Follow us on our new-look blog – http://traumadissociation.wordpress.com
old posts have moved there as well
Follow us on our new-look blog – http://traumadissociation.wordpress.com
old posts have moved there as well
Commentry on Rebuilding community resilience in a post-war context: developing insight and recommendations – a qualitative study in Northern Sri Lanka, published by the International Journal of Mental Health Systems.
How can traumatized people recover when individual ‘talking therapy’ isn’t always possible because of a lack of availability? And when a significant proportion of the population is suffering from the adverse effects of traumas that almost the entire population was subjected to to some degree? This is the situation which often results from civil war, mass natural disasters like the Asian tsunami and military/political oppression by a previous or current government.
North and East Sri Lanka has experienced all of these, and the political/military oppression continues – is it safe, or even possible to speak about trauma at the hands of the authorities when still oppressed at the hands of the same individuals/group? In these circumstances would disclosure put victims/survivors and professionals at serious risk?
Added to this are practical consequences for internally displaced populations (IDPs) including loss of employment, physical disability from war injuries, the break up of communities and extended families, some still unable to return to their home, and some of those able to return finding their homes and buildings destroyed, and cultivated land damaged.
The consequences go way beyond the direct effects of trauma and negatively affect social environments, indirectly leading to greater amounts of interpersonal trauma including violence, domestic and child abuse. The This is a summary of events in Sri Lanka and their mental health consequences:
Individuals, families and communities in Sri Lanka, particularly in the North, the East and so called border areas of Sri Lanka, have undergone twenty five years of war trauma, multiple displacements, injury, detentions, torture, and loss of family, kin, friends, homes, employment and other valued resources . In addition to widespread individual mental health consequences [82,83], such as PTSD (13%), anxiety (49%) and depression (42%) in the recent Vanni IDP’s ; families and communities have been uprooted from familiar and traditional ecological contexts such as ways of life, villages, relationships, connectedness, social capital, structures and institutions. The results are termed collective trauma which has resulted in tearing of the social fabric, lack of social cohesion, disconnection, mistrust, hopelessness, dependency, lack of motivation, powerlessness and despondency. The social disorganization led to unpredictability, low efficacy, low social control of anti-social behavior patterns and high emigration which in turn causes breakdown of social norms, anomie, learned helplessness, thwarted aspirations, low self-esteem, and insecurity. Social pathologies like substance abuse, violence, gender based- and child- abuse have increased.
The authors in this report state that collective trauma does not fit the model of PTSD:
“modern psychology and psychiatry as it has developed has had a western medical illness model perspective that is primarily individualistic in orientation“. With many people in the area believing that counseling and psychosocial interventions are not allowed, the authors consider different community-based interventions, the value of traditional, cultural rituals in healing trauma and culturally appropriate ways to improve the mental health within the population.
The report also considers what is increasingly called Posttraumatic Growth – the positive adaptive changes and resistance shown, and makes recommendations for affecting the effects of such widespread trauma.
Read the full research paper: http://www.ijmhs.com/content/7/1/3
Warning: distressing experiences are described including suicide methods.
Research by Daya Somasundaram and Sambasivamoorthy Sivayokan.
International Journal of Mental Health Systems 2013, 7:3 doi:10.1186/1752-4458-7-3 http://www.ijmhs.com/content/7/1/3
The authors have stated that this article is published under a Creative Commons Attribution 4.0 license, which allows anyone to share or build upon it without charge.
An excellent set of books for male survivors, check them out here…
In the habit of apologizing? Do you put yourself last?
Originally posted on Healing From Complex Trauma & PTSD/CPTSD:
A post to my Facebook page..
Do you feel compelled to apologise for things, you actually don’t need to apologise for?
I have done this all my life. All due to past abuse.
I have been spending less time on social media recently, which is good for me, and part of my self care.
I nearly apologised on Twitter just now, for my lack of tweets recently…
And I stopped myself and thought…
“Why am I apologising for something that is about my self care?
I am under no obligation to tweet a certain amount per day.
It is not my duty, or responsibility to have to be tweeting all day.
I’m not hurting anyone, or doing anything wrong.
And I don’t need to feel guilty about this either.”
Go me – on facing the issues of self care, guilt, over-responsibility to others.
I don’t need to apologise, when I haven’t…
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An excellent blog about the myths preventing some people from seeking therapy.
Considerations for survivors of extreme trauma and ritual abuse
Timescales for healing
The treatment guidelines for Complex PTSD by the ISTSS give a longer healing than the article above – between 18 months and 2 years is suggested, but this will depend on the degree of trauma and your current situation in life. If you are one of the many survivors who is still living with domestic violence or experience a bereavement during treatment, for example, then it may take longer.
Myth No. 2: No therapist can handle all of my trauma and emotions. It is just too much.
