Who’s Afraid of the Mentally Ill? Better to Fear the “Frustrated Entitled”

By epower
Image: Flickr/JohnMcStravick

Image: Flickr/JohnMcStravick

Headline reads, “Attorney: Mental Health Could Factor in Dog Killings.”  The story is out of Reno, Nevada.  The man dismembered six—count them—six dogs.  “Mental Illness Cases Swamp Criminal Justice System,” the USA Today headline reads, describing a 2006 Justice Department study.  When a person diagnosed with mental illness commits a crime, it’s news. But when thousands of non-diagnosed people commit crimes, it’s not.

I get it: a diagnosis lets everyone without a diagnosis “explain” violent crimes – lets them blame these actions on people who are unlike themselves, dangerous “mentally ill” people who should be incarcerated. And of course instead of care (not cure, care) it’s easier to incarcerate folks (which usually makes them more, not less, mentally ill).

Why is it, I wonder, that only the people who commit mass murder  (more than 4 people in one rampage) in the U.S. are lumped in with “the mentally ill”?  Where are the domestic violence perpetrators? Or the common everyday maniacs who shoot down commercial airliners, blast each other to smithereens, lie in wait with pounds of plastic explosives strapped to their bodies? Who is served by withholding diagnostic labels from people—men (and women)—who beat or murder the people they say they love?  Or by leaving out those whose life work it is to exterminate a people, a race, a country?  Who does it help to distort the figures?

Not people who actually have a diagnosis ranging from everyday depression to the psychosis of grief or schizophrenia, I’ll tell you that. These people are lumped in with the violent mentally ill, layering stigma on top of what may already be challenge. The stigma of “the other” – of being included in a category that only includes the most perverse perpetrators – drives people in need of connection underground, isolating them even further.

In fact, the people I know with a mental health diagnosis are more likely to be victim than perpetrator. For example, the people I work with who provide services to people who escape intimate partner violence know their clients are called “victims” and “survivors” and the people they run from are called “perpetrators”—and the clients are often the ones who get a diagnosis.

Not the perpetrators, who are spoken of with contempt, scorn and fury but without diagnoses, labels that stigmatize and separate.  The perpetrator may go to work the next day as if nothing at all had happened, without a diagnosis, without the stigma, as if they had not just broken a child’s arm as he shielded his mother; as if they had not snapped a kitten’s neck in front of a little girl to show her what would happen if she talked to anyone about seeing her mom get beaten.

The terrible truth is that it is more common for people diagnosed with major mental illnesses to be vulnerable to assault and abuse than it is for these individuals to be prone to violence.  Sadly, we spend a lot of time taking in what the media tell us about mental illness instead of looking at the research.

For example, and I’ll say it again:  the research—solid research—indicates that at most 17 percent of violent crimes are committed by people diagnosed with mental illness.  That word “diagnosed” makes it easy to leave out the everyday maniac who belittles, berates, and beats his wife.  The parent who slams their child against the wall, and many others. And, again, researchers Charlotte and Harriet Childress, showed that 98 percent of the mass murderers were men between the ages of 23 and 40 who, contrary to the stereotype of being “mentally ill”, simply felt entitled to something they weren’t getting like women or attention.

Maybe violence isn’t the fault of the “the mentally ill.”  Maybe it’s the “frustrated entitled” who think they aren’t getting what they believe they deserve?  This could certainly include people with diagnoses, and it would umbrella the disgruntled religious, the bullied, the people wrestling with loss of privilege, those oppressed who snap—a much larger umbrella than the inaccurate “mentally ill.”

Unfortunately, if you say something loud enough and often enough, people start to believe without looking at the data.  We have been told that the “mentally ill” are responsible for the worst violent crimes so often and so loudly that we have come to believe it.

Due to this belief, a diagnosis of mental illness essentially means—for many—invisibility when it comes to opinion, believability, and place.  In fact, those diagnosed with mental illness are disallowed “normal” feelings of anger and rage – in a situation that evokes anger in “normal” people, the “mentally ill” are not allowed to feel this natural anger because something might happen.

