Psych Central

Risking Connection After Trauma

By epower

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.

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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

One Heartbreaking Way Treatment Centers Incentivize Illness

By epower

Carrott.StickA few weeks ago, I had the privilege of teaching at an organization that is named a “treatment program” for addicted women who live there with their children.  I met with the staff in the chapel where the chairs were predictably lined up so that everyone looked at the back of everyone else’s head.  Soon, though, the chairs we had replaced the chairs with a bunch of square luncheon-like tables with seats pointing in at all of our faces. Now there was a place to put food, drink, papers, elbows.  Especially elbows.

The service providers wanted to know the causes of addiction: some believed addiction was a reflection of a woman’s character; others believed it was the product of the chemical soup in addicts’ brains, all called it an illness.  And they wanted to know how to treat these women’s illnesses – these women who with their children had all come to love the facility and the service providers along with it.  They wanted to know how to help these women struggling with the illness of addiction.

“So,” I asked, “this is a treatment program for women and their children, right?”

“Yes,” they said.

“And the women and their children love you, and love being here, right?”

“Yes,” they said proudly, “many of them come back often!”

“And to be here, receiving this love, they have to be in active addiction, correct?”

There was a long silence.

If a woman must be an addict to have a caring and supportive relationship, and if living somewhere where she can have that love includes the entry requirement of addiction, then these women must relapse in order to earn love, and you can see how the treatment program will always be a revolving door.  Does anybody see how (ahem…) crazy this is?

The program wants women and their children to come in, get clean, learn how to stay clean, and return to the community as examples of better health and healthier living.  This is the definition of “successful treatment“.  The paradox is that in the time women and their children are at the center, they form bonds they can’t find outside. A woman who is loved and cared for—and who must be addicted to access that love—is in a heck of a spot.  To give up addiction means to give up love.

So the women “get better,” leave the facility, leave the relationships they created, and then the pain of whatever happened to them that got them using in the first place returns in an environment where they are perhaps not as loved as they might have been in the “treatment program.”  What do you think happens then? Can it be anything but relapse?

So what’s the answer? Certainly it’s not to avoid forming loving relationships in treatment! No, the answer is dealing with trauma. Trauma is the driver that causes people to need relief.  When the world is too big and overwhelming, when the big people around you can’t help you find relief, you find whatever you can.  Dissociation, drugs, sex, work, money, pick something, anything that makes you feel better (or not feel at all).  When the goal of treatment is disconnection from a group where one experiences connection, love, and caring, the result is often relapse.

But if the goal of treatment is the real processing of the underlying trauma, then people struggling with addiction may be more equipped to find the connection they need in the world outside treatment. Only by equipping people with the skills to look beyond trauma can treatment programs prevent relapse.

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

Trauma or Brain Chemistry? What Science and Rick Warren Say About the Cause of Mental Illness

By epower
Pastor Rick Warren at Saddleback Church

Pastor Rick Warren at Saddleback Church

Last week, Rick Warren, author of “The Purpose Driven Life,” pastor of Saddleback Church in Orange County, CA, and whose son committed suicide, joined with the National Alliance on Mental Illness (NAMI) Orange County and the Catholic church to shine light on mental illness and the church.  God knows many churches need this light: churches of all traditions can be some of the meanest places for people who are struggling with depression, PTSD, addiction, dissociation or other disorders.

Unfortunately, Warren’s misguided comments show it’s going to take a brighter bulb to bring light into spaces in the church that are so dark when it comes to mental illness. For example, Warren explained to a person who had just finished speaking about his life with schizophrenia, “Your chemistry in your brain is not your character, and your illness is not your identity. ” Tell that to the guy’s employer, if he has one, or the people who want nothing to do with him because of his diagnosis.

There are two major schools of thought about the cause of mental illness – nature and nurture, or in this case brain chemistry versus a person’s history and environment. Of course, the brain chemistry culprit is the baby of Big Pharma, which is devoted to manufacturing drugs that are sometimes worse than the symptoms they seek to quell. NAMI also has an extensive history of promoting the “brain-based disorder” cause of mental illness. It’s easy to see how Rick Warren could find himself swept along at this conference to the point of removing mental illness completely from a person’s character: if mental illness is about chemistry in the brain, it’s not about the broken world we live in. And it’s easy to see how NAMI could do the same: if mental illness is a disorder of brain chemistry, there’s no blame on parents and families.

But no matter how comfortable it is, no matter how much Warren, Venn, NAMI or Big Pharma, or anyone wants it to be THE cause, it’s not.

The facts are clear: the majority of people in treatment for substance use have histories of childhood trauma.  And as many as 90% of the people receiving care in the public system have histories of childhood trauma, most notably abuse and neglect.   An even bigger truth is that there are lots of things in addition to abuse and neglect that overwhelm children—and parents – leading to what is frequently diagnosed as mental illness.

Let me be blunt about why I say this with such confidence.

My family moved twelve times before I was two because my father was a GI who was recalled and deployed before being separated from service.  He died of cancer not long after.  I was not quite three.  At four-ish,I had a rare disease that put me on phenobarbital for weeks on end to quiet flailing limbs, and I spent the time out of my body watching the priest at church deliver the Eucharist.  By the time I was six, my knees began to dislocate anytime anywhere. And even before my father died, there were already reports of my exceptional ability to become invisible – present but not seen or heard so as to keep things quiet – no matter what the cost was to me.

Did my brain—the wiring, the connections, the chemistry—change due to being overwhelmed by these traumas?  You betcha: the chemistry of my brain changed because of what happened.  But the what’s wrong (“bad chemistry”) came about as a result of what happened (“overwhelming events”).

