvenile by 53 percent and of arrest for a violent crime as an adult by 38 percent.” Plus, there are long-term consequences for the child. Educational difficulties, alcohol and drug abuse, employment problems and mental health problems such as posttraumatic stress disorder (PTSD) were mentioned for children who were exposed to violence in some way.

As a result of the summit and national attention on childhood exposure to violence, 11 Safe From the Start demonstration sites launched in 2000, with Chicago Safe Start as one of the original locations. A program of the Chicago Department of Public Health, it provides therapy for children ages six and under who have been exposed to violence, either directly or as a witness in the home or in public. Its ultimate aim is to help prevent and reduce the negative impact that violence can have on young children.

Alongside social workers who intern in the program, therapists identify and approach any issues that the child may have, such as aggression, sleep difficulties or anxiety. Through mental health and family support services, such as child-parent psychotherapy, workers treat the trauma, which can include a parent or caregiver as well.

According to the report, the program has successfully helped children and caregivers. “The data to date indicates that families that participate in Safe From the Start Services experience a significant reduction in child symptoms and caregiver stress, and an improvement in child and caregiver functioning … examination of key outcome indicators over the last several years of the project suggests that sites are having an increasingly positive impact on families that they serve.”

The success of this program could ultimately be used to help even more children across the country. “As program development continues, Safe From the Start will likely serve as a model program nationally for efforts to address issues related to young children’s exposure to violence.”

2. Elev8 at Perspectives Academy

Who it helps: Since opening in 2008, Perspectives has helped more than 2,800 middle school students in one or more Elev8 programs. When the health center opened in May 2008, the immunization rate increased from 43 percent to 94 percent over the next 12 months. Also, since the health center opened, Perspectives has reached 100 percent compliance rates each year.

Taking place in more than a dozen schools across Baltimore, Oakland, New Mexico and Chicago, Elev8 brings together schools, families and community partners in low-income area middle schools to help students succeed in high school. Perspectives Middle Academy in Auburn Gresham is one of five public middle schools in the Chicago area, giving children access to a school-based health center and exciting possibilities in the cornerstone of the program, extended day opportunities.

These after school services help give students not only a safe space, but the skills needed to succeed in high school and beyond. “We really wanted to use the after school programs as a way to help students develop new skills, but also expose students to different areas of thinking about ‘What do I want to do when I grow up? Do I want to be a chef? Should I take culinary arts? What does that really look like?’” said Tenisha Jones, education director at Greater Auburn-Gresham Development Corporation. “So if you were in a culinary arts program, at the end of the eight weeks you’re able to get on a bus and go to a real culinary arts program to cook with a real cook in a real kitchen to really make the after school programs tie back into real world experiences for the students.”

One program geared toward STEM for girls has led one graduate to make a college decision to pursue forensic chemistry at Western Illinois University, reports Gordon Walek, writer for Local Initiatives Support Corporation (LISC). From STEM and the culinary arts to martial arts, students can find something they love and get a real glimpse into their future opportunities.

The extended day opportunities are offered from 3:45 to 6:30 p.m. Monday through Thursday, in addition to a four-week summer program that runs 8:00 a.m. to 3:00 p.m. Monday through Thursday. The school-based health center provides primary care such as immunizations and physicals, and mental health services are planned for the future.

For Jones, the success of Elev8 at Perspectives has meant a great deal. “I feel as though I have truly been blessed. It’s been a really special opportunity to be a part of having the resources to develop and implement a project of this nature with many moving pieces, and really looking at the theory behind why we need to do these things,” she said. “The results that I’ve seen because of this project have been phenomenal, really the crowning glory of my career at this point. I’ve seen kids go from sixth grade to 12th grade, and I’ve seen mentorship happen because after school providers take special interest in kids and wind up saving a kid from going off the wrong track.”

3. Chicago Neighborhood Initiatives

Who it helps: Low- and moderate-income communities such as West Garfield Park. According to analysis from the Social IMPACT Research Center, more than 40 percent of West Garfield Park households are below the poverty level, and 19.4 percent of households are in extreme poverty with incomes below 50 percent of the poverty line.

Chicago Neighborhood Initiatives (CNI) has announced plans for the world’s largest rooftop farm at the Method Home Products manufacturing facility. Designed, built and operated by Gotham Greens, the state-of-the-art agricultural greenhouse will produce up to 1 million pounds of fresh produce each year and bring nearly 150 jobs to Pullman. The food will then be distributed to local farmer’s markets, retailers, restaurants and community groups.

This is one of many accomplishments for CNI, a nonprofit community development organization that helps low- and moderate-income communities revitalize neighborhoods and improve economically. Since 2010, it has generated 12,000 jobs and 135 affordable housing units in Chicago neighborhoods located on the Far South Side and the West Side, such as those in Pullman, Englewood, West Garfield Park and Austin.

In February of 2015, CNI was recognized with the Community Strategy of the Year Award at the annual Chicago Neighborhood Development Awards by LISC. According to U.S. Bank, which funds and supports CNI, CNI has achieved a number of high-profile initiatives in 2014:

  • Completing the first phase of Pullman Park, bringing a Walmart, Planet Fitness and Ross Dress to an abandoned factory site.
  • Selling of 38 rehabbed homes to revitalize houses in local communities.
  • Launch of a microlending program, CNI Micro Finance Group. It has helped more than 40 businesses with $500,000 in microloans, 82 percent of loan recipients were firms owned by African-Americans and 52 percent went to small businesses owned by women.

As a result, CNI has helped strengthened in-need communities across the greater Chicagoland area.

4. Chicago Help Initiative

Who it helps: Since 2001, 157,000 meals have been served to Chicago-area people in need.

In 1999, commercial real estate broker Jacqueline C. Hayes came face-to-face with the homeless when trying to show a location, when a major street closed just off Michigan Avenue and Oak Street. “A lot of the homeless started coming and living in the doorways, and I had to ask them to move, in order to show spaces,” Hayes said. “I was so anxious that this is what tourists would see when they came to the city; then I reversed it, and I thought, ‘How awful that people felt safe living in doorways?’ And so I just wanted to do something about it, and I gathered various organizations together.”

This moment prompted Hayes to action. It began with handouts on how to help the homeless, and later became the Chicago Help Initiative (CHI), which provides meals to those in need and connects them to resources that can break the cycle of hunger.

Most of the guests are homeless. Many have mental issues. And about 20 percent are veterans. But every Wednesday, at the dining hall facilities provided by Catholic Charities, a distinguished meal is served for 135 people (and bag meals for another 70 to 90). Tablecloths and flowers are set, and food is provided by area restaurants, hotels, businesses and people in the community. It’s this approach that has made such an impact on guests; once, the InterContinental Chicago hotel catered in prime rib, a gesture that caused some guests to become emotional because they had never had it before.

The food is just a part of the experience. The Wednesday dinners often include birthday celebrations, and sometimes there is live entertainment or a game night. Often, guests hear a presentation on a certain topic that can help. For instance, the CHI has had the Safer Foundation discuss expunging one’s criminal record, the Lincoln Park Community Shelter present housing information and Streetwise speak on employment opportunities. Guests also have access to a jobs table and a resource table for housing and other needs. A nurse practitioner and other health representatives are on hand, and, according to Hayes, there are plans to provide dentistry and eye care support for guests.