Protesting doesn’t do much good either, because the well-meaning and frightened caretakers decide that a mentally ill person’s protests are a byproduct of the disease.  And getting upset must be an indication of being off one’s medication. Where is the right of a person diagnosed with mental illness to express natural, healthy anger? Where is their right to have this important emotion taken seriously? Is it any wonder the mentally ill snap a second time, sometimes more profoundly than the first?  The box in which they are kept is so very small…



5 Ways People Diagnosed With Mental Illness Can Become “Athletes of the Mind”

By epower

Mentally.IllI once spoke at Pike’s Peak Mental Health Center at the invitation of Dr. Honeybee Crandall, MD, to the staff working with people with severe and persistent mental illness. I asked how the patients behaved, how they functioned.  Not well, I was told, because they had mental illnesses. We assume people diagnosed with mental illness can’t do well, and we are perilously unwilling to let them—and the Finnish studies on Open Dialogue are good reminders of how we can do something different.  Looking at the mental health systems and practices other countries employ is helpful.  We get what we expect from people.  People with mental illness are expected to conform to others’ expectations and when they do, we say they’re “not doing well”. But what is doing well? Is it being “normal” (a setting on a dryer, as some say)? Instead, I know people with severe and persistent mental illness who defy the expectations and “do well” on their own terms: they hold jobs, they have friends, their lives are rich and full. I call these people athletes of the mind. Here are five keys to helping people diagnosed with mental illness find their own, unique paths to “doing well” in life:

1. Forget Insight

The old “anosgosnia” argument says we can’t get better because we don’t believe we are ill – without insight into the fact of our mental illness, we can’t change this mental illness. I’m not the only one saying it:  Insight doesn’t equal change; different behavior—even without insight—produces change.  Insight is the booby prize, and sometimes it can even lead to feelings much worse than the ones that preceded it.

2. Find the Courage to Look Past “Evidence-Based”

It takes a very long time for a practice or process to clear double-blind studies to earn the gold standard label of “evidence-based”.  Then, the number of people who become trained to deliver evidence-based practices grows at a desperately slow rate. This system of research and testing is poorly constructed to allow new ideas. Don’t get me wrong: evidence based practices are great for the populations on whom they are tested when there are people who are trained to use them properly. But keep in mind that most “evidence-based” practices are tested on small subpopulations of one culture—and the evidence is not there for many groups. They don’t work so well with indigenous populations because they are universally Western in thinking—which means a population in desperate need is left out. They haven’t been tested to determine the impact of gender differences. Give me a treatment that I will work for me, one that helps me learn to function the way people who do well function—and let’s define “do well” first.

3. Promote Relationships

Relationships—and their power—are hard to study with quantitative techniques.  Qualitative analysis is dismissed with the wave of a hand in the face of the scientific method, as if it can have no validity. And yet relationships are often the key ingredient in recovery and healing from mild to severe mental illness.  Risking Connection, Sidran Institute’s flagship model for healing after trauma, gave me words for this.  People who feel they are worthy of life, who have skills for managing and modulating feelings, and who have strong positive connections with others (people, animals, God, etc.) have far fewer crises.   And, of course, when sturdy relationships are never developed, missing, or ruptured, or when the situation exceeds the individual’s self-capacities, problematic behavior erupts. By focusing on helping parents have more fun with their children in meaningful ways, or providing what Bruce Perry calls “kind support” we can help people reduce mental illnesses and create relationships that give rise to better functioning. By the way, have you checked out the Goldfish Fun Zone from Pepperidge Farm? It’s a great free resource for family fun.

4. Embrace Differences

We assume that differences in how people process life mentally and emotionally are bad. Yet, we value people like Einstein, Schweitzer, Hawking—we value Joan Borysenko, Marsha Linehan, and Elyn Saks. John Nash won a Nobel Prize in economics. Each of these have very different mental processing styles. Here’s an example: take hearing voices – the dominant approach is to make the voices shut up, rather than wondering what the voices have to say, trying to befriend them. We do the same with visual and sensate experiences. Only a couple of organizations like Hearing Voices and the Open Dialogue Project consider people with unique mental abilities on equal footing with those who have majority mental experiences. Other cultures do, such as the spiritual traditions of the Dagora in Africa and some indigenous communities in the United States.

