The Fotophreak Model of the Week

“It is no measure of health to be well adjusted to a profoundly sick society.” Krishnamurti. This is a short story on the evolution of mental health.
In August 2014, the Islamic State of Iraq and Syria (ISIS), a terrorist organization, attacked the Yazidi’s ancestral homeland in northwestern Iraq. Among other atrocities, they abducted thousands of women and girls and traded many of them into sexual slavery. This led to cases of mental disorders among women and girls who survived. A high number of traumatic events were reported after the attack. More than 80% of girls and women, and almost all participants who were formerly enslaved, met criteria for a probable PTSD diagnosis. Trauma exposure and enslavement predicted poor mental health.

These children ended up living in a society where different individuals have gone through unique experiences since their childhood. This, in one way or the other affected their psychological well-being. In such a way it led to inabilities to cope up with day to day stress, low productivity at the work place and an individual being unable to contribute to his/her community.

Below is a series of excerpts in a conversation between Mr Gabe Howard; who is amental health speaker, writer and activist, Dr. Robert T Muller, a psychotherapist and Mr. Vincent M. Wales, a speculative fiction novelist.

TRAUMA SHOW TRANSCRIPT

Editor’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.

Narrator 1: Welcome to the Psych Central show, where each episode presents an in-depth look at issues from the field of psychology and mental health – with host Gabe Howard and co-host Vincent M. Wales.

Gabe Howard: Hello, everyone, and welcome to this week’s episode of the Psych Central Show Podcast. My name is Gabe Howard and I’m here with my fellow host Vincent M. Wales and our guest today is Dr. Robert T. Muller and he is the author of the psychotherapy book Trauma and the Struggle to Open Up: From Avoidance to Recovery and Growth, which focuses on healing from trauma. Robert welcome to the show.

Dr. Robert T. Muller: Very, very glad to be here.

Vincent M. Wales: We are glad to have you. So the word trauma is thrown around a lot these days. What do we really mean by that?

Dr. Robert T. Muller: Well, so there are different kinds of traumatic experiences but they all are based in the fact that something clear has happened to the person in the external world. Something that overwhelms their normal coping abilities and this can be a natural disaster, of course, but it can also be an event that occurs in the home. It could be something like physical or sexual abuse from a caregiver or various kinds of assault. And these are experiences that are overwhelming and most people who go through these overwhelming experiences don’t end up with post-traumatic stress disorder or various kinds of consequences. But a number of them do. and when they do and they’re left with these feelings of great distress and that’s what we refer to as trauma. The feelings that are left in the person that affect them, that affect their choices, that affect their relationships, that affect the way they engage in friendships following an overwhelming experience. And it’s hard, it’s very, very tough for people to deal with.

Gabe Howard: You know, outside of people who work in this field, the only really thing that they understand about trauma is post-traumatic stress disorder. That’s like the closest that the general public gets when you’re talking about trauma. Where does PTSD fit in? Can you kind of help people understand that?

Dr. Robert T. Muller: So the term PTSD we see in the psychiatric literature, and by PTSD we mean that the person has a disorder after a traumatic event post-traumatic stress disorder. So that means that they are continuing to suffer and by disorder we mean that their mental health is suffering and that they’re experiencing symptoms of re-experiencing the event, flashbacks. They may remember and have memory intrusions, memories of the event. And that’s very severe. They also have startle responses where they’re stressed very, very easily and by stress that can be very overwhelming stress. They also have problems with mood because they often feel depressed because of these traumatic experiences. And then finally they try to stay away from the things that remind them about whatever happened. So we see post-traumatic stress disorder in Vietnam vets, Gulf Wars vets, vets who’ve come back from Afghanistan, for sure. So we can also see these symptoms in victims of domestic violence and people who have been to experiences even who haven’t gone to war. So PTSD refers to the psychiatric language that’s used to describe the symptoms that many people have after a traumatic event. So that’s what it’s really meant by PTSD.

Gabe Howard: Thank you so much for that. And just to clarify, you can be traumatized and not develop PTSD. Is that correct?