This is all possible through volunteers that help during the weekly dinners and other events such as the literacy program and the bike fair. Interns in the CHI make phone calls to social workers to secure speakers for the dinners, and they get to interface with the guests. Donors and sponsors in the community also help the CHI reach guests.

“It’s been an amazing experience,” Hayes said. “It gives you a lot of contentment to know that I’m helping, and that’s true for each of the volunteers and the board members, that we know we’re doing something.”

5. Urban Initiatives

Who it helps: Beginning in 2003 with just 12 children and two teachers, Urban Initiatives now serves more than 16,000 children, a majority who are minorities and living in households that are at or below the poverty line.

Across 38 Chicago Public Schools, children from kindergarten through twelfth grade have access to programs that can improve their health and academic performance — and, perhaps most notably, their character.

This is all offered by Urban Initiatives, taking place in three sports-based youth development programs:

  • Work to Play is the flagship program from Urban Initiatives that allows children from kindergarten to fourth grade to participate on a soccer team. With two practices and one game each week, children must meet behavioral and academic standards to play. There are no skill level requirements for children to participate.
  • Take the Lead is a leadership development program for children from fifth to eighth grade who are alumni from the Work to Play program. These children serve as team captains on Work to Play teams, engaging with coaches to build leadership skills and focus on community service and academic goals.
  • Play with Potential is a recess program that is offered to all students in kindergarten through twelfth grade, focusing on teamwork and physical activity.

The programs have found success. According to Urban Initiatives, 96 percent of Work to Play participants play for at least 60 minutes, five days per week. One-hundred percent of Take the Lead captains are confident in their ability to lead younger teammates. And in the Play with Potential program, students are 45 percent more likely to perform moderate to vigorous physical activity than those at other schools.

A full staff of program associates and coordinators, in addition to volunteers and the management staff, works with the children to make the most of mentoring opportunities that take place in the programs.

For the mentors that make a difference in the lives of students, they are quick to acknowledge what they learn in the process. “It is the goal of Urban Initiatives coaches not just to be a mentor but to teach and train students to be mentors themselves, no matter how old they are and no matter the age of those they mentor,” Urban Initiatives program director Brendan McAlpine writes. “The Urban Initiatives team is proud and grateful to state that we have learned just as much from our students as we have taught them.”

Making Chicago a Better Place to Live

The aforementioned programs and initiatives embody the commitment that many have in helping those who are less fortunate or susceptible to certain social issues. Across crime, education, poverty and hunger, they are making a difference in Chicago communities where they serve.

One thing these initiatives have in common is the presence of social workers. These professionals organize programs, secure resources to help those in need and work alongside of other professionals to touch the lives of others. Hundreds of thousands of social workers can be found across America, changing the lives of those in need.

This article was written in conjunction with Aurora University Bachelor of Social Work Program.

How X-Men Helped Me Overcome PTSD

Xmen
“What wouldn’t I give to be normal!” -Mystique in X-Men First Class

I grew up on fiction. It was brain food to me. I generally preferred to read books to just about any other activity. Over the past few years I’ve been incorporating fictional characters into Superhero Therapy. For me these characters hold a deep and personal meaning, after all, some of them actually helped me recover from my own traumatic history.

On April 26, 1986, there was an explosion at the Chernobyl Nuclear Power Plant, located in Ukraine. I was just a few months short of 3 and was only a few towns away. The people in Ukraine didn’t know about the disaster, or at the very least about the extent of it.

chernobyl

This is my first memory. I remember some parts of it quite vividly while others were filled in by my parents. It was May Day, which is a big holiday in Ukraine, where I was born and raised. My parents and I were marching in the parade along with hundreds of other people. I was sitting on my father’s shoulders and holding a red balloon. The music was playing and despite being overwhelmed by the amount of people present there, I was excited.

To my left there was a scream.

Someone, I think it might have been a woman, was convulsing on the ground. Some people ran to call the paramedics.

Then other people started to fall down. Some were bleeding from their noses.

My father kept me on his shoulders and he and my mother ran all the way home. It wasn’t until some time later that we found out about the extent of the explosion and the amount of radiation spilled. Until then, completely unaware, we continued drinking the water from the faucet, going outside, and eating fresh fruits and vegetables. All of these were poisoned.

When the news broke, we were all encouraged to seek medical attention and underwent iodine treatments. Still, many people suffered from some kind of physical (and many also psychological) illnesses as a result. For me, I started having frequent nosebleeds that wouldn’t clot for a long time and severe migraines.

Photo
Dr. Janina Scarlet

My migraines were especially intrusive. There was one time, it might have been when I was around 7 or 8, I was in so much pain that a blood vessel in my eye popped. On other occasions my migraines would lead to seizures.

My migraines seemed to be triggered by weather and environmental changes. When the barometric pressure would drop (before it rains) and also when there would be radiation changes in the atmosphere (such as solar flares, for example), that was when I was most likely to experience these symptoms.

I also started having nightmares and was too afraid to sleep without a light on. For many years after that incident I was really nervous about being in large crowds, and did not want to talk about anything related to Chernobyl (I still struggle with this last one to this day). I obviously didn’t know it back then, but I was struggling with PTSD.

Things got worse when my family and I first moved to the United States. I was in 7th grade, did not speak English too well, and most people my age did not have a good understanding of what radiation poisoning was nor what a seizure disorder was. On a couple of occasions I would overhear people cautioning one another not to touch me because I might be “radioactive.”

Feeling extremely lonely and not having any friends for an extended period of time I started to feel depressed. I avoided people for the fear that they would make fun of me or would judge me. During a parent-teacher conference, my homeroom teacher told my mother that I was a good student but that she couldn’t figure out why I always looked so sad. When my mother asked me about it, I shrugged it off. How could I tell her that I felt like a freak?

For years I felt alone and ashamed, and even disgusted with my physical and emotional experiences. There were times when I just wanted to die.

Until I saw the first X-Men movie.

I didn’t know much about the X-Men when I went to see it but from the moment I realized that they were mutants, I was hooked. These incredible people all had some kind of a genetic mutation, some of them due to radiation exposure, just like me. And somehow realizing that I was not alone, even if the people I was relating to were fictional, for the first time in many years helped me feel connected…helped me feel…normal.

The character I especially connected to was Storm because she could control the weather (how cool is that?)!

Storm-Ororo-Munroe-wallpapers-x-men-31690257-1920-1080

The more I found out about Storm, the more I identified with her. Storm (real name: Ororo Munroe) also had a childhood trauma history. When she was 6 years old, her parents were crushed to death by a fallen plane. Ororo barely made it out alive. After that Ororo became claustrophobic (having an intense fear of tight spaces), which persisted even after she had joined the X-Men.

Storm’s powers come from her connection with the Earth and her emotions allow her to influence the weather. Somehow learning this made me rethink my own symptoms as my own special way of connecting with the Earth, like Storm. I feel when the Earth changes and when the weather changes. This reframe allowed me to view my symptoms as a kind of Superpower. And somehow, in this process my symptoms began to change. I still have them but they no longer stop me from doing what is truly important to me. I’ve made space for these symptoms and they made space for me.