5. Practice New Thoughts, Feelings

Of the many people I know who have diagnoses of some sort, almost everyone wants to believe they can be happier, healthier, and more functional. They want to be “athletes of the mind.”  You don’t get there simply through awareness, or by trying to squish unique mental experiences into the small box of “normal”, or by using medications to change one’s brain chemistry without learning new behaviors to accompany it. The people who have a diagnosis and live well with it? Who function with aplomb? They get there by adopting different thoughts and feelings and practicing new ways of being. They are the athletes of the mind.

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“Assisted Outpatient Treatment” and Psychiatric Hospitalization is Costly, Ineffective and Dangerous

By epower

Mental.HealthLaws mandating court-ordered involuntary outpatient treatment and forced medication have been on the books for 20 years in some states. States soften the language, calling it Assisted Outpatient Treatment (AOT), intending the treatment for those diagnosed with sever bipolar disorder or schizophrenia. I can see how appropriate use could save money and lives. But the extension of coercive mental health care proposed by Rep. Tim Murphy (R., Pa.) goes too far – there is great danger in forced medication and psychiatric hospitalization. Murphy’s reactionary bill has the potential to trap the bodies and blunt the brains of hundreds of thousands of patients fairly or unfairly diagnosed with mental illness.

First let’s look at a quick cost-benefit. Larry Drain of Hopeworks Community has done the research. He says, in contrast to psychiatric hospitalization, that, “Peer support centers in Tennessee serve 3500 people a day for $4.5 million dollars and reduce hospitalization for 90% of the people who attend. A hospital bed costs $335K a year and doesn’t even reduce psychiatric hospitalization.” Do the math: hospitalizing people for psychiatric concerns is costly and one hospitalization does nothing to lower the risk of future hospitalizations (as opposed to peer support models that do reduce future hospitalizations).

The broader definition of effectiveness is another issue. Why do lawmakers assume that psychiatric hospitalization is helpful?  Anecdotally, I know very few people in the health care industry who think inpatient care is particularly effective.  And, any time the UNHRC issues bulletins in which mental health care is compared to torture, and class action suits about terrifying care in hospitals are brought and won, it seems as if legislators would get the point: restrictive care is expensive and doesn’t work!

From the patient perspective, almost no one wants hospitalization. It’s terrifying and often as injurious as it is helpful. It used to be a familiar threat for us kids when we misbehaved: “We’ll send you to Broughton!” From the patient perspective, “effective” means you get better.  And “better” means you can function outside of the hospital. Psychiatric hospitalization doesn’t make patients better.

The problem is assumptions and expectations. We are whipped in a frenzy to correlate mental illness with horrific violent behavior. For some, this unfair assumption justifies drugging people diagnosed with mental illness into stupor (or perhaps unintended violence as side effects of medication!). The expectation is that “those people” are violent, and that “those people” who are medicated are unable to function. Physical incarceration or mental incapacitation is preferable to the violence we expect. Who cares about human rights?

Representative Murphy probably can’t conceive of the value of healthy, strong, sustaining relationships that are honest and effective as healing in situations of mental illness.  If he could, he might see, as I do, that reducing the crises in mental health care is dependent on helping people increase their self-capacities (not making them dependent on medications or psychiatric incarceration).  Only by working with instead of against people diagnosed with mental illness to boost skills and coping mechanisms can we contain health care costs and create true effectiveness. By collaborating with instead of incarcerating this population of vibrant, worthwhile, challenged individuals we can see real change.

***

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PTSD Goes Beyond the Moment of Your Terror

By epower

LonelinessJune is PTSD awareness month. Whether the diagnosis is from medical events, natural disaster, accident, abuse, neglect, combat or exposure to trauma in other ways, PTSD is life changing.

I was diagnosed with PTSD in the very early 80s — not from combat — and the very real challenge was, then, to illuminate the discrimination against non-combat PTSD and in particular women with the disorder. At the time, PTSD was gaining acceptance as a legitimate diagnosis for combat veterans of Vietnam and Korea – no longer were they considered “shell shocked” but were starting to be seen as patients with a condition as real as cancer or Alzheimer’s.

Not so for people whose PTSD was generated by other sources, especially for women. Though our trauma was no less real (believe me), our diagnosis and especially the acceptance of this diagnosis as a “real” disease lagged far behind. For women in the 80s, PTSD was “all in our mind”. A veteran with PTSD engendered compassion; a woman with PTSD created doubt about our experience or even contempt for daring to put our trauma on par with that of those who served in the military.