Well you can be. Yeah. So here we get into a little bit of different words can sometimes mean similar things but when we talk about someone who is traumatized, they have all kinds of symptoms. They may not have exactly that cluster of things that I mentioned that we call PTSD but they’re going to have very similar experiences. There’s something called Complex PTSD and that’s a little bit different. Complex PTSD refers to people very often who have had traumatic events happen in childhood and in relationships. They feel betrayed by people who have who they thought were going to care for them the most. And when people have complex PTSD, very often what they have are huge problems in relationships. So, they’ve been hurt by somebody, they may feel tremendously abandoned by someone who they trusted. And then in life and in relationships, they now struggle to trust and they often really question other people. They question whether they can really trust them and they have a hard time with developing relationships because they feel scared. There are many feelings of fear that come over them. Shame, feelings of shame are common in complex PTSD. So, complex PTSD can take longer to heal than PTSD. If treatment for PTSD tends to be something more like six months to a year, treatment of complex PTSD can be two, three years, maybe even four years something like that. Pretty common. So those are some distinctions.

Vincent M. Wales: Thank you. Gabe and I are both very familiar with abandonment disorder and that sort of thing, attachment disorders. And there seems to be a very clear relation there with complex PTSD?

Dr. Robert T. Muller: For sure there is. There often is that for sure. There are feelings of abandonment very often and people with complex PTSD, and there are attachment problems. So, by attachment, that means that in times of distress they have difficulty turning to others who if you had a secure, what’s called a secure attachment, you might have an easier time turning to the people who feel, you know, should care about you. You know you might do that more easily; you might turn to them and ask for help and feel comfortable with that. But when people have what’s called an insecure attachment, and this is very common in complex PTSD, they have a great deal of difficulty turning to those people, who really you would think that they could turn to, their husbands, wives, their friends. They have a hard time turning to them because they feel very very frightened very often that people are going to just going to let them down. It’s a very very challenging disorder to treat. But it’s important for a therapist who works with people like this be what’s called trauma informed. Where they know about the effects of trauma so they can help people like this manage and find their way through their trauma.

Gabe Howard: Trauma informed care is something again, coming up more and more in mental health circles. Can you explain what trauma informed care means?

Dr. Robert T. Muller: So, there are many conditions that are related to trauma. It’s not just trauma therapists who come across people who have trauma histories. Family doctors very often will come across people who come in complaining of migraines, fibromyalgia, chronic fatigue, irritable bowel syndrome, immune system kind of disorders, stress related disorders. All of those are greatly exacerbated in people who have trauma histories. So it’s very important for family doctors. It’s very important for teachers, actually, to be trauma informed because you may see a kid in your class who appears like they have ADHD. They can’t sit still, they’re irritable, and that may also be a reaction to trauma. And I’m not saying that every person with all these disorders has a trauma history. I’m not saying that. Most of time people have migraines not because of trauma. But, if you do have a trauma history, all of those conditions can be greatly exacerbated. And so it’s very important for professionals who work interpersonally with people, family doctors, chiropractors, dentists, temporomandibular joint dysfunctions can be a symptom of trauma. Teachers, nurses, it’s very important for them to be trauma informed. For them to understand about the different manifestations of trauma. And there are many very often the immune system because of the stress of trauma the immune system has been affected. And that makes you more susceptible to a variety of different disorders. That’s why you need to be trauma informed.

Gabe Howard: Who should go to trauma therapy? I mean who is, I know that the answer might be anybody who is traumatized, but you know more specifically, like who is trauma therapy for exactly?