And somehow from this adventure, Superhero Therapy was born. After having spoken to many people, having heard so many stories, I am convinced that if we connect to someone, be it real or fictional, we just might find the very kind of strength and inspiration that we need to recover.

What is Superhero Therapy?

Superman-couch

Did you ever want to be a Superhero? Did you ever wish that you could possess magical powers, like Harry Potter, or travel around the world in a time machine, called the T.A.R.D.I.S. with an alien who calls himself The Doctor? What if you could, in a way?

Many of us wish we had some kind of magical or extraordinary abilities, and many of us strongly identify with fictional characters, like Batman, Superman, Buffy the Vampire Slayer, characters from Harry Potter, Firefly, and many others. Recent research findings suggest that identifying with fictional characters can actually be extremely beneficial as it can teach us empathy, remind us that we are not alone in our painful experience, inspire us to eat healthier, and allow us to better cope with difficult life transitions.

The goal of Superhero Therapy, therefore, is to help patients who identify with a particular fictional character to use that relationship with that character in order to identify and process their own experiences and feelings, as well as to encourage them to make meaningful changes in their lives. Thus, the goal of Superhero Therapy is to teach us how to become the very magical Superhero-Jedi that we need in order to become the very best versions of ourselves. Superhero Therapy refers to using examples of Superheroes, as well as characters from fantasy and science fiction in research supported therapy, such as cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT).

Why Superhero Therapy?

Many people have a hard time identifying their own thoughts and emotions, either because it’s too painful, or they’ve never thought about it. I see many patients with posttraumatic stress disorder (PTSD), including active duty service members, Veterans, and non-military civilians. I find that a lot of the time when I ask my patients how they felt at the time of the traumatic event, or even about which emotions they are experiencing in the present moment, many state that they aren’t sure or do not wish to answer.

However, discussing how a specific character felt at a given moment can be helpful in understanding our own emotions. For example, in the Defense Department’s recent efforts to assist Veterans with PTSD, they’ve contracted an independent company, Theater of War, to put on theatre plays for Veterans with combat-related themes, based on Ancient Greek plays. One of these plays, Ajax, for example, tells a story about a character struggling with his symptoms after the war and eventually committing suicide. Veterans and their spouses who saw the play reported that the play helped them understand their own emotions by relating to the characters. One Veteran in particular was moved by the play, stating: “I’ve been Ajax. I’ve spoken to Ajax.”

Talking about fictional characters’ emotional experiences might seem safer than talking about our own, so with my patients, that is where we often start, later drawing parallels to their own feelings and subsequently switching over to focusing on those. For instance, many service members and Veterans I’ve worked with strongly identify with Superheroes, in particular, Batman, Superman, and The Hulk. Let’s take a look at Superman.

Superman (real name Kal-El) is a comic book character who is an alien from another planet, Krypton, who was sent to Earth as a child. His Earth name is Clark Kent, and while in the Solar System, including Planet Earth, he appears to have superhuman abilities: he possesses super strength, super speed, he can fly, he can fight, he has X-ray vision, and many other cool powers. It is no surprise that Superman is a role model to many service members and Veterans, who believe him to be invincible. The phrase or a variation of the phrase I often hear in this population is “I wanted to be Superman… I failed.” This is a common response many people have, harshly judging their own experiences of having PTSD. This is a common dialogue I’ve engaged in with many of my patients:

Patient: “I just feel like such a failure.”

Therapist: “What makes you say that?”

Patient: “I wanted to be like Superman, you know? Strong.”

Therapist: “And now you don’t feel that way?”

Patient: “No, I have PTSD.”

Therapist: “And what does that mean about you?”

Patient: “It means that I’m weak.”

Therapist: “Wow, that’s harsh. Let me ask you this, did Superman have any vulnerabilities?”

Patient: “No.”

Therapist: “No?”

Patient: “Well, there’s Kryptonite…”

Therapist: “Right. What is it and what does it do?”

Patient: “Kryptonite is this radioactive material from Krypton, where Superman was born. It takes away his powers and can kill him.”

Therapist: “So Kryptonite makes him vulnerable?”

Patient: “Yes.”

Therapist: “And does this make him any less of a Superhero?”

Patient: “No, of course not… Oh, I see what you mean, that having PTSD doesn’t mean I’m not Superman.”

This is an example of how cognitive behavioral therapy (CBT) could look when using Superhero examples in session. CBT is a type of therapy that looks at the relationship between thoughts, feelings, and behaviors, which are bidirectional, meaning that they affect one another. In the example above, the patient’s thought: “because I have PTSD, that means I’m weak, and I failed in being Superman” is affecting his feelings (making him feel more depressed) and is affecting his behavior (for example, not wanting to socialize with others).

Some of the thoughts we have might not be 100% accurate, often leading to some painful emotions, and maladaptive behaviors. By challenging the validity of the thoughts (testing to see whether or not the thought is accurate), we can get out of the maladaptive loop. A CBT therapist’s job is to teach a patient how to implement the skill of challenging their own thoughts, to change the maladaptive behaviors in order to help the patient recover, as well as become their own therapist, to be able to help themselves in the future.

The other type of therapy that lends itself nicely to Superhero Therapy is acceptance and commitment therapy (ACT). I often describe it as Superhero Training, as ACT teaches us to become the very Superhero (or witch/wizard, vampire slayer, Jedi, or any other title that seems most helpful) that we wish to be by following our values, (the most important things to us, like family, friends, creativity, altruism, spirituality, and others), and by facing whatever dragons show up along the way (thoughts, feelings, personal stories we tell ourselves, such as “I’m a failure” or “I’m not good enough”) and practicing the Jedi-like skill of mindfulness.

Let’s take a look at how Harry Potter can be used in therapy to teach us some of these skills. Briefly, Harry Potter is a young wizard in training, whose parents were killed by Lord Voldemort, an evil wizard. Harry and his friends, Ron and Hermione, are studying magic at Hogwarts School of Witchcraft and Wizardry. When Lord Voldemort and his followers, the Death Eaters, start to come back to power, aiming to exterminate all non-magical humans (called Muggles), as well as all Muggle-born witches and wizards, it is up to Harry and his friends to stop them.

In the first book of the Harry Potter series, Harry, Ron, and Hermione find out that Lord Voldemort is attempting to come to power by trying to steal the Philosopher’s Stone, which grants immortality to its owner. In trying to stop him, Harry and his friends have to undergo a series of dangerous tests. One of them, the Devil’s Snare, is a magical plant that uses its tentacle-like branches to suffocate the person that touches it.

The Devil’s Snare presents a great ACT metaphor of acceptance and experiential avoidance: the plant seems to respond to tension levels, the more one struggles with it, the tighter its grip and the more likely it is to choke them. This is experiential avoidance, trying to escape the present experience, and just like the Devil’s Snare, in most cases, the more we try to escape, the deeper our struggle becomes. However, if we stop struggling and are willing to experience this discomfort (acceptance), then we are more likely to survive – when Hermione lets go of the struggle with the plant, for example, the Devil’s Snare releases her.