While I have in many ways recovered—not without a few side trips along the way—the costs have been enormous. Work? I kept it together well enough to work and even complete graduate school, even during the most challenging years in the 90s. While I have the skills to deal with retirement, I certainly don’t have the necessary savings. Therapy for PTSD and associated concerns consumed over a quarter of a million out of pocket. Yes, out of pocket—not one penny through insurance. Physical health? Pretty good, but the changes we now know are correlated with chronic overwhelming events beginning in early childhood are starting to show.

And so in addition to the acute experience of PTSD there are the very real, poorly understood long-term consequences of PTSD that are just starting to rise from the water like Godzilla hitting the Tokyo shore. The first generation of diagnosed PTSD is aging – me and women like me along with the combat vets. Many of us have done hard work to put our lives back together in some fashion. While we are far more than we would have been without the trauma that caused the PTSD—post-traumatic growth is good—the ravages of trauma exact a price.

The roots of PTSD are in being chronically overwhelmed —and the earlier trauma began, without the ability to be soothed and re-regulated, without what can be called “kind support”, the greater the long term challenges. No matter the source, overwhelming events with which we cannot cope and from which there is no reprieve can create PTSD. And no matter the source, the acute experience of PTSD is only one side of the coin.

This June during PTSD Awareness Month, please join me in extending compassion and kind support to all those who diagnosed with PTSD. Whether they flutter like moths too close to the flame or they are experiencing the long-term effects of changed life possibilities and second-order health consequences, extend them your care.

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Image: SYED ALI WASIF via Compfight



DARPA Brain Implant Project: Mind Control Redux?

By epower

preparing (cc)A new $71 million program at the Defense Advanced Research Project Agency, or DARPA, working with Massachusetts General Hospital and UCSF, focuses on developing implants to place in the brain for the purpose of “treating depression, anxiety and symptoms of PTSD.”  If this doesn’t make the hair on the back of your neck stand up, it should. 

Or should it?  What do you think about brain implants?  Do you fear they will be forced on people, required of soldiers?  And if they work, does it matter?  When the symptoms of anxiety, depression or PTSD run your life, it seems like the obvious answer is no – the benefits may outweigh the risks.  I think even in light of potential cases of dramatic symptom reduction, the morality, development, rigor and ethics of brain implants deserve a closer look. I resonate with the comments of Carl Erik Fisher in the January/February 2014 Scientific American Mind in the article “Psychiatry’s New Surgeons.”

While brain implants in the non-defense sector show promise in treating such disorders as Parkinson’s, specializing them for the purpose of treating those conditions we call mental illness becomes a much riskier issue.  For example, when there’s problematic behavior—e.g. psychiatric symptoms—involved, who is the person bothered?  How does the problematic behavior help the person who’s expressing the behavior?  How do we avoid the risk of creating a mind-control nightmare the likes of which hasn’t been seen since the work of Dr. Ewen Cameron, recorded by Harvey Weinstein in “Psychiatry and the CIA”? (Not to seem doomsday or anything.)

To reduce the role of a behavior’s meaning is to challenge our notions of what it means to be fully human.  The risk of allowing others to control one’s behavior by manipulating devices implanted in the brain is even more challenging—and by no means do I wish to demean the positive impact of DBS, or Deep Brain Stimulation, or the other techniques involving brain implants that benefit people with medical problems

Our government has long history of asserting that its intention is one thing while covertly doing another.  Such secrecy is the nature of all hierarchies seeking to preserve themselves.  Even without a healthy dose of conspiracy theory added in, experiments with mind-altering drugs, giving people syphilis, and countless other instances of government misbehavior should raise the alarm on the well-meaning sound of fine-tuning a person’s brain to treat anxiety, depression and PTSD.

Specifically, evaluate the plusses and minuses of brain implants in light of the following:

 

1.       The overwhelming events, many beginning in early childhood, that are foundational in the development of anxiety and PTSD—and perhaps depression—are often accompanied by behavior that is both adaptive and problematic, and has meaning that needs to be found or made.  Simply extinguishing this behavior by changing the circuitry may eliminate the opportunity of appropriate meaning making.

