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In his recent guest editorial, Richard McNally voices skepticism about the National Vietnam Veteran’s Readjustment Study (NVVRS) data reporting that over one-half of those who served in the Vietnam War have posttraumatic stress disorder (PTSD) or subclinical PTSD. Dr McNally is particularly skeptical because only 15% of soldiers served in combat units (1). He writes, “the mystery behind the discrepancy in numbers of those with the disease and of those in combat remains unsolved today” (4, p 815). He talks about bizarre facts and implies many, if not most, cases of PTSD are malingered or iatrogenic. Dr McNally ignores the obvious reality that when people are deployed to a war zone, exposure to trauma is not limited to members of combat units (2,3). At the Operational Trauma and Stress Support Centre of the Canadian Forces in Ottawa, we have assessed over 100 Canadian soldiers, many of whom have never been in combat units, who have experienced a range of horrific traumas and threats in places like Rwanda, Somalia, Bosnia, and Afghanistan. We must inform Dr McNally that, in real world practice, even cooks and clerks are affected when faced with death, genocide, ethnic cleansing, bombs, landmines, snipers, and suicide bombers ...One theory suggests that there is a conscious decision on the part of some individuals to deny trauma and its impact. Another suggests that some individuals may use dissociation or repression to block from consciousness what is quite obvious to those who listen to real-life patients." Cameron, C., & Heber, A. (2006). Re: Troubles in Traumatology, and Debunking Myths about Trauma and Memory/Reply: Troubles in Traumatology and Debunking Myths about Trauma and Memory. Canadian journal of psychiatry, 51(6), 402.
Colin Cameron
Traumas produce their disintegrating effects in proportion to their intensity, duration and repetition. (1909)
Pierre Janet
Our work calls on us to confront, with our patients and within ourselves, extraordinary human experiences. This confrontation is profoundly humbling in that at all times these experiences challenge the limits of our humanity and our view of the world...
John P. Wilson
EMDR is a bizarre and wondrous treatment and anybody who first hears about it, myself included, thinks this is pretty hokey and strange. It's something invented by Francine Shapiro who found that, if you move your eyes from side to side as you think about distressing memories, that the memories lose their power.And because of some experiences, both with myself, but even more with the patients of mine who told me about their experiences, I took a training in it. It turned out to be incredibly helpful. Then I did what's probably the largest NIH-funded study on EMDR. And we found that, of people with adult-onset traumas, a one-time trauma as an adult, that it had the best outcome of any treatment that has been published.What's intriguing about EMDR is both how well it works and the question is how it works and that got me into this dream stuff that I talked about earlier, and how it does not work through figuring things out and understanding things. But it activates some natural processes in the brain that's helped you to integrate these past memories.
Bessel A. van der Kolk
July 15, 1991Nita: My mother was a paragon of our neighborhood, People always come up to us with hugs, saying "You have the most wonderful mother." l'd think. “Don't you see what's going on in this house?” To this day, if somehow even in jest raises their hand to me, I will do this (raises hands to protect face and cowers) I cringe. Then they look at me like, what's your probem? You don't get that from a great childhood.
Sarah E. Olson
Trauma is any stressor that occurs in a sudden and forceful way and is experienced as overwhelming.
Stephanie S. Covington
In order to believe clients' accounts of trauma, you need to suspend any pre-conceived notions that you have about what is possible and impossible in human experience. As simple as they may sound, it may be difficult to do so.
Aphrodite Matsakis
TRAUMA STEALS YOUR VOICE People get so tired of asking you what's wrong and you've run out of nothings to tell them. You've tried and they've tried, but the words just turn to ashes every time they try to leave your mouth. They start as fire in the pit of your stomach, but come out in a puff of smoke. You are not you anymore. And you don't know how to fix this. The worst part is...you don't even know how to try.
nikitta gill
I became what I am today at the age of twelve, on a frigid overcast day in the winter of 1975. I remember the precise moment, crouching behind a crumbling mud wall, peeking into the alley near the frozen creek. That was a long time ago, but it’s wrong what they say about the past, I’ve learned, about how you can bury it. Because the past claws its way out. Looking back now, I realize I have been peeking into that deserted alley for the last twenty-six years.