Here is how Superhero Therapy using ACT can look in a clinical setting. One of my clients was struggling with panic disorder and was too scared to go to places where a panic attack might take place and where escape might be difficult (this is called agoraphobia). The patient (let’s call her “Lucy”) stated that as a result of her fears of getting additional panic attacks she had to drop out of college, move back in with her parents, was unable to spend time with her friends, was unable to volunteer in a community theatre, which was something she really enjoyed, and essentially put her life on hold. While she did not have many panic attacks when staying at home, Lucy’s life became constricted, based solely around her anxiety disorder. Lucy stated that she would not be willing to go to unfamiliar places until her panic attacks went away completely and she was absolutely sure that they would not happen again. Her thoughts, such as “if I go out, I will have a panic attack” and “I’m weak” prevented her from living the kind of life she wanted.

In our sessions together we talked about the Harry Potter series; her favorite character was Harry’s friend, Ron Weasley. She said that she identified with Ron because of his fear of spiders. While Lucy herself did not have a fear of spiders, she stated that she could relate to Ron because “he knows what it’s like to be really scared, he gets so overwhelmed by spiders that he can’t even move. That’s exactly how I feel.”

In discussing Ron in therapy, Lucy was able to identify that as scared as Ron was of the spiders, when it was really important, specifically, when Hermione was Petrified (turned to stone) by an unknown monster in Harry Potter and the Chamber of Secrets, Ron (as well as Harry) followed the spiders into the Forbidden Forest in order to get the information needed to save Hermione and other Petrified students. This is a great example of the ACT concept of values. No one who read the books can deny that Ron was terrified when he followed and interacted with the spiders. He was probably also doubting his own abilities and might have had many insecure thoughts, such as “I will fail,” or “I’m not good enough,” or maybe even “I’m a coward.” And yet, despite his fear he was able to follow through, he was willing to experience whatever terrifying emotions and thoughts showed up in order to save his friend, showing true courage and heroism.

I will never forget the first time that Lucy and I drove around her block as a part of her facing her fears. She was trembling and was saying that she did not think that she could do it. However, she got behind the wheel, tightened her Gryffindor scarf, and turned on the engine. It took less than 5 minutes to go around the block and when we were finished Lucy was ecstatic. She was in tears, she was laughing, and saying, “I can’t believe I just did that!”

Lucy and I continued working on taking “superhero steps” in her valued direction and practiced driving to a movie theatre and other locations. Lucy still gets anxious sometimes but just like a true Superhero that she is, she courageously goes out with her friends, she’s back in school, and has even traveled abroad with her family.

I always say that the bravest people I know are my patients. It takes a lot of courage to experience overwhelming, and at times, incapacitating, anxiety, to come to treatment, and to face our fears. Many people believe that fear is bad, something that needs to go away for us to live a normal life. However, fear can actually be quite advantageous. In a recent Doctor Who episode, Listen, we learn that fear can be a Superpower. Doctor Who is a British science fiction TV show about an alien, who calls himself The Doctor. The Doctor travels around the universe in a time machine, called the T.A.R.D.I.S. (which stands for Time and Relative Dimension in Space) and saves those in need.

The Doctor is over 2,000 years old, and seems to know a thing or two about fear. His take is this: Fear is a Superpower. Fear causes the release of adrenaline, which makes us think faster and fight harder, suggesting that we don’t need to run away from fear, fear might actually be helpful.

The bottom line is that running away from fear and not living our lives according to our values isn’t helpful, whereas learning how to face our fears in the service of what’s most important to us, that’s what being a Superhero is all about.

Giving Students Therapy is Not the Answer to Dealing with Microaggressions in Education

This article is continuing analysis of the Atlantic’s article, Coddling of the American Mind written by authors Jonathan Haidt and Greg Lukianoff . The authors believe that ‘political correctness’, or reacting to ‘microaggressions’, is damaging students’ intellectual and emotional wellbeing on university campuses. In an earlier article, I considered what microaggressions are and some of the unsaid assumptions and attitudes of the authors as well as taking into consideration their backgrounds.

In short, microaggressions are small and unconscious acts of oppression, such as erasure, using someone’s identity (sexuality, gender, race) as an insult, assimilation as a compliment, and assuming badness or deviance as a result of someone’s identity. Here, I want to consider more of Haidt and Lukianoff’s content, beginning with their concern:

“What exactly are students learning when they spend four years or more in a community that polices unintentional slights, places warning labels on works of classic literature, and in many other ways conveys the sense that words can be forms of violence that require strict control by campus authorities, who are expected to act as both protectors and prosecutors?”

I’ve already noted their victimising, legal vocabulary – ‘polices’, ‘prosecutors’, ‘strict control’, ‘authorities’, but it is worth bearing in mind. In fact, American college campuses are surprisingly lax in their response to problems around race and sexual assault. Sexual assault is common on college campuses and misogynistic language is rife, yet policies, discussions, and ‘messages’ around dealing with rape and sexual assault properly are lacking.

Likewise, there are examples of students who have not faced consequences aside from criticism and discussion after chanting actively racist slurs on film, and there are a great many incidents of verbal or physical racism with no real consequences to the perpetrator (although, as the last link shows, there are also cases that do have real consequences, such as court cases).

Essentially, it’s difficult to believe that whilst overt cases of aggression are not being dealt with effectively, college campuses are somehow ‘policing’ microaggressions. In fact, the authors later go on to give an example of pro-‘trigger warning’ policy that was “subsequently retracted in the face of faculty pushback”, which does not suggest ‘policing’ or ‘victims’, but people who were listened to.

Haidt and Lukianoff’s lamentation that words can be treated as a “form of violence” is also somewhat problematic. They state it as though words and actions are completely separate. For example, by saying “You don’t look like a lesbian” as a compliment, you are performing the act of reducing the status of lesbians.

There are other ways that words perform actions, such as “I now pronounce you X and X” being the act of marriage, and “Sold” being the act of ending an auction. In fact, the part of the brain that responds to social pain (e.g. social insults) is the same circuitry of the brain that responds to physical pain. Additionally, words can be worse, as the damage of psychological abuse equals or outweighs the damage of physical abuse. So whilst words are clearly not the same as physical violence, that doesn’t mean they can’t be violent.

Now, let’s move on to another point they make: “Students seem to be reporting more emotional crises; many seem fragile”. These statements are curious. Firstly, somebody with a mental health or wellbeing ‘crisis’ is at risk of significantly harming themselves or others.

Most people, most of the time, are not in a state of ‘crisis’, nor would most students claim to be. And the problem is framed as the inherent fragility of the students, rather than emotional distress being a rational response to the way things are at the moment. They hedge this with “We do not mean to imply simple causation, but…” and then go on to do essentially that.

There is no mention of the fact that American college prices are utterly extortionate, and unemployment high in the young. America has been at war for most of students’ lives. Privacy is now essentially nonexistent, people’s very bodies are becoming objects as women and men are increasingly exposed to unnatural and unrealistic ideals. Lives are doctored through social media, so everyone else looks like they’re doing great while the gap between the haves and the have-nots in America is bigger than ever. More people are going to university, making it more competitive, yet job prospects are poor. This wasn’t always the case with university degrees.

Indeed, the two well-off men who wrote this article forgot, or just didn’t know, that the biggest predictor of ‘mental health’ and wellbeing problems in any society is its socioeconomic inequality.

That’s right, Socioeconomic inequality, and America does not do well on that front. On top of this, socioeconomic inequality is directly threatening university students. It seems staggering, if not downright insulting, that anyone could claim in light of this that students’ suffering is primarily due to their own faulty thinking patterns and oversensitivity to ‘triggers’.