2.       The risk of external control is possible, until and unless the device is a purely closed loop device that once set, has zero risk of malfunction or being adjusted by anyone—the user for a greater sense of wellbeing, the implanter for the purpose of control.

3.       The potential of capitalizing on emergent understandings of neuroplasticity is phenomenal.  We know the brain is adaptive, and it may be that anxiety, depression, and PTSD are adaptations that can be quickly and easily changed again with implanted devices.  This would reduce the time, trauma, and cost of healing.

4.       While it may reduce or eliminate symptoms, improve the wiring, no device can teach the user how to function as a person without anxiety, depression or PTSD—which is where health develops.

 

Promise and challenge: DARPA’s brain implant program offers both. I desperately hope that in this case, ethics keep pace with science.

– Please join me on Facebook to discuss personal and organizational trauma, healing, ethics, and innovation.

Image: Martin Fisch via Compfight



Oscar Pistorius: Blade Runner, Trauma Survivor, “Other”

By epower

PistoriusOscar Pistorius is known to many as Blade Runner – the man who rose to fame as an athlete running on curved blades for lower limbs in events for those with and without disabilities.  These days, the question is whether or not he has a mental illness that caused him to shoot his girlfriend as she was locked behind a bathroom door.

Perhaps the larger question is this: how does an understanding of trauma and disability culture affect framing of his situation? It does not bring Steenkamp back. It does not excuse abusive behavior in relationships, take the gun out of Pistorius’ hand, or make anything that happened okay. It does not let Pistorius off the hook, no matter the outcome. But it may raise curious questions.

It seems as if parents of children with disabilities raise their children in one of two ways: expecting the child to adapt to the world or the world to adapt to the child.  Pistorius and I were raised in the same manner – we were to disregard our disabilities.  Both of us were born with congenital defects. Mine led to frequent knee dislocations and multiple surgeries later in childhood along with behavioral health challenges; his resulted in double amputation at 11 months, just as he might have been about to learn to walk.  Temple Grandin, the woman who has autism and is acclaimed by Time Magazine as one of the”100 Most Influential People in the World,” was also raised in a family who said “you can” instead of “you can’t.”

This approach of dealing with visible and invisible disabilities in which we were people first taught us to constantly and forever adapt, to do things differently.  Expecting the world to adapt to the disabled child fosters pity and entitlement by placing the disability in the center of the child’s life at the expense of learning how to live in the world everyone else lives in.

Every parent does his or her best. And despite our parents’ protection, deep-seated terrors rooted in our disabilities remain.  Height, mobility, vision, strength – all play key roles in being able to protect oneself from harm.  To be taunted and have others take prosthetics or critical assistive technology of other sorts—glasses, braces, crutches, canes, hearing aids, walkers, speech boards, for example—and set them out of reach, or deliberately beyond reach? These actions make our vulnerability so much more profound. They evoke primal responses from deep within if the will to live is present, sometimes blinding terror, sometimes blinding rage. We learn—those of us who have some degree of self-respect—to both tolerate and shrug them off, tamping down the terror and rage, converting it to fuel for performance, gardening, something.

There is trauma associated with having a disability that is based on how our bodies work that is outside of the realm of the world of mental illness. Often when people can “get inside” our world they realize, painfully, that our reactions mimic the reactions that 90% of the people who are not hospitalized or even diagnosed would also have.

There is trauma for the parents and families that raise children with visible and invisible disabilities, and in some—such as Oscar Pistorius,’ based on the reports in the news—don’t make it. Something bad happens that causes a husbandless mum to sleep with a gun in her hand, while her son whose limbs are absent from below the knee sleeps nearby. Something awful must have happened for Oscar Pistorius, too.

He can’t undo the amputation of both legs when he was 11 months, the challenges his mum faced from his father, or the years of internal challenge—what has been labeled General Anxiety Disorder. Generalized Anxiety Disorder does not a murderer make. Nor an inherently violent person, contrary to the worries of many of the relatives of those who have disclosed their diagnosis, now calling it the “Oscar disease.”

Generalized Anxiety Disease makes worriers, not killers. Disability doesn’t either. But a man who is notably shorter without his prostheses, top heavy, balancing on his stumps in the dark of the night, and who is terrified? The adrenaline of vulnerability can cause murderous things to happen. The challenge of disability is not always what we can or can’t “do” but how we deal in the world when we are the “Other.”