Firstly, in common with the Complex PTSD treatment guidelines, the Dissociative Identity Disorder treatment guidelines describe the first stage in treatment as focusing on Safety and Stability – learning more ways to cope with difficult emotions and trauma symptoms before trauma is discussed directly. Ways to contain existing trauma memories for a time may be needed. Therapists should also be comfortable working with clients who have additional diagnoses, self-injure and have previously had multiple suicide attempts. These are all common in survivors of severe and prolonged trauma.
Secondly, it is true that many therapists cannot manage the severity of trauma that many people with Dissociative Identity Disorder, Other Specified Dissociative Disorder (DDNOS) or extreme abuse have experienced. It can be particularly difficult because both disorders are caused with very early repeated trauma, typically at pre-school age or younger. Consequences can be either the vicarious traumatization of the therapist, or denial and minimization because he/she can’t face the reality of it. Things that help include:
1. Looking for a therapist who has worked with similar disorders or trauma before, rather than someone mostly familiar with simple PTSD. E.g. try Find a Therapist on http://isst-d.org or Trauma / Dissociation professional organizations, and ask for recommendations if none are close by/or available for very long term work.
Therapists working with such complex clients need to be available for long term work, and willing to spend additional time on professional development. Therapists considering working with ritual abuse survivors can find valuable guidance in Dr Alison Miller’s book, Healing the Unimaginable (2012). Chapter 7 by survivor Stella Katz describes her ‘job’ in the cult, containing graphic descriptions of her role in torturing children, and explaining why she did this before she left the cult and ultimately healed. The ISST-D ritual abuse special interest group (for professionals) may be helpful.
Therapists who are suitable may be very difficult find, but some exist.
Myth No. 5: The therapist will judge me if I tell him or her what happened.
A trauma therapist’s role is to help guide and support someone who has experienced trauma, not to criticize or blame.
The DSM-5 diagnostic criteria for PTSD (criteria D) include distorted thinking surrounding the trauma resulting in self-blame, persistent shame, guilt, horror and/or anger, and negative beliefs about yourself, example ‘I am bad’. A therapist will be able to work through these with you, along with the additional symptoms of Complex PTSD and Dissociation.
All victims have been forced to perpetrate against others, usually since early childhood. All perpetrators are victims of severe abuse. Keeping this in mind is critical in treating survivors. Black-white or evil-good frameworks feed into survivors’ fears that they are irredeemably evil.
Dr Ellen P. Lacter, clinical psychologist
If you experienced ritual abuse then it is extremely likely that you were forced or tricked into doing things which horrify you and carry immense shame. You may have been forced to harm or kill others (forced perpetration) or have been forced to make impossible ‘choices’ such as choosing between having another child harmed or being harmed (double binds). These are common ways that abusive groups use to damage children and vulnerable adults – it is one way that abusers use to keep survivors silent, they often blame you or pretend ‘choice’ when you were not free choose to do normal childhood things or to leave. This is so awful and unbearable that it commonly creates different alter identities to do what abusers demand, an identity lacking empathy may be needed. Feeling intense guilt and shame now shows that you regret what happened, a sign that you are not truly ‘bad’.
Therapy should be able to help you understand why you acted as did, the effect of previous trauma on your mind, and help you reinterpret the trauma with an adult perspective.
Lastly, the no particular type of therapy is recommended above others for complex Dissociative Disorders, a good alliance between therapist and client leads to the most effective therapy. According to Kluft Dissociative Identity Disorder will not spontaneously resolve without treatment (a small number of cases of PTSD without a dissociative disorder do resolve treatment).
Dissociative Identity Disorder -Working with difficult and destructive alters
Originally posted on Discussing Dissociation:
I’m going to take a slight detour in the internal communication series and write a little about working with difficult alters. It is crucial to work with these internal parts, no matter how challenging and hopeless things seem in the beginning. Your therapy and healing will never be resolved unless you approach the issues connected with these difficult insiders.
And for that matter, the whole process of building a connection with these difficult, complicated insiders is based on building good communication skills with them, so in that sense, this post is still part of the internal communication series. System work, in whatever way it happens, is a critical part of internal communication and the overall healing journey for everyone with Dissociative Identity Disorder (DID/MPD).
Insiders may first appear in your therapy process being difficult – obstinate, obnoxious, aggressive, scary – and they may maintain destructive behaviors for a long time…
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You can’t patch a wounded soul with a band aid
New book looks at combats vets after conflict
Thank You for Your Service ― David Finkel
David Finkel, author of the New York Times bestselling book The Good Soldiers- a journalistic account of the lives of the men from the 2-16 infantry battalion on the front lines of Baghdad, emerges once again with a gripping addition to his work – Thank You for Your Service. This new book takes a look into the lives of soldiers who serve in Iraq, this time with a glimpse into what happens when they return home.
In Thank You for Your Service, Finkel meets with men from 2-16 to look at the way the war has affected their lives outside the battlefield. First person accounts of adjusting to life outside Iraq throw light on a new war fought by many soldiers, this time with themselves.
The wars of the 21st century have been well covered by journalists, reporters and…
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