June 2017

All posts from June 2017

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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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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

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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

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