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Inhale Relief: The Link Between Smoking and Mental Health

By epower

Cafe @ Trại Mát, 02/2014TIME Magazine recently reported on “The Weird Link Between E-Cigarettes and Mental Health Disorders”. When you think about it, the link is fairly intuitive (and proven by the ACE study): people, as it says “suffering from depression, anxiety, and other mental disorders”, are much likelier to smoke something.  In fact, the connection is so strong that, the study writes, “People suffering from mental disorders buy upwards of 50 percent of cigarettes sold in the U.S. annually.”

Continue reading… »



Trauma, Imagery, Remembrance and Healing

By epower

FireSometimes it’s easy to forget how far I have come.  Anyone with a history of trauma who is aware of its impact in their life might know what I mean.  It’s like this: there are a lot of sounds, noises, smells and sights that I can enjoy with great relish and gusto—even those that used to cause me to hold my breath and freeze internally. I love the smell of a good fire (though I still have to remind myself that this is “now” and not then).  When I hear sirens I can send up petitions for the safety of the people the first responders are going to care for.  When I feel either knee buckle just a little I can lock it, and avoid the avalanche of images and internal howlings that used to come with every unannounced dislocation.  When I need to visit an ailing friend or comfort someone in hospital, I can take a deep breath, center myself and be present for them instead of tremble and sweat and flee.

But not today.  Today my housemate was sharpening the lawn mower blade, using a hand-held electric grinder, and the noise took me places I could not be, times I did not want to remember.  The images were old and long gone, but were evoked by a noise so heinous I had to stop working on an overdue writing project and go to at least see what on earth was happening.  And when I walked in the old, dusty, relic of a garage and saw sparks flying amidst the old paper, dust, and other flammables, my housemate with his earbuds in, I really struggled.  I was, for a moment, in the fire.  Only for a moment, but there nonetheless.

Thank goodness I know how to breathe, self-soothe, and put the essential nanosecond of distance between stimulus and response.  Thank goodness I have been practicing a long time, working to make sure there is that distance between old primitive lizard-brain responses and what I know is more effective, more helpful, and preserving of relationship. The sound of the grinder had me wound up like a Chihuahua on go juice and without hard-won unlinking of traumatic stimulus and response, I would have been Pavlov’s poor dog, drooling itself into dehydration.

My housemate didn’t realize sparks can linger, catch fire hours later, lie waiting for enough air and fuel to fulfill their destiny of making fire.  Like a lot of young men, he’s used grinders in places like that a lot, without incident.  And he meant only good: to care for the ailing mower so he could make the yard beautiful.  It was my stuff, old terror, reminders of sounds that had nothing to do with him.  He has his own sounds and smells and sights to wrangle, and these were mine – mine that caused my eyeballs to pop out on springs and my eyebrows to crawl up my grizzled head, and the veins in my neck to bulge like garden hoses in that moment.

It was my stuff that gave me an opportunity to do everything I have practiced: slow down my pace, stretch my breathing, smile and unpucker.

He’s fine.  The garage is fine (the mower is still ailing, we are both sad to say).  Sparks did not fulfill their destiny this day.  He now has my portable bench to use outside the garage when he needs to grind things.  And I am grateful for his care and respect of our tools and our space.  That means a lot to me.  Seldom do you find a housemate of enough valor and compassion to be able to say to them, honestly, “I am frightened by this. It is dangerous to do this inside.  I have been in fires.  I have had people I love deeply die in fires.  And I can barely tolerate the noise of grinding because of it. It reminds me of things I cannot speak of. “

Even better, when they can say, “I am sorry. I did not mean to frighten you.  How can I help you feel happy again?”

Communities of care—your house, caring people, a neighborhood, even the self which, believe me, can be a community: these systems are either informed about or ignorant to the impact of traumatic events.  We talk about how big things scare us so badly we can’t sleep.  We talk about how good it is to have each other in this house.  How we know the other’s footfall coming in the door.  We have even changed, temporarily, which door we use to come and go to accommodate a robin who has built her nest now full of eggs atop the light fixture on the back door.  The front door has no tinkly bell on it, and I sleep with one ear awake, listening for when he comes in.  I know when he leaves early each day to go to work.