Khaled Hosseini
Unlike simple stress, trauma changes your view of your life and yourself. It shatters your most basic assumptions about yourself and your world — “Life is good,” “I’m safe,” “People are kind,” “I can trust others,” “The future is likely to be good” — and replaces them with feelings like “The world is dangerous,” “I can’t win,” “I can’t trust other people,” or “There’s no hope.
Mark Goulston
Much, much later. when I am back home and being treated for Post Traumatic Stress Disorder (PTSD). I will be enabled to see what was going on in my mind immediately after 11 August.I am still capable of operating mechanically as a soldier in these following days. But operating mechanically as a soldier is now all I am capable of.Martin says he is worried about me. He says I have the thousand-yard stare'.Of course, I cannot see this stare. But by now we both have more than an idea what it means.So, among all the soldiers here, this is nothing to be ashamed of. But as it really does just go with the territory we find ourselves in. it is just as equally not a badge of h
Jake Wood
In the culture people talk about trauma as an event that happened a long time ago. But what trauma is, is the imprints that event has left on your mind and in your sensations... the discomfort you feel and the agitation you feel and the rage and the helplessness you feel right now.
Bessel A. van der Kolk
As you may already know, post-traumatic stress disorder is extremely complex. Each client has a unique, perhaps virtually unbelievable, set of experiences, and an almost equally set of reactions to those experiences.
Aphrodite Matsakis
However, if you do not believe your clients, they may sense your doubt and never fully trust you. As Bruce Goderez (1986), director of a PTSD inpatient unit says, "It is important for the clinician and counselor to be willing to be made a fool." In other words, it is better that you believe a client who is lying or distorting the truth than to disbelieve a hurting trauma survivor who may never seek help again if your attitude is one of disbelief or disdain. Even if that client were to continue in therapy, they would never fully trust you.
Aphrodite Matsakis
Always remember, if you have been diagnosed with PTSD, it is not a sign of weakness; rather, it is proof of your strength, because you have survived!
Michelle Templet
Denial and minimizing is often seen in genuine PTSD and, hence, should be a target of detection and measurement.
Harold V. Hall
The central mechanism of the avoidance mechanism of PTSD is the ego defense of denial
Frank M. Ochberg
There is clear evidence from internal investigations in the past that some raters actually see themselves as adversaries to veterans. If a claim can be minimized, then the government has saved money, regardless of the need of the veteran. Just recently, the press exposed an official e-mail from a high-level staff person who stated in essence that PTSD diagnosis was becoming too prevalent and offered ways to delay and deflect ratings in order to save the government money.
Taylor Armstrong
The SCID-D may be used to assess the nature and severity of dissociative symptoms in a variety of Axis I and II psychiatric disorders, including the Anxiety Disorders (such as Posttraumatic Stress Disorder [PTSD] and Acute Stress Disorder), Affective Disorders, Psychotic Disorders, Eating Disorders, and Personality Disorders.The SCID-D was developed to reduce variability in clinical diagnostic procedures and was designed for use with psychiatric patients as well as with nonpatients (community subjects or research subjects in primary care).
Marlene Steinberg
In talking with people that have experienced it, I learned that PTSD is something that a person in a position of authority sometimes thinks they’re not supposed to have. They don’t always have an avenue to personally address it or even discuss it.