Regarding ‘triggering’, the phrase ‘trigger warning’ can indeed be used thoughtlessly, or overmuch. Pre-discussions about potentially upsetting content, however, aren’t unreasonable. We often have these in my doctorate; it teaches us to trust and understand our rational and emotional responses together, wisely.

It also makes us realise things that weren’t a problem for us might still be a problem for someone else – the ‘social learning’ of which Haidt and Lukianoff warn is not learning to fear what others fear, but learning how to empathise with others who are bothered by things that we aren’t. Finally, it facilitates learning, because animals physically can’t learn when overly stressed and anxious.

They say of this: “However, there is a deeper problem with trigger warnings. According to the most-basic tenets of psychology, the very idea of helping people with anxiety disorders avoid the things they fear is misguided.” They appear to use one particular branch of psychological therapy to represent both their argument, and psychology as a whole.

It is difficult to provide an semi-objective reply to authors who have suggested that microaggressions based on societal oppression and ‘anxiety disorders’ are the same thing. It’s a struggle to understand quite how the cognitive leap from one to the other occurred.

The Cognitive Behaviour Therapy (CBT) data to which they refer is based on samples of people who have clinical diagnoses of anxiety disorders. The most ‘basic’ tenets of cognitive behaviour psychology suggest that, in people with anxiety disorders, exposing themselves to things they fear will habituate them, so long as this exposure doesn’t result in a negative outcome like a poisonous spider bite or falling off a high ledge.

CBT is effective for anxiety disorders not just because it exposes people to unpleasant thoughts and situations. It also provides through learned experience for individuals to see their fears aren’t as bad as they first thought. However, if your so-called ‘distortions’ are proved true through experience, then you are unlikely to be ‘cured’ as Haidt and Lukianoff suggest. This is why behavioural experiments must be chosen carefully – not to ‘fix’ a positive outcome, but to test reasonable situations. Indeed, Martin Seligman’s theory of learned helplessness suggests that the more you are exposed to negative stimuli over which you have no control, the more likely you are to get depression.

Microaggressions are rooted in real societal inequality. They cause a complex range of emotions, from anger, shame, confusion, self-consciousness, and perhaps fear if the person microaggressing seems threatening. The point is, there is an extraordinary gap between CBT for anxiety disorders, and calling people out on societally oppressive actions and comments.

Now, some people who ask for certain things (e.g. rape not to be included on an exam paper) may have PTSD or an anxiety disorder. However, that is a separate issue to ‘microaggressions’ as a whole, and should be dealt with on a purely individual basis – though I don’t see the problem in at least asking about individual support.

Additionally, we can make the argument there are some ideas we would rather people not be habituated to such as violence, hardcore porn or constant absorption in technology for example. Perhaps society-wide habituation is simply what we call ‘the norm’. In the case of microaggressions, is habituation for the people oppressed by societal power dynamics really what we want?  There is a statement about calling people up on microaggressions which has almost become proverbial:

“If you step on my foot, you need to get off my foot. If you step on my foot without meaning to, you need to get off my foot. If you step on my foot without realising it, you need to get off my foot.”

The last thing we should be doing is habituating people to having their foot stepped on. But this seems to be what Haidt and Lukianoff support by saying: “What are we doing to our students if we encourage them to develop extra-thin skin in the years just before they leave the cocoon of adult protection and enter the workforce? Would they not be better prepared to flourish if we taught them to question their own emotional reactions, and to give people the benefit of the doubt?”.

People from oppressed groups don’t suddenly hit university and therefore enter a “cocoon of adult protection” where discrimination no longer exists. They are, in fact, consistently taught to question their own emotional reactions to microaggressions, and to give people the benefit of the doubt, their entire lives. An example is women being harassed – ‘boys will be boys’, he ‘didn’t mean anything by it’, or the ever-present ‘it was a compliment’. People don’t need more of this.

Of course banning books like Huckleberry Finn isn’t appropriate. Treating such books, concepts and ideas with context, consideration and respect is appropriate. Demonising people based on their ignorant comments is an understandably contentious matter; there are unresolved arguments regarding “letting people learn” versus “when can we stop catering to the privileged”. However, the middlespace between intellectual freedom and respect is still being hashed out.  And people who have systematically been ignored and oppressed are angry. They have every right to be.

In their deep analysis of how this ‘situation’ came about, Haidt and Lukianoff fail to see that oppression and microaggressions may be becoming more prevalent discussions points on college campuses simply because people from traditionally marginalised groups are now more likely to go to universities in the first place.

Haidt and Lukianoff suggest “students should also be taught how to live in a world full of potential offenses”, but don’t seem to consider that this is exactly what people of oppressed demographics are doing by being vocal about microaggressions. They are probably pretty good at navigating the ‘offence’-laden system actually, having got to university in the first place. Now they’re trying to change it.

Perhaps we don’t want to prepare students for ‘the workforce’ as it stands. There is still racism, sexism and homophobia, particularly at higher levels of employment. There is still a gender pay gap. People’s income is still more likely to match that of their parents’ income, their skin colour, and their gender, than that of their potential. Why would anyone suggest people take therapy to get used to this system, rather than trying to change it? There is a balance to be had with dealing with and accepting current circumstances, whilst also committing to make changes where possible.

Is it not more reasonable to suggest that during their university education, students start to think about the actions that their words perform, instead of pretending ‘academia’ and ‘intellectual debate’ happens in a vacuum? Might it not be academically important to consider the context of one’s ideas, where they come from and why, and moreover in whose interests these ideas work?

If these ideas are perceived to be dangerous, and “fear of federal investigations” and “fear of unreasonable investigation and sanction” are rife within institutions, then perhaps it is not the students who should be receiving therapy for their dysfunctional thinking patterns.

Perhaps, instead, we should deal with the cognitive distortions within the system.

Helping Law Enforcement the Social Work Way

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One story that is trending on news and social media is that of a law enforcement officer who drew his gun on unarmed teenagers.  The same officer was videotaped ordering teenagers to lie on the ground and was viewed physically holding a teenage girl on the ground.  The teenagers were reportedly at a neighborhood pool when an incident occurred and law enforcement was called.

It should be noted that not all of the officers approached the incident in the same manner.  Another officer was videotaped calmly but assertively asking several youngsters about the incident.  His questioning was interrupted by the officer, who eventually drew his weapon.

Comments and opinions on the blogosphere regarding this current event are emotionally charged.  They clearly show biases that originate from the writers’ life experiences and beliefs.  These opinions are often framed in combative ‘them versus us’ tones.  If one expresses concern for the law enforcement officer, another opinion will refute its validity and claim concern for the alleged victims.  If one expresses concern for the victims, another writer will invalidate the comment and express full support for all actions, good, bad, or indifferent by the law enforcement officer.

Unfortunately, these comments do not solve the problem and do not address the needs of the victims or law enforcement officers.

Law enforcement officers and first responders have been found to have a higher incidence of Post Traumatic Stress Disorder (PTSD) than the general population. In the article “What is Post Traumatic Stress Disorder” author Pamela Kulbarsh, R.N. wrote that the prevalence of PTSD ranges from 4-14% among law enforcement officers.  Many articles state that an exact number is difficult to obtain due to underreporting.