In a house whose occupants, neighbors, neighborhood is more trauma-responsive than some, peace returns more quickly and there are no leftovers, no saved stamps, no additional burdens added to anyone’s life.

By living held in this trauma-responsive system, our lives and the lives of those around us are lifted.  These ways of responding are vital, viral, and impact everything around us from far-flung people to the mirror neurons in our brains.

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5 Reasons We Struggle to be “Trauma Responsive” – And Why the Struggle Should Continue

By epower
Please Don't Tell Them I've Escaped

When we make people with a mental health diagnosis into the “Other” we fail to be trauma responsive.

I listened to her. She was young, an overnight worker in a congregate care facility.  She was in anguish, her voice tight with pain, as she described seeing another worker taser a youth who was upset, and then high-five a co-worker and say “Got another one!”  How could her organization claim to be trauma informed, she asked?  She said she knew better than to file a complaint, because the youth who was tasered had been labeled a problem, and wouldn’t be believed.

How indeed?  Trauma-informed is a buzzword right now.  Everyone wants on the bandwagon.  Some states even mandate trauma-informed care.  But it’s clear—trauma-informed isn’t trauma-responsive.

Even the United Nations Human Rights Council understands that we need to “walk the talk” and “practice what we preach.”  In 2013, the UN Special Rapporteur, Juan Mendez, delivered a stunning report that called for eliminating practices in mental health care that are tantamount to torture (including coercion and restraint).  Ask the kid that got tasered if you don’t understand the connection.

So why don’t we “walk the talk” and put what we know into practice to move from being trauma-informed to trauma-responsive?:

1.      Fear of “what might happen”

Because we have made people whose behavior reflects a history of trauma the “Other”, and have demonized these people, and because society’s barbaric and retraumatizing responses to people with trauma histories have often evoked behaviors that strongly reflect these trauma histories, society fears that “something might happen”.  In short, society considers people with trauma histories dangerous. I am pleased to say that “something did happen” in the 90s, when residents in a state psychiatric hospital sued saying they were getting worse instead of better, and ultimately out of that legal case came the model of care called Risking Connection. I remember sitting at a table to receive an award for work I’d done on helping dissociative people learn associative skills and one of the most significant figures in the field of trauma and dissociation asked me if I was pursuing my own integration.  “No,” I replied, “I’m pursuing better functioning, more cooperation, and quality of life.”  He leaned forward, “But aren’t you afraid something might happen in the future?” I knew him to be a Vietnam vet with a difficult combat history.  I thought a minute and replied, “If the people from whom I have learned how to be more functional have helped me effectively, my risks are as minimal as they are for you as a Vietnam vet”.

2.      “Power-over” is the time-tried way of responding to people whom we have deemed “less than”  

We are unaccustomed to affording respect, dignity, access, agency, and self-knowledge to people who are different or around whom we might feel uncomfortable.  We often make our way in this world by oppressing others overtly or covertly.  Add to that the fact there are few places where people are rewarded for practicing collaboration and consensus.  In the absence of skills to do it different, “power-over” is our fallback response.  Most of us can remember frustrated parents saying, “Because I said so!”

3.      Most payers focus on managing use instead of getting better

I am devoted to the notion that people’s functioning is paramount in mental health. This includes the mental health of people who provide services and all others who work in agencies. The third party payer system defines care as providing a set number of sessions or specific medications based on a diagnosis.  It’s as if the payer system has decided how many coats of paint a brightly-painted person needs in order to be recolored a nice neutral tone.  The third party decides that a good primer and at most three coats will cover purple and red  and so that’s what the system is paid to provide.  After all, the people who determine what folks need to “get better” are pretty sure it’s a recipe.   “Managing use” is about leveling payments and metering, not functioning.

4.      There’s less money in it, and it’s not as billable

Sandy Bloom’s book, Destroying Sanctuary, does a great job describing what happened when she started a trauma-informed and trauma-responsive unit: it didn’t make it.  Likewise, look at the demise of all the units addressing dissociative disorders – while they may not have been perfectly trauma-responsive, they were aware of the impacts of trauma (esp. child abuse, issues with attachment, and more), but meeting the needs of  the people they served wasn’t compatible with any existing business model.

