June 2017

All posts from June 2017

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PTSD: not just for soldiers any more

It took decades for PTSD to be recognised in soldiers, so it really isn’t surprising that it took a few decades for it to be realised that soldiers aren’t the only ones who can suffer from it.

There are many different traumatic situations that can result in PTSD. After soldiers had finally been recognised as suffering from PTSD, it gradually began to be realised that women who had been in severely abusive relationships were suffering the same set of symptoms that soldiers were.

Victims of extreme domestic violence develop the same hyper-vigilance that soldiers on the combat field do, and will have nightmares, night terrors, flashbacks, triggers, dread that something awful is going to happen. They will actively avoid any place or activities that remind them of the abuse or that the abuser had forbidden while they were with him. They will be unable to stop their minds from spinning around in constant worry, unable to sleep, unable to concentrate. It is sadly more difficult for soldiers to get treatment and support than it is for women who are victims of domestic violence, and men who are victims of domestic violence can have a more difficult time getting help. It seems rather ironic that the first group to be acknowledged as suffering from a disorder that was thought of as “just for soldiers” is now left behind to a large degree in terms of treatment and support.

I have found soldiers to be very accepting of others who suffer from PTSD, even if theirs didn’t come from combat. In seems that to soldiers, the suffering, the wound, is what counts, not whether or not you were wearing a uniform when it happened. The camaraderie of soldiers is a unique bond of shared experience, but they also can share with others who experience PTSD in the same way that they do. I’ve never heard a soldier say that PTSD is “just for soldiers”. PTSD in victims of domestic violence is still very often misdiagnosed as depression due to the fact that PTSD is considered to be “just for soldiers” by many in the medical field. Doctors simply don’t recognise what they’re looking at in many cases if they aren’t looking at a soldier.

PTSD is a disability. It’s crippling in its intensity and scope, affecting every aspect of the person’s life, every breath she takes. Movement is restricted. Just as a soldier wouldn’t necessarily consider taking a day trip out to the battlefield where the bloodiest conflict took place, domestic violence victims will try to avoid any area or activities that remind them of the abuse. Flashbacks and triggers are a nightmare to live with. They can be terrifying and embarrassing, especially when the victim realises that no one is reacting to the situations in the same way she is, and that people think she’s lost the plot. Going out can be nearly impossible due to the fact that the brain is spinning in so many directions that she forgets where she is and ends up miles away from where she meant to go. She gets lost just walking down the street. It can be terrifying to look up and down a street that you know you’ve been down a million times, but at the same time not recognise it. She won’t be able to finish a thought, a sentence, a book or a film. Lack of sleep because her brain won’t stop spinning, as well as the fact that everything going on in her mind is worse at night, makes her life exhausting. Under such circumstances, social activities or employment are virtually impossible. Outbursts of anger that don’t make sense to the people around her, irritability, sudden sobbing or coldness that doesn’t make sense to the outsider make it very difficult for people to be around her, which makes her just as isolated as she was when she was with her abuser. In the case of soldiers, the war isn’t ever really over. This holds true for the victim of domestic violence, as well. Leaving the abuser doesn’t change anything. Her mind is stuck in that time period, and she is completely unaware of the passage of time. This of course means that for the soldier, life is stuck on the battlefield and never really moves forward. Each category of sufferer will experience the same symptoms, even though their nightmares and flashbacks will centre around different causes. The symptoms can be just as severe for each category of sufferer.

In addition to soldiers, people who can suffer from PTSD are victims of one-off terrorist events, victims of robberies, people who are involved in a car crash, pedestrians who have been hit by a car, or anyone who has suffered any kind of traumatic event. People who have been raped or who have been sexually abused as children can have PTSD, and in most of those cases, they won’t recognise that this is what they’re suffering from. PTSD for soldiers is readily recognised now, but many people who have been sexually abused as children do not realise that they’re suffering from PTSD themselves, and most will wait until they’re middle-aged before asking for help anyway due to the shame and secrecy around the entire subject.

The fact remains that even though PTSD isn’t just for soldiers, soldiers are the ones most likely to commit suicide because of it. For them, the severity of it can be overwhelming, the lack of help and support unendurable. They fight hard to get heard, to get a few pills thrown at them. The pills don’t work on their own, but a soldier can travel long distances trying to find support only to be put on waiting lists a mile long. Some turn to online groups in desperation for some kind of support, and though many groups are good, there is that risk of anonymity that can allow trolling by fakes who got in with an agenda in mind. The soldiers who returned home from the Vietnam War not only had their as yet unrecognised PTSD to contend with, they also had to endure abuse from people who were against the war and needed to punish the soldier for having gone. Some of the abuses that returning soldiers endured are unbelievably horrible, and the introduction of the internet didn’t help. It can be difficult to find someone to talk to who can handle whatever they have to say, and they can feel that no one who hasn’t been a soldier could really understand. This can be very isolating if they don’t have a support group readily available. Most of them do reach out to each other in a buddy system, but when the buddies are all suffering as well, it can be a downward spiral that seems to have no end. Soldiers who come home from the battlefield don’t always survive the war. The first group to be recognised as having PTSD has been left behind, and in many ways, has been failed.