Dr. Robert T. Muller: So very often if you’re holding something that feels like it’s a huge burden that’s something to notice. So pay attention. Pay attention to this question. Ask yourself, am I carrying around a deep burden from years ago? Am I holding on to a secret? A secret that if other people knew, I would feel judged? I would feel that they would hate me? I would feel ashamed of those sorts of things? Am I being loyal to people who harm me? Those are all questions that you can ask yourself. I talk a little bit about this in Trauma and the Struggle to Open Up, the idea of how people, how many trauma symptoms develop, and these themes are really, really big. The themes of secrecy, feelings of betrayal, themes of loyalty to those who maybe you shouldn’t necessarily be so loyal to. But those are the kinds of questions to ask yourself. That is does the thought or some memory about something, does it make you feel sick? Does it make you feel like this feeling of I’m a bad person? You know, when I think about x y z that happened to me, I feel terrible guilt. How could I? How could I have done that? If you’re asking some questions like why me? Or if you’re asking questions of yourself like why not me? Why did X Y Z happen to my brother and not me? Those sorts of questions are very important questions that can be addressed in trauma therapy. And very often people have those questions in association with symptoms. When you know when you think about x y z that I just mentioned, maybe you feel depressed? Or maybe you feel self-loathing or disappointed in yourself? Why did I do that? Why didn’t I help my sister when such and such? When dad was, I don’t know, especially when Dad was drinking the way he was or mom was? Why didn’t I? So if you ask yourself those kinds of questions and you’re pained by it, that might be a sign that getting help, that talking to a therapist around your history is important. Because you’ve been trying to deal with this on your own for so long, and that can feel very lonely, it can feel very burdensome. And you don’t have to be alone in dealing with these things. That’s where I would think of therapy.

Vincent M. Wales: Right. We also have what we call post-traumatic growth. Is that just a fancy word for recovery or?

Dr. Robert T. Muller: Well no. No, it’s related to recovery. I mean people you hope that through trauma therapy people will get back to the way they were before you know they started really deteriorating. But it doesn’t exactly work that way. Recovery is a bit unpredictable. And what happens is as people start to talk about their problems, and start to talk about their history, they start to deal with things in a way that they never dealt with before. And so they start asking themselves questions like I mentioned. Why me? Why not me? Maybe those kinds of questions. Like what’s my place in the world after what happened to me? I thought my identity would be such and such but now I just don’t know. So when you start addressing questions like that, those kinds of questions lead to a re-evaluation of yourself. And so along with recovery, along with feeling better, along with removing, or removing and recovering from these psychiatric symptoms, that you really want to recover from, along with that comes a new understanding as you start to delve into issues from the past. And so that’s where there’s an opportunity for what’s called post-traumatic growth. That through the process of talking about and questioning and dealing with, there’s a reckoning. And that reckoning can help you grow in ways you may not have imagined. You may realize things about yourself that you hadn’t really thought of before. You know, like you may realize things like previously when I thought about such and such, I just felt guilt about what I did. But now, as I think about it now, actually, I was pretty strong the way I stood up to so and the way I did such and such. And I feel, I actually feel proud of myself for that. That may not sound like a big deal, but it can really feel like a big deal if you’ve felt ashamed of yourself for so long.

Gabe Howard: Do you do you think there’s a lot of people who are suffering from trauma who just don’t realize it? And how do we reach those people? Because you can’t exactly go ask for help if you don’t know that you are in need of help, right?

Dr. Robert T. Muller: Well this is why trauma education is so important. There’s getting to be more and more education about this. I have an online therapy and mental health magazine called The Trauma & Mental Health Report where you know my students and I, we publish articles and they’re very, very straightforward articles written for general consumption. They’re not academic heavy kinds of articles. And we’re trying to teach people about what happens in trauma. We have a lot of stories. You know for example, one of my favorite stories is A Corporal Speaks: 10 Questions for a Soldier Who Served in Afghanistan. And he tells his story. This corporal who came back and happened to be a Canadian, and who served alongside Americans. And many of the stories relate actually to the American soldiers who he served with. And it’s just a really interesting story. And these stories and so we’re trying to teach about how people struggle with these things in a way that the general public can start to learn. Not just people in mental health or whatever academics who know about this stuff, but that people in the general population can start to learn about this. And I think there’s greater interest. There’s more interest lately I’ve noticed in the topic of disassociation, people who have been through trauma, many of them dissociate. So they check out. They sort of go absent at times, you know. Why do they do this? Because sometimes. emotional trauma can be so overwhelming that they lose focus and lose attention to that and start thinking about some totally different things. And that allows them to feel okay. But you know that can be very very challenging when you dissociate a lot in your everyday life. So there’s a little bit more knowledge about that in the general public. I mean I’m noticing increasingly. So I think it’s, I think it’s really about education. And I think what you guys are doing here with this podcast and other people, other mental health podcasts, are becoming much more commonplace and people are asking these questions. There’s more stuff out there. I think that I think is the way to get people to learn about this stuff.

Be trauma informed

#ITS OKAY NOT TO BE OKAY

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