Law enforcement officers are repeatedly exposed to threats of death and actual death.  They are expected to make split second decisions that could result in major injuries or loss of life.  Officers are sent to situations with cursory information and expected to provide appropriate solutions.  Gary G. Felt, MA, MHC expounds on this concern in the article “The Relationship of Post Traumatic Stress Disorder to Law Enforcement: The Importance of Education.”

Social workers and mental health workers understand that individuals who experience PTSD symptoms may believe they are under constant threat particularly in situations that are similar to other trauma related experiences.  They may display demonstrate irritability, anger and aggression with little to no provocation.

These events provide opportunity for social work professionals to provide solutions using their knowledge and expertise of social work practice.  Professional social workers, who are entrepreneurial minded, should also view these incidents as opportunities for career growth and advancement as well.

Social workers can provide law enforcement officers with solutions and training to avert the appearance of being overly aggressive, unyielding and unreasonable.  Social workers can also provide strategies that will enable law enforcement professionals to do their jobs while providing them with substantive protection.

Social workers use social work methods and strategies.  Solution enabling strategies include:

Developing appropriate responses to problems based on client needs.

Creatively combining knowledge, values and skills to gain understanding and build relationships.

Respecting and facilitating healthy interactions among individuals, groups and environments.

Assessing, planning, implementing, and evaluating work at every level.

A partnership between social work and law enforcement will create and promote an environment of support and safety for law enforcement officers and the community at large.

Why Aren’t We Talking About Sexual Assault On Campus?

By Leah Greenidge, Rosedad Francois, Valerie Jean-louis, Farah Robles

As children, we embark on various journeys in life from attending our 8th grade dance, making the cheer-leading team or making the varsity sports team in high school. Then, if fortunate enough, its surviving the hectic and often stressful 4 years of college in hopes of obtaining your degree. With this journey comes many obstacles and sadly sexual assault on campus can be one of the harsher obstacles in life someone may experience with many long-term and devastating effects.

Students found guilty of sexual assault on campuses have a high probability of receiving no consequences for their actions. It is usually the victim that has to endure the shame, feelings of embarrassment and anger which may change their outlook on life. Victims are either too scared to report or feel as if they some how caused the events to happen. Most survivors suffer high rates of Posttraumatic Stress Disorder (PTSD), depression, and co-occurring drug/alcohol abuse. Due to under-reporting, it is believed that 1 in every 5 women will be sexually assaulted while in college.

According to an article in Mother Jones,

The NIJ-funded study also examined the circumstances and risk factors surrounding sexual assault on campus, including the role of alcohol and fraternities. Nearly 60 percent of campus sexual-assault victims were under the influence of booze or drugs when they were attacked; one-fourth said their assailant was a frat member. Read Full Article

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To make our campuses safer, change needs to happen with school policies and practices to prevent these assaults from happening. Across all demographics, rapists and sex offenders are too often escape paying for their crimes and are free to assault again. Sexual assault in general is a subject that people keep on “the hush hush”, but we need to start talking about sexual assault on campus in order to create a safe environment for students to excel.

We are students passionate about empowering people, and we’ve started this campaign to give a voice to those who don’t have one #‎outofyourshadow

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Why Calling It Trauma Minimizes American Torture

On April 14th, Mayor Rahm Emanuel backed a proposal to established a 5.5 million dollar reparations fund for victims tortured by police which included electrocution, beatings, and suffocation to obtain confessions. From 1972 to late 1991, Police Commander Jon Burge and his midnight crew of rogue detectives tortured over 120 men who were largely African-American. After costing the City of Chicago over 100 million dollars in lawsuit settlements, Burge received only 4 1/2 years in prison while still being allowed to collect his tax payer funded police pension. From year to date, Burge has collected approximately $700,00.00 despite his illegal activities and conviction.

CClIL5yW8AQ8TrjAfter consulting with over a hundred international human rights advocates representing over eighty nations around the world, it has become clear that even those of us who are deeply compassionate advocates in America have been numbed to the circumstances that present themselves each day in the United States.

If we are to widen our panoramic view of the world, and step out of our relative cultural insularity, there will be a collective realization that Americans have truly entered and accepted (consciously or unconsciously) a torture culture.

The Black Lives Matter movement is responding to torture and genocide, and death penalty abolitionists are responding to torture and genocide. The immigration movement is responding to torture. Everyday citizens are responding to torture. People feel tortured. Not traumatized. Let’s call a spade a spade.

The notion of physical and psychological trauma are concepts that are evolving every day among medical, mental health, and the legal field. Research has grown tremendously to the point that we now know trauma extends to situations well beyond war and the conditions that veterans typically develop.

While predominantly white institutions credit Dr. Judith Herman and her book, Trauma and Recovery, for contextualizing trauma in other acute scenarios that occur within everyday civilian life, the work of Dr. Frantz Fanon predates Dr. Herman’s contribution to traumatized and tortured communities in his books,Wretched of the Earth, and Black Skin, White Masks.

Other important concepts such as secondary trauma, vicarious trauma, and compassion fatigue were born into a general school of thought when describing the level of burnout and high stress symptoms that doctors, clinicians, and human rights workers developed over time in their work. The collective effort to raise consciousness and awareness of this issue has been critical to the understanding of what can happen to service providers while working with client populations they serve.

Still, as we continue to wake up to the realities around us within the United States, this awakening process has largely been too slow under international human rights standards. The high rate of gun possession per capita in the U.S., use of the death penalty despite high rates of proven wrongful incarcerations and exonerations, America’s system of mass incarceration and deportation,the astronomical expansion of the prison system, inhumane practices of solitary confinement and deprivation, and the rising tide of police violence and killings within communities of color suggest that the use of the term “trauma,” simply minimizes and serves to desensitize what is really happening around us and more importantly to us.

Why Is Language Important?

Even highly trained trauma specialists who are conditioned to the culture in which we live have largely become desensitized, and often lack confidence enough to assert a reality for what it is. And it is not really their faults if they are required to function within systems that do not acknowledge, ignore, or minimize PTSD and Complex Trauma in the first place. The milieus in which they operate must be able to care and respond to trauma informed providers for them to gain footing in a collective reality that is occurring.

There is often also a persistent feeling of guilt among relatively privileged trauma informed care providers. This can often blind professionals from accurately seeing and identifying truths that may be different from their own.

When applying international human rights standards to issues such as violence against women, incarceration, detention, etc. the U.S. standard falls egregiously short in its medical semantics for domestic torture. In this regard, there is a sense of imperialism that is attached to the word, “torture,” as if it is something primitive and only happens within the boundaries of indigenous cultures, not westernized ones. Yet, it is a nation like the U.S. that is in the technological position to carry out torture practices whether in broad daylight and in plain view or clandestinely.

Enforcing the Convention Against Torture

Using the term, “torture,” in lieu of trauma also demands a more urgent response from those doing and committing the torturing and especially the masses of well-meaning people that have compassion but have collectively been taught to care less and minimize the problems their neighbors endure.

We have grown so culturally complacent with the horrors that are taking place, that labeling something as “torture,” would simply jolt us out of that complacency like a splash of ice water. We need to be jarred awake and perhaps calling everything trauma only makes us unresponsive.