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PTSD: Not just for soldiers, part two

In the late 1950s, the American government became curious about the affects of imprisonment and torture on POWs during WWII.

German war camps had exposed the prisoners of war to ruthless and relentless torture and labour, but the men were not broken. They kept fighting back, kept strong. However, those who were captured by the Chinese during the war were left so brainwashed that they could be left unguarded and would still feel that they couldn’t escape. What caused this difference in the behaviours of the prisoners? Biderman investigated and found that whereas the Germans had resorted to simple, brute force in every aspect of their war crimes, be it the concentration camps or the prisoner of war camps, the Chinese had utilised a more focused methodology of torture that wore the prisoners down and made them controllable. Biderman’s research produced what is known today as the Biderman Chart of Coercion.

In German camps, the prisoners were still able to stay together as a group and offer each other support. They strengthened one another, kept one another’s hope burning, and were able to withstand unbelievable torture, hard labour, and malnutrition. They were allowed to sleep, even during brutal marches, because their captors needed sleep. Their captors also didn’t understand something that the Chinese did. Group support and even small amounts of sleep kept the prisoners strong. United we stand, divided they fall. Even in the concentration camps, groups of Jews or groups of Jehovah’s Witnesses, or any other communities being imprisoned would stick together and encourage each other to stay alive and hope for rescue. The Chinese had a different way of dealing with prisoners. Biderman’s research showed that the Chinese had used different tactics to break the prisoners, and the first one was isolation.

Extended periods of isolation weakens a person’s ability to resist, and makes the victim dependent on the interrogator. Sleep deprivation was also used, as well as threats of death, threats of never being allowed to go free, threats that that the interrogation would never end, vague threats that would keep the prisoner guessing, and threats against the prisoner’s family. The interrogators would occasionally give the prisoner some small indulgence which would provide positive motivation for compliance and interrupt the adjustment to deprivation. The interrogators would suggest that they were omnipotent and that resistance was futile. They would use degradation to make resistance appear more damaging than giving in, and they would enforce trivial rules. The prisoners were most often eventually broken by this mental and emotional torture, while the prisoners of the German war camps could not be broken even with the most brutal beatings.

Modern researchers who were studying domestic violence and how it was affecting victims came to realise that these were the methods that perpetrators were very successfully using against their victims. The prison was their home instead of a war camp, but the methods were every bit as cruel….and at least as successful. Just as the soldiers had come back from the war broken, the victims of these coercive behaviours were also broken, and it isn’t hard to understand why. An abuser will use a number of related tactics to keep her focused on him and his demands so that he can have complete control. He can give her detailed instructions for doing impossible tasks while he’s away, telling her that he has a secret way of finding out if she followed the instructions or not, and that she’ll be punished if she doesn’t.

Sometimes, he’ll deliberately set her up to fail so that he has an excuse to punish her. He’ll keep her guessing as to what the punishment will be, but she knows that it will be horrible. He keeps her in a state of terror. If she is allowed to go out, he’ll do little things to make her know that he can be watching her, and she wouldn’t know it. Anything from a random text message to a bunch of flowers sent to the place where she’s supposed to be can show her that she’s under his watch. At night, he can pick an argument to keep her from sleeping, or sometimes wake her up to accuse her and argue with her over some imagined transgression. Eventually, she won’t be able to relax and sleep because she’ll be worried about what he might do next. He will occasionally buy her something nice in order to keep her obligated to him, and then tell her she’s ungrateful and horrid.

He might destroy the gift because he says that she didn’t deserve it after all. He might destroy things that she’s attached to and leave them for her to find later. There is always an unspoken threat in the air. She can come to feel that no matter where she goes, he can see what she’s doing, and she could be punished. He can pop up sometimes during the day just to show her that he knew where she would be and that he’s watching her. She then reaches the point where she’s looking over her shoulder all the time, waiting for him to show up. He gradually takes control of the finances and won’t let her have any access to money, no passport, nothing essential unless she has “earned” it or “deserves” it. He’s the one who decides if she has. He eventually has so much control over her that she has no other life and no other thought. She can’t risk falling asleep because he might do something to her while she’s asleep. She has to keep watching him to know what she might be up against from moment to moment. He could even reach up suddenly and slap her while they’re quietly watching telly, just to keep her on her guard. She can never relax. He isolates her from her family and friends, not letting her visit them or talk to them anymore unless he’s listening in.

He reads her emails, monitors her phone. He can even make threats against her family. The most common threat is that he will kill the children if she tries to get away. He will make her feel that anything the children suffer will be her fault, and that if she “makes him” kill the children by leaving him, it will be all her fault and no one will love her anymore. He will convince her that no one will ever have her again, and that he’s doing her a favour just by being with her. She will eventually have the same symptoms of PTSD as soldiers do who have been in frontline combat. She will be hyper-vigilant, will have nightmares, will be highly anxious, and will have constant dread that something awful is about to happen. Every moment of her life will be about surviving every moment of her life, and she is never allowed to let her guard down. This doesn’t end just because she managed to get away from him and to survive doing so. Her brain is locked into this never-ending spin. Just as it is for soldiers, where the battle never really ends, so it is for the victims of extreme domestic violence. They get stuck in that time frame, and can’t move out of it.