Stana Katic
Treating Abuse Today (Tat), 3(4), pp. 26-33Freyd: I see what you're saying but people in psychology don't have a uniform agreement on this issue of the depth of -- I guess the term that was used at the conference was -- "robust repression."TAT: Well, Pamela, there's a whole lot of evidence that people dissociate traumatic things. What's interesting to me is how the concept of "dissociation" is side-stepped in favor of "repression." I don't think it's as much about repression as it is about traumatic amnesia and dissociation. That has been documented in a variety of trauma survivors. Army psychiatrists in the Second World War, for instance, documented that following battles, many soldiers had amnesia for the battles. Often, the memories wouldn't break through until much later when they were in psychotherapy.Freyd: But I think I mentioned Dr. Loren Pankratz. He is a psychologist who was studying veterans for post-traumatic stress in a Veterans Administration Hospital in Portland. They found some people who were admitted to Veteran's hospitals for postrraumatic stress in Vietnam who didn't serve in Vietnam. They found at least one patient who was being treated who wasn't even a veteran. Without external validation, we just can't know --TAT: -- Well, we have external validation in some of our cases.Freyd: In this field you're going to find people who have all levels of belief, understanding, experience with the area of repression. As I said before it's not an area in which there's any kind of uniform agreement in the field. The full notion of repression has a meaning within a psychoanalytic framework and it's got a meaning to people in everyday use and everyday language. What there is evidence for is that any kind of memory is reconstructed and reinterpreted. It has not been shown to be anything else. Memories are reconstructed and reinterpreted from fragments. Some memories are true and some memories are confabulated and some are downright false.TAT: It is certainly possible for in offender to dissociate a memory. It's possible that some of the people who call you could have done or witnessed some of the things they've been accused of -- maybe in an alcoholic black-out or in a dissociative state -- and truly not remember. I think that's very possible.Freyd: I would say that virtually anything is possible. But when the stories include murdering babies and breeding babies and some of the rather bizarre things that come up, it's mighty puzzling.TAT: I've treated adults with dissociative disorders who were both victimized and victimizers. I've seen previously repressed memories of my clients' earlier sexual offenses coming back to them in therapy. You guys seem to be saying, be skeptical if the person claims to have forgotten previously, especially if it is about something horrible. Should we be equally skeptical if someone says "I'm remembering that I perpetrated and I didn't remember before. It's been repressed for years and now it's surfacing because of therapy." I ask you, should we have the same degree of skepticism for this type of delayed-memory that you have for the other kind?Freyd: Does that happen?TAT: Oh, yes. A lot.
David L. Calof
This book appears at a time when public discussion of the common atrocities of sexual and domestic life has been made possible by the women’s movement, and when public discussion of the common atrocities of political life has been made possible by the movement for human rights. I expect the book to be controversial—first, because it is written from a feminist perspective; second, because it challenges established diagnostic concepts; but third and perhaps most importantly, because it speaks about horrible things, things that no one really wants to hear about.
Judith Lewis Herman
After a traumatic experience, the human system of self-preservation seems to go onto permanent alert, as if the danger might return at any moment.
Judith Lewis Herman
Blame is a Defense Against PowerlessnessBetrayal trauma changes you. You have endured a life-altering shock, and are likely living with PTSD symptoms— hypervigilance, flashbacks and bewilderment—with broken trust, with the inability to cope with many situations, and with the complete shut down of parts of your mind, including your ability to focus and regulate your emotions.Nevertheless, if you are unable to recognize the higher purpose in your pain, to forgive and forget and move on, you clearly have chosen to be addicted to your pain and must enjoy playing the victim.And the worst is, we are only too ready to agree with this assessment! Trauma victims commonly blame themselves. Blaming oneself for the shame of being a victim is recognized by trauma specialists as a defense against the extreme powerlessness we feel in the wake of a traumatic event. Self-blame continues the illusion of control shock destroys, but prevents us from the necessary working through of the traumatic feelings and memories to heal and recover.
Sandra Lee Dennis
The power we discover inside ourselves as we survive a life-threatening experience can be utilized equally well outside of crisis, too. I am, in every moment, capable of mustering the strength to survive again—or of tapping that strength in other good, productive, healthy ways.
Michele Rosenthal
As modern neurobiologists point out, the repetition of the traumatic experience in the flashbacks can be itself re-traumatizing; if not life-threatening, it is at least threatening to the chemical structure of the brain and can ultimately lead to deterioration. And this would also seem to explain the high suicide rate of survivor, for example, survivors of Vietnam.
Cathy Caruth
Dissociation is the common response of children to repetitive, overwhelming trauma and holds the untenable knowledge out of awareness. The losses and the emotions engendered by the assaults on soul and body cannot, however be held indefinitely. In the absence of effective restorative experiences, the reactions to trauma will find expression. As the child gets older, he will turn the rage in upon himself or act it out on others, else it all will turn into madness.
Judith Spencer
Traumatic events, by definition, overwhelm our ability to cope. When the mind becomes flooded with emotion, a circuit breaker is thrown that allows us to survive the experience fairly intact, that is, without becoming psychotic or frying out one of the brain centers. The cost of this blown circuit is emotion frozen within the body. In other words, we often unconsciously stop feeling our trauma partway into it, like a movie that is still going after the sound has been turned off. We cannot heal until we move fully through that trauma, including all the feelings of the event.