The Convention Against Torture, in fact, is an international human rights instrument that enforces this notion and demands that we recognize the torture that occurs. From a legal perspective, if we look at the language, it rarely uses the term trauma.

We will only be equipped to adequately respond to various crises that are repeatedly happening and are seemingly unending when we wake up to the realities that are occurring, rather than using flowery language that serves to minimize or hide certain truths; that serves to numb us and desensitize us from the high degree of pain that people truly experience.

Barriers to Treating PTSD in Prisons and Immigration Detention

During the past ten years, I traveled to over 100 jails and prisons in the entire east coast of the United States, giving me the to opportunity to observe the dire lack of appropriate medical and mental health care in our prison system. The most immediate and urgent need is to screen routinely for Post Traumatic Stress Disorder (PTSD) among incarcerated individuals.

alcatraz_prison_block_cc_imgAfter assessing over a thousand men who face lengthy prison sentences and endured long periods of solitary confinement, almost every person I have encountered has had an unaccounted childhood history of abuse and/or sexual abuse. To me, this has been most notable among those who have had a long connection to the criminal justice system— namely African American men, and more specifically those who have endured long years in the foster care system.

Many of the same patterns are also emerging within our immigration detention system, and so parallel conclusions can be applied to the immigrant population who are being held in prison-like settings. The goal of this article is to make the public aware of a growing epidemic of PTSD in our system of mass incarceration and detention. It calls for urgent attention to this immediate public health crisis. Addressing PTSD both in and out of correctional settings would lead to less violence and killings in prison and in the community.

The effects of living with untreated PTSD almost always flags a misdiagnosis of a mental health disorder of some other kind and no clinical account of the person’s abuse that can then lead to relevant basis for mitigation and the proper course for rehabilitation. It can also implicate mistreatment of symptoms and prescribing the wrong psychotropic medications to a person. In some instances, identifying PTSD can offer context to a whole host of other issues such as Traumatic Brain Injury (TBI), Depression, or co-occurring polysubstance abuse issues. Once PTSD is identified, it should lead to a long-term regimen of individual psychotherapy and addiction treatment where appropriate, with an emphasis on the mental health component. PTSD does not have to last forever but when it remains untreated, it can certainly last a lifetime.

“Post Traumatic Stress Disorder (PTSD) is caused by both traumatic experiences before incarceration and institutional abuse during incarceration that includes the six clusters of symptoms: (1) intrusive memories and flashbacks to episodes of severe institutional abuse; (2) intense psychological distress and physiological reactivity when exposed to cues triggering memories of the institutional abuse; (3) episodes of dissociation, emotional numbing, and restricted affect; (4) chronic problems with mental functioning that include irritability, outbursts of anger, difficulty concentrating, sleep disturbances, and an exaggerated startle response. (5) persistent avoidance of anything that would trigger memories of the traumatic events; (6) hypervigilance, generalized paranoia, and reduced capacity to trust caused by constant fear of abuse from both correctional staff and other inmates that can be generalized to others after release,” according to Terence Gorski.

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What Are Some Barriers to Identifying PTSD in Prisons and Detention Centers?

  • A lack of basic trust between communities of color and mental health professionals who present themselves as affiliates of the system is pervasive among the prison population. Just within the past year, I met seven different incarcerated men who admitted to never disclosing their sexual abuse histories in previous psychological settings, largely due to feelings of distrust about disclosing personal information, deep shame, and feelings of worthlessness surrounding the abuse events. Indeed, an appropriate conversation about one’s traumatic histories leads one to be in his or her most vulnerable state. It requires a delicate process of assigning a substantive amount of time to assessing trauma between the interviewer and the person.
  • Just the physical environment of a prison setting alone can deter an appropriate atmosphere for eliciting intimate information about one’s trauma history. Advocates, lawyers, social workers, and counselors may have to request appropriate accommodations within the prison to do a proper trauma assessment. It is always most ideal for the incarcerated person to feel as comfortable as possible before disclosing details of their past and present abuse. In many cases, this will not be possible and the one performing a trauma assessment has to decide whether it is appropriate for the person to be engaged in this type of interview. Conversations regarding trauma histories should be facilitated in a manner in which the person will not be re-traumatized while recounting past events.
  • Proper training of correctional health staff, forensic health professionals, and legal advocates is necessary and critical. Those within correctional settings and the legal system should become a trauma-informed community to address the incarcerated population in a more realistic manner. Becoming a trauma-informed community will lead to less prison abuse and killings within correctional settings. Treating the root of an undetected problem will likely reduce recidivism among those that keep getting re-arrested and have long criminal histories.
  • Cross-cultural biases may influence the interviewer to associate symptoms such as anger, hypervigilance, avoidance, or depressive symptoms of PTSD with other culturally and stereotypically held beliefs about men of color in the prison system. In addition, attributing the nature of the criminal charge against a person can cloud the belief that the incarcerated individual was also a victim of trauma in the past. This often leads many professionals to dismiss the likelihood that a client has a substantive abuse history.
  • Even today’s well-trained lawyers and mental health advocates erroneously assume that if a person had an early history of trauma and abuse, it would have been documented a long time ago during an earlier course of treatment in previous years. This is an inaccurate assumption. It should be stressed that PTSD has only been truly understood among the medical community as recently as 2013 and this framework is not yet integrated within the legal and correctional system. Thus, the correctional and legal system largely still relies on outdated tools and outmoded diagnostic resources. Our historical pattern of under-treating PTSD among the incarcerated begs for a concerted effort and inquiry.
  • Language barriers can also deter identifying PTSD when it exists. If the person is unable to speak English, it is critical that a trauma assessment is conducted and modified to the individual’s native language.

What We Can Do

Anyone who has had contact with the criminal justice system should be automatically considered predisposed to the conditions of PTSD and Complex PTSD. This assumption should be more pronounced among those who have been charged with a violent crime.

Becoming trauma-informed almost always requires a client-centered approach in either mental health or legal advocacy. It is absolutely essential that clients are put at ease, especially within prisons. Conducting trauma assessments almost always requires a skilled clinician who understands the continuum of PTSD and what its components look like. It is also important to allot an appropriate amount of time to acquire information related to one’s trauma history.

Commonly used universal screening tools in a proper trauma assessment are the PTSD Checklist (PCL-C) and the Life Events Checklist (LEC). To screen for signs of Traumatic Brain Injury or TBI, you can use the Harvard Trauma Questionnaire-Revised, a more developed cross-cultural tool to assess one’s history of torture, severe head injuries, and other extreme life hardships. You can also use the Hopkins Symptom Checklist-25, to screen for depression and anxiety symptoms. You may want to also use the Beck Depression Inventory II (BDI II) to look for depression symptoms that frequently co-exist with PTSD when left untreated for a long period of time.

After conducting a trauma assessment, various relaxation and stress reduction techniques can be taught to the one facing and enduring incarceration. An appropriate amount of follow-up should be done to see that the person is referred to proper treatment of PTSD for the long-run.

Recovering Into a Different Normal

Many would describe normal as confirming to a standard, the usual, typical, or what’s expected, but those with mental illness have a different approach to normality. My recent conversation with the resilient Eleanore taught me that normality isn’t always has society defines it. As a unique child who kept her head in books, Eleanore learned to develop her own approach to normality from an early age. Through her battles with sexual assault and mental illness, Eleanore proved that one does not need to confirm to societal norms to become truly inspirational. 