And that, Pastor Rick, NAMI, and Bishop Vann, is something you desperately need to add to your beliefs.  Traumatic experiences before birth, after birth, growing up—all change how we respond to ourselves and others, and rewire the brain.  For generations.

There’s a whole body of Christians out here, and many people of other faiths, who are or have been diagnosed with mental illness and are disenfranchised because of their religion’s primary erroneous belief that brain chemistry alone shapes illness. It’s easy and it’s safe: when we settle for “chemistry in the brain” we can overlook so many things that Pastor Rick Warren and Bishop Kevin Venn would call sinful whether they are sins of omission or commission.

This perspective allows us to turn away from what is uncomfortable. And yet it continues to disregard the truths that a pill isn’t always the answer, that the easy culprit of chemical imbalance isn’t always at the root of illness, and that the messy lives we lead or the messy experiences into which we are thrown are so often at the root of a mental health diagnosis.  In any organization, the way in which we continue to turn towards health through prescription and practice reshapes our lives.

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

Bullying in Mental Health Care: Misuse of Authority and Power Can Trump Wellness

By epower

PowerYou can’t open a newspaper or turn on the radio without hearing about bullying in kids. It’s a form of violence that degrades the self, disconnects children from social networks, and often paralyzes their ability emotionally regulate.  No physical violence needs to occur to create these drastic consequences.  The emotional injury is enough.  What we see in the media is often the tragic end results: suicide or murder in an effort to stop the pain or get others to stop hurting you.  People do incredible things in an effort to “be” instead of being erased by meanness.  They either give up or get even.  A few have the good sense to leave and start over somewhere else—when they have the power, authority, and access to do so. But what about the longer term effects of bullying on kids who are now adults, or bullying that takes place between adults?

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Double Standard in Medication Compliance for Those Diagnosed with Mental Illness

By epower

MedicinesI have a friend who has diabetes.  When she doesn’t check her blood sugar or take her medication, people don’t say it’s because of her diabetes.  Another friend has hypertension.  When he doesn’t take his medication, people don’t say it’s because of his hypertension. But it’s a different story for my many friends and neighbors who take some form of psychotropic medication — if they don’t take their psychotropic medication, people assume the noncompliance is because of their mental illness.  Seriously?

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4 Tips to Avoid Excluding and Isolating People Affected by a Mental Health Diagnosis

By epower

Mental.IllnessA reader asked me last week why I focus so much on being sure to include everyone in the population of people diagnosed with mental illness, able to be diagnosed, or with a family member diagnosed. However uncomfortable it may be, the answer is simple:  it’s the truth. Nearly all of us are directly affected by mental illness.

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Trauma, Bush, and Broadening the Definition of PTSD (Without the “D”)

By epower

I Want YOU to Care About PTSD
Last week in the Dallas Morning News, staff writer Tom Benning wrote about Former President George W. Bush:“Bush, speaking at a summit he convened on veterans’ issues, said that the condition has been mislabeled as a ‘disorder’ and that calling it just ‘post-traumatic stress’ would go a long way in erasing the stigma that affects many vets.”

I think he’s right about that, although after 40 years of the “D” on the end of PTS, it may be hard to change. When the conversation changes from “something that happened” to someone, to “something that’s wrong” with them, stigma gets embedded in media and the public’s mind.  In this case news and entertainment associate PTSD with gun rampages, domestic violence, and other very bad behavior. It becomes “something that’s wrong” and of course there is stigma.

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Caseloads, Budgets, and Care: Pills Trump People When It Comes to Revenue

By epower

40+139 ChemistryHere’s what a typical workday looks like for an employee at a mental health agency: Eight hours minus two 15-minute breaks and a 30-minute lunch.  In most states, that leaves only seven hours for “value-added work.”  CPT codes allow the provider to bill between 38 and 52 minutes every hour, which doesn’t include documenting, scheduling, etc.

All I can say is that service providers had better be fast! And service recipients had better be ready to dish, do well, and dry up at minute 38 of a 45-minute appointment so you can talk about the next appointment, or at least close gracefully.  There is no time for crises, bathroom breaks, people who are late, hard times, celebration or the recovery time a provider requires to manage his or her inevitable vicarious trauma.

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The Clinician’s Illusion: How Mental/Behavioral Health Agencies Suggest and Reinforce Mental Illness

By epower

As a clinician, are you seeing a true cross-section of people who could be diagnosed with mental illness, or only those who need and seek your help?

It was 1995.  I was seated at a banquet table to receive an award for a set of training videos useful in helping people learn to associate (the complement of dissociation).  I’d had the idea that if dissociation was learned, association could be learned, too. After breaking the skill down into the requisite knowledge and skills, I created the ASk (Associative Skills) model.  Looking back, the production quality of the three videos we made makes me wince.  In any case, the conversation at the awards dinner kept gravitating toward the many people diagnosed with dissociative disorders the other attendees knew.  Most were described as hopeless, helpless and homeless within months of diagnosis and for years afterward.  I asked what they thought caused this. And as I remember it, these were some of the responses:

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6 Ways Agencies Can Reduce the Terror of Living as a Person with a Diagnosis of Mental Illness

By epower

Summer, English Bay, Vancouver. Does it Matter That it is Not Raining?....
There are a lot of people who think Martin Luther King’s greatest contribution to society was the “I Have a Dream” speech. I think it was something far more profound and important. Hamden Rice, in a brilliant blog on, said that Martin Luther King “ended the terror of living as a black, especially in the South.” He momentarily interrupted the times when blacks were afraid to be –simply be – because white people could go berserk at any moment over anything.

For many people living with a diagnosis of mental illness, this same terror resonates except it is not people of a certain color who might go berserk. It is anyone who has been assigned greater power, knowledge or authority than the person diagnosed, including media, law enforcement, ill equipped and overwhelmed caregivers, and many others.

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