Susan Pease Banitt
The scientific study of suffering inevitably raises questions of causation, and with these, issues of blame and responsibility. Historically, doctors have highlighted predisposing vulnerability factors for developing PTSD, at the expense of recognizing the reality of their patients' experiences… This search for predisposing factors probably had its origins in the need to deny that all people can be stressed beyond endurance, rather than in solid scientific data; until recently such data were simply not available… When the issue of causation becomes a legitimate area of investigation, one is inevitably confronted with issues of man's inhumanity to man, with carelessness and callousness, with abrogation of responsibility, with manipulation and with failures to protect.
Bessel A. van der Kolk
Years ago I had realized I was blaming myself for it. People and doctors would tell me it wasn't my fault, but I couldn't “BELIEVE” it! Then I was talking to my friend Kieran and he explained to me in a way that I could PERCEIVE that I was not at fault. No one else could ever do that before, though many tried. Many, many people had tried to tell me it wasn't my fault, but I was convinced it was my fault because I was trying to cheer up my dad.
Robert Anthony
The most common emotional defense is avoidance (an ineffective coping skill for any stressor) as expressed through denial (e.g., "That wasn't really bad, I barely remember it").
Brian Luke Seaward
Early relational trauma results from the fact that we are often given more to experience in this life than we can bear to experience consciously. This problem has been around since the beginning of time, but it is especially acute in early childhood where, because of the immaturity of the psyche and/or brain, we are ill-equipped to metabolize our experience. An infant or young child who is abused, violated or seriously neglected by a caretaking adult is overwhelmed by intolerable affects that are impossible for it to metabolize, much less understand or even think about.
Donald Kalsched
Admitting the need for help may also compound the survivor's sense of defeat. The therapists Inger Agger and Soren Jensen, who work with political refugees, describe the case of K, a torture survivor with severe post-traumatic symptoms who adamantly insisted that he had no psychological problems: "K...did not understand why he was to talk with a therapist. His problems were medical: the reason why he did not sleep at night was due to the pain in his legs and feet. He was asked by the therapist...about his political background, and K told him that he was a Marxist and that he had read about Freud and he did not believe in any of that stuff: how could his pain go away by talking to a therapist?
Judith Lewis Herman
Acknowledgement of the prevalence and impact of trauma challenges psychological theories that localize dysfunction within the individual while ignoring the contribution of social forces on adjustment (Brett, 1996; Ross, 2000).
Rachel E. Goldsmith
Although psychoanalysts, including Freud, tended to acknowledge sexual trauma as tragic and harmful (Freud, 1905b, 1917), the subject seems to have been too awful to consider seriously in civilized company. One notable exception, Sandor Ferenczi, presented a paper entitled “Confusion of Tongues between the Adult and the Child: The Language of Tenderness and of Passion” (1955), to the Psychoanalytic Congress in 1932. In this presentation he talked about the helplessness of the child when confronted with an adult who uses the child’s vulnerability to gain sexual gratification. Ferenczi talked with more eloquence than any psychiatrist before him about the helplessness and terror experienced by children who were victims of interpersonal violence, and he introduced the critical concept that the predominant defense available to children so traumatized is “identification with aggressor.” The response of the psychoanalytic community seems to have been one of embarrassment, and the paper was not published in English until 1949, 17 years after Ferenczi’s death (Masson, 1984).
Matthew J. Friedman
Childhood trauma does not come in one single package.
Asa Don Brown
It is indeed the truth of the traumatic experience that forms the center of its psychopathology; it is not a pathology of falsehood or displacement of meaning, but of history itself” (p. 5)
Cathy Caruth
When he first said my diagnosis, I couldn't believe it. There must be another PTSD than post-traumatic stress disorder, I thought. I have only heard of war veterans who have served on the front lines and seen the horrors of battle being diagnosed with PTSD. I am a Beverly Hills housewife, not a soldier. I can't have PTSD. Well, I was wrong. Housewives can get PTSD, too, and yours, truly did.