5.      Organizational and cultural change takes generations and great effort

Even with all the resources of a major car manufacturer, GM’s culture change experiment, Saturn, lasted less than 50 years from idea to shuttering.  Yes, many of the concepts bled back into traditional GM, and I still can’t buy a new Saturn. I will tell you, as the third contractor hired in Saturn’s People Systems Training and Development group, the issues Saturn faced were the same as the ones outlined above.  Power over as a fallback position, managing to budget but not quality became the key, the new business model that wasn’t as immediately profitable and fear on both labor and management’s part about what might happen” all helped stop the change.

 

Any time a group chooses to start a cultural revolution, resistance is inevitable.  And it’s a good thing: resistance proves there’s substance to the concern. But as long as we systematically validate pathological oppression we will have trauma-informed, but not trauma-responsive systems. We will “know” but not “do”.

Yet as each of us develops and informs others about respect, dignity, choice, and helping people learn how to have these things, we will make progress one step by one step.   I see the degree to which people are convinced that we should increase coercive, restrictive mental health care in this country as evidence of a groundswell in support of the opposite.  I see the oppressed beginning to speak out en masse – I see the roots of a cultural revolution in mental health care.  Perhaps Juan Mendez will see his report enacted.  Perhaps the distraught service provider will see the tasers locked up.  Perhaps the young man who used the taser will overcome his use of power over relationship.  Perhaps the youth who was tasered will recover.

# # #

Elizabeth Power’s firm, EPower & Associates, is an authorized provider for Sidran Institute’s model, Risking Connection.® She helps organizations of all types (including faith communities) learn and adopt trauma responsive practices based on relational processes as a trainer, speaker, and consultant.

Image: Lotus Carroll via Compfight



Risking Connection After Trauma

By epower
Connection

ConnectionRisking connection is the most challenging task for people who have experienced trauma—that is, any event so overwhelming that it causes the inability to cope resets expectations for the world and can adjust your opinion of what people are capable of. Trauma can big “big” or “small,” and being overwhelmed is being overwhelmed. It’s subjective, because “it” (trauma) is measured by its impact on the person who experiences it. That varies hugely based on age, development, and all manner of factors.  But this is known: once disconnected by trauma, risking connection with others is incredibly challenging.

That’s because relationships are what help us learn how to be human.  They help us learn who responds to us how, and how to respond to ourselves, how to soothe when we are distressed.  When we are unable to do so, or when our brains get stuck in alarm states, life can seem like an anxiety-filled experience of stumbling from one panic to the next; the moment your brain registers threat, everything goes on alert.

In response, you do whatever you know to do if it appears there is no safety in sight.  Some of us fuzz up like the Halloween cat, our mask of fear making it look as if we are ready to take on the world.  Others take flight and leave our bodies behind.  (In this way, dissociation can be a wonderful gift.)  Some turn to drugs, drink, sex, work, or other things.  But no one stands their ground in the face of being overwhelmed without awful consequences to our body, brain, feelings.  It’s totally contrary to survival.

What we need is relationships.  We need to relearn how to assess levels and types of danger or safety or collaboration and health in other people.  We need to learn how to help our brains and bodies recover from being startled, perceiving threat.  We need places—with people in them– to practice doing things differently.  Relationships it allows us to be around people we think cope a little better than we think we do.  We need connections to others that are sturdy enough we can fuzz up like that cat, space out, reach for something—and then change our minds.  Do something different.  And still be connected, paying our dues for being human in ways that lift us up instead of tear us down.

Relational processes—how we are as we encounter each other—are the lifeblood of community, healing and hope. Every day, we take the risk and connect with others—or we end up living in isolation, deliberately working to make ourselves invisible to reduce the threats from being known and from our histories.

# # #

Elizabeth Power’s firm, EPower & Associates, is an authorized provider for Sidran Institute’s model, Risking Connection.® She helps organizations of all types (including faith communities) learn and adopt trauma responsive practices based on relational processes as a trainer, speaker, and consultant.

Image Credit: WhoLogWhy via Flickr cc License



 
 

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  • Harold A. Maio: One of the clearest articles I have read. Thank you, Harold A. Maio
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