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PTSD: Mental health disorder or mental illness?

PTSD is classified as a mental health disorder. Mental health disorders are changes in an individual’s thinking and feeling that have significant impact on the ability to function in everyday life.

These changes can be the result of an external circumstance, such as trauma in the case of PTSD. Mental illness, on the other hand, has a biological basis, such as with schizophrenia. People tend to use the two terms interchangeably, which leads to stigma and confusion.

When people who have been the victims of domestic violence are diagnosed with anxieties, depression or PTSD as a mental health disorder, it can be very difficult for them to accept. When it’s referred to as mental illness, it’s easy to understand why they would be inclined to reject that completely. In the past, I’ve advised well-meaning people working with the NHS to put up information whilst leaving any reference to mental health off of the flyers, posters, etc. that they create in order to reach out to victims. I’ve had many victims protest to me that they are being told that they have mental health problems, and they insist that they don’t because “this was done to me”. The interchangeable use of the terms mental health disorder and mental illness have led to the popular understanding that if it’s damage caused by someone else’s actions, then it can’t be a mental health problem. Until the correct understanding is more universally known, there’s no point in trying to use the term mental health in your outreach programmes. It will continue to get rejected.

So, how do we approach the problem? I would suggest that it would be beneficial to approach it from the victim’s point of view. We can approach it from the perspective of their symptoms being an injury that has been inflicted on them by the behaviour that they’ve been subjected to over the long term. This is easier to accomplish with PTSD. Complex PTSD is recently being argued to be in actual fact a physical injury to the brain. In the cases of very significant PTSD or complex PTSD, there are sometimes “scars”, or residual symptoms that aren’t ever completely cured. With proper treatment by a well-qualified psychologist specialising in PTSD, the remaining symptoms will be very mild and quite easily managed. These occurrences would happen very infrequently, with most symptoms completely cured. This can be compared to a significant scar from major surgery, which even decades later will still sometimes be sensitive if touched. It will occasionally remind you that you once had surgery, but the memory won’t be traumatic anymore. Most people who suffer from PTSD will be completely cured, so the prognosis is usually quite good.

AVA (Against Violence and Abuse) are doing some amazing work in this area, training mental health professionals to be able to recognise and understand what’s happening for the victims. However, victims of very severe domestic violence don’t have places where they can go for support. I’ve found that support groups not affiliated with AVA but which claim to support victims of domestic violence will “silence” the victim whose stories are harrowing, telling him/her not to talk about the experiences because they would be too upsetting for the others in the group. Not being allowed to talk about it not only violates the reason they go to the group, but it also reverberates with echoes of the abuser telling them to be silent because no one would listen anyway, or that people would think they were mad. My domestic violence experiences were extreme, so I was told not to talk about my experiences because it would be too upsetting to the other women. Understandably, I decided to stop going. It didn’t seem to me that the domestic violence workers were able to really support the full range of experiences. I was told repeatedly by different professionals that my complex PTSD was the same as that suffered by soldiers who had been in front-line combat for years, so I asked about going to a soldiers’ support group. I was told by these same professionals that this wouldn’t be appropriate, either, because I hadn’t actually been in a war. That was actually a rather narrow view. The soldiers to whom I’ve spoken are actually very supportive and open to the suffering, regardless of where it came from. I was more welcomed by them to open up than by any area of the domestic violence programming. This leaves a gap that surely must be addressed at some point. Like soldiers, I had to fight for a few years to finally get the specialised help that I needed, and I still to this day know of no group where victims who had similar experiences to mine can go. For someone who is suffering from a mental health disorder to have nowhere to go and no one to turn to is surely not acceptable.

A person who has been subjected to severe experiences of domestic violence has no one to turn to. She doesn’t talk to anyone because she doesn’t believe that they would understand. Many of them wouldn’t. I had people ask me why I didn’t just stop having nightmares. I had a psychiatrist who was untrained in these things ask me, “but it’s over now….why don’t you just get over it?”. This really shows why the work that AVA do in training these professionals is so very vital. Mental health disorders, such as PTSD, have a significant impact on the daily lives of those who suffer from them, which is why they are classified as such. People who suffer from PTSD are unable to concentrate, sleep, read a book or finish a film. They are plagued with flashbacks, and triggers can cause them to melt down. People don’t understand what they’re going through, so when they have to call in sick from work, it can cause problems.

I’m qualified to work with PTSD, depression, and anxieties. I offer help to soldiers who need someone to talk to whilst awaiting any other treatment options that are on offer for them, and I offer help to victims of domestic violence and sexual assault. I can also work with people who have unresolved childhood traumas, or unexplained anger issues.

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