SWH: What are you diagnosed with and how did it progress over the years?

unnamedEleanore: I was initially diagnosed and medicated for depression. When I was put on celexa, I became increasingly manic. When I hit my teen years, things started getting a little more intense. I started taking on more and more activities so that I would have to spend less time at home, and I excelled at those activities for a while – but there was always one point in mid-November (every year) that I would crash and burn. I’d skip school for about a week, skip all my activities, and devote a significant chunk of my time to overwhelming panic.

My doctor discovered that bipolar runs in my family and after treating me successfully for that, it became my diagnosis. I was diagnosed with anorexia binge/purge subtype separate from any of the bipolar or depression. I was pretty recently diagnosed with Post Traumatic Stress Disorder (PTSD) and panic disorder, but a lot of my mental illness stems from my PTSD in the first place.

Celexa turned what was a tough situation into an absolute nightmare. I had a lot of sex (I still have a lot of sex, but this was borderline dangerous promiscuity with inadequate protection), I shaved my head, my self-harm was more frequent, I developed a lot of disordered eating habits

SWH:What is it about November that triggers your panic attacks?

Eleanor:November is an interesting month for me. I live in the Midwest, so it’s when my seasonal depression always gets really bad. My bipolar tends to be manic/depressive according to the seasons, so when it’s summer I tend to overestimate my abilities and take on too much, and the inevitable crash happens in November. It’s also when a lot of the worst abuse happened in my relationship, and that tends to bring back some unpleasant memories.

SWH:How did your sexual activity play a role into your recovery and current relationship?Eleanore:I’ve always really enjoyed sex. After I was sexually assaulted I needed to reacquaint myself with the idea that sex felt good and it was okay, and it ended up becoming a distraction from the things that were going on in my life. I had about 10 sexual partners over a span of 3 months, and it wasn’t the healthiest decision. Part of sex, for me, is that it is one of the easiest times for me to take joy in my body, and for me to be comfortable in my skin. Feeling appreciated and feeling sexy has been instrumental to my recovery, because even on days that I’m feeling bloated or particularly dysmorphic, my partner still finds me desirable.

SWH: What does feeling normal mean to you?

Eleanore:To me, feeling normal means being able to cope with the things that happen on a day to day basis without panicking or bursting into tears. Obviously, I still have a good cry after a stressful work day, but normal to me is being physically healthy, happy, and in a place mentally that isn’t mania or depression.I don’t think that my normal aligns closely with society’s normal. Traditional normal doesn’t involve panic attacks or crying in the back room, but my normal occasionally does, and that’s okay!

SWH:What is the most rewarding part of your recovery so far?

I think that the most rewarding part of my recovery so far has been that I can look at myself and say “I am a valuable human being, and my faults are okay”. It’s been a long road but looking at where I am now and comparing it to where I was when I started; I have reached goals I didn’t even think were possible. I run a business, I’m in a healthy relationship, and most importantly, I wake up happy most days.

SWH: Where are you today in your recovery?

I’ve reached a truce with my eating disorder. My body image is good most days. My PTSD sneaks up on me – there are things that remind me of him, like a pair of boots or cologne a customer is wearing, but I’ve gotten better at handling that too. The biggest thing I’ve taken away from the last three years is that honesty, while painful, is what works. Honesty with my support network, honesty with my doctors, and honesty with myself.

What advice could you give someone suffering from mental illness?

You are not your illness. Your illness is a part of you and that’s okay. It isn’t something to be ashamed of, and it isn’t something to ignore. Asking for help is okay. Being sad is okay. Something that may seem ordinary for anyone else may be super difficult for you and that’s okay, and that makes it even more incredible when you do it. Everyone has a different road to travel but no matter where you start from, it gets better.

Denied Service at a Restaurant Because of Service Dog

by Vilissa K. Thompson, LMSW

In Mooresville, North Carolina, a disabled veteran was denied service at a restaurant because of his service dog.  Benjamin Wardrid, a veteran who served in the Iraq War, experienced his first taste of discrimination as someone with a disability who uses a service animal.  Wardrid was diagnosed with post-traumatic stress disorder, or PTSD, upon returning home from serving in the U.S. Army.  Beau, Wardrid’s service dog, assists in ameliorating the symptoms of PTSD Wardrid may experience in his day-to-day life.

Service Dog in Training 1Last Wednesday, Wardrid was prevented from being served at a local restaurant while on a family outing because he had his service dog with him.  Wardrid knew that his rights had been violated, and he and Beau returned to the restaurant the following day accompanied by two police officers.  During the second visit, Wardrid and Beau were finally allowed in, and Wardrid was served.  The owner of the restaurant provided an off-camera statement that he has had “bad experiences” with service animals in the past.

The Americans with Disabilities Act (ADA) clearly outlines privately-own businesses’ responsibilities that serve the general population when it comes to service animals:

Privately owned businesses that serve the public, such as restaurants, hotels, retail stores, taxicabs, theaters, concert halls, and sports facilities, are prohibited from discriminating against individuals with disabilities.

The ADA requires these businesses to allow people with disabilities to bring their service animals onto business premises in whatever areas customers are generally allowed.

The ADA defines a service animal as:

Any guide dog, signal dog, or other animal individually trained to provide assistance to an individual with a disability.  Service animals perform some of the functions and tasks that the individual with a disability cannot perform for him or herself.

(Excerpt from the ADA’s Commonly Asked Questions about Service Animals in Places of Business webpage.)

The ADA clearly states that a service animal is NOT a pet.  When a service animal is assisting its owner, they are considered to be “working.”  Though some people may not be aware, it is discouraged to pet or stroke a service animal while working (especially if wearing a harness); to do so distracts the animal who has been trained to provide a service.

When this story was brought to my attention, I was shocked at the lackluster excuse the owner of the restaurant provided regarding his refusal to serve Wardrid.  Dogs who provide such services undergo vigorous selection and training processes; dogs with an aggressive temperament or demeanor are not selected to serve in this manner.  In my experience, the service dogs I have come into contact with were very calm and friendly when they were “off,” and attentive to their owner’s needs when “working.”

Regardless of the restaurant owner’s previous encounters with service animals, Wardrid should not have been denied because he had a service dog.  Any hesitations the owner may have had could have been resolved in a different manner; for instance, he could have brought his concerns to Wardrid’s attention, and an alternate seating arrangement could have been chosen.  Or Wardrid could have eased the owner’s concerns by discussing Beau’s demeanor, and how he would not be disruptive.

The ignorance or “fear” displayed by the owner is disturbing because it makes me, and possibly others who hear this story, wonder how many other “Wardrids and Beaus” were denied at this restaurant before this incident made news.  I also wonder about the treatment of people with disabilities at this restaurant; do people with disabilities feel welcomed, or is there an air of hostility that exists?

Have any of you witnessed discrimination against those who used service animals at public venues?  Have you been the victim of such discriminatory acts?  If so, how did you react, and what was the outcome?  I would like to have the opportunity to learn of your experiences and responses surrounding this matter.

(Featured headlining image:  Courtesy of Petfinder.)

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