Taylor Armstrong
In response to threat and injury, animals, including humans, execute biologically based, non-conscious action patterns that prepare them to meet the threat and defend themselves. The very structure of trauma, including activation, dissociation and freezing are based on the evolution of survival behaviors. When threatened or injured, all animals draw from a "library" of possible responses. We orient, dodge, duck, stiffen, brace, retract, fight, flee, freeze, collapse, etc. All of these coordinated responses are somatically based- they are things that the body does to protect and defend itself. It is when these orienting and defending responses are overwhelmed that we see trauma.The bodies of traumatized people portray "snapshots" of their unsuccessful attempts to defend themselves in the face of threat and injury. Trauma is a highly activated incomplete biological response to threat, frozen in time. For example, when we prepare to fight or to flee, muscles throughout our entire body are tensed in specific patterns of high energy readiness. When we are unable to complete the appropriate actions, we fail to discharge the tremendous energy generated by our survival preparations. This energy becomes fixed in specific patterns of neuromuscular readiness. The person then stays in a state of acute and then chronic arousal and dysfunction in the central nervous system. Traumatized people are not suffering from a disease in the normal sense of the word- they have become stuck in an aroused state. It is difficult if not impossible to function normally under these circumstances.
Peter A. Levine
So, what role does memory play in the understanding and treatment of trauma? There is a form of implicit memory that is profoundly unconscious and forms the basis for the imprint trauma leaves on the body/mind. The type of memory utilized in learning most physical activities (walking, riding a bike, skiing, etc.) is a form of implicit memory called procedural memory. Procedural or "body memories" are learned sequences of coordinated "motor acts" chained together into meaningful actions. You may not remember explicitly how and when you learned them, but, at the appropriate moment, they are (implicitly) "recalled" and mobilized (acted out) simultaneously. These memories (action patterns) are formed and orchestrated largely by involuntary structures in the cerebellum and basal ganglia.When a person is exposed to overwhelming stress, threat or injury, they develop a procedural memory. Trauma occurs when these implicit procedures are not neutralized. The failure to restore homeostasis is at the basis for the maladaptive and debilitating symptoms of trauma.
Peter A. Levine
One of the paradoxical and transformative aspects of implicit traumatic memory is that once it is accessed in a resourced way (through the felt sense), it, by its very nature, changes. Out of the shattered fragments of her deeply injured psyche, Jody discovered and nurtured a nascent, emergent self. From the ashes of the frantically activated, hypervigilant, frozen, traumatized girl of twenty-five years ago, Jody began to reorient to a new, less threatening world. Gradually she shaped into a more fluid, resilient, woman, coming to terms with the felt capacity to fiercely defend herself when necessary, and to surrender in quiet ecstasy.
Peter A. Levine
Victims are members of society whose problems represent the memory of suffering, rage, and pain in a world that longs to forget.
Bessel A. van der Kolk
In World War One, they called it shell shock. Second time around, they called it battle fatigue. After 'Nam, it was post-traumatic stress disorder.
Jan Karon
PTSD is a whole-body tragedy, an integral human event of enormous proportions with massive repercussions.
Susan Pease Banitt
The ORDINARY RESPONSE TO ATROCITIES is to banish them from consciousness. Certain violations of the social compact are too terrible to utter aloud: this is the meaning of the word unspeakable.Atrocities, however, refuse to be buried. Equally as powerful as the desire to deny atrocities is the conviction that denial does not work. Folk wisdom is filled with ghosts who refuse to rest in their graves until their stories are told. Murder will out. Remembering and telling the truth about terrible events are prerequisites both for the restoration of the social order and for the healing of individual victims.The conflict between the will to deny horrible events and the will to proclaim them aloud is the central dialectic of psychological trauma. People who have survived atrocities often tell their stories in a highly emotional, contradictory, and fragmented manner that undermines their credibility and thereby serves the twin imperatives of truth-telling and secrecy. When the truth is finally recognized, survivors can begin their recovery. But far too often secrecy prevails, and the story of the traumatic event surfaces not as a verbal narrative but as a symptom.The psychological distress symptoms of traumatized people simultaneously call attention to the existence of an unspeakable secret and deflect attention from it. This is most apparent in the way traumatized people alternate between feeling numb and reliving the event. The dialectic of trauma gives rise to complicated, sometimes uncanny alterations of consciousness, which George Orwell, one of the committed truth-tellers of our century, called "doublethink," and which mental health professionals, searching for calm, precise language, call "dissociation." It results in protean, dramatic, and often bizarre symptoms of hysteria which Freud recognized a century ago as disguised communications about sexual abuse in childhood. . . .
Judith Lewis Herman
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