Wednesday, January 27, 2010

How About a Little Compassion?

As I was standing in the grocery line this evening, I browsed through this week's notable and highly-esteemed news source, In Touch magazine. I flipped through some photos of plastic women in overpriced dresses and the essential who's cheating on who articles until I reached the REAL news that spills the beans... Kate Gosselin is stressed! The magazine featured a photo of Kate popping one of her little one's in the mouth, reportedly after scolding the youngster. I didn't read the entire article but saw blurbs about how Kate is falling apart; Kate is reaching a boiling point with the kids; Kate is caught again roughing up the kids, etc. I do not regularly write about celebrities or current news, but this issue really needs to be addressed.

Here's what I know-- Kate Gosselin is a single mother of eight children, due to a humiliating, heart-wrenching divorce that dominated television and magazine headlines for months. Even if the divorce had not been a very public one, it was still a divorce. I'm very grateful I have never had to experience divorce and pray to God I never have to, but having watched many friends, family, and clients go through this hellacious struggle, I know it ain't pretty! Divorce is just about one of the toughest events a person can possibly face, even if the divorce is from a cheating, abusive, or just plain obnoxious spouse. It is still an ending of everything you once believed your life was going to be. This is made all the more agonizing when there are young children involved. Can you imagine the agony when there are EIGHT young children involved?

I do not ever want to try to excuse poor or abusive parenting. My point is this-- why is Kate Gosselin being stressed considered news? An article that went something like this would really be news: "After a public and grueling divorce, single mother of eight, Kate Gosselin, demonstrates patience and profound tolerance with her children. While on an outing with the eight children, a frenzy of paparazzi snapped photos of the cheerful, well-rested Kate embracing her children and laughing kindly at their sibling squabbles." Of course this woman is stressed! She is alone, and I would imagine angry, scared, humiliated, and emotionally disoriented! She is a human being. She is not perfect. Her husband is across the country jet-setting with his latest 20-something love affair, while she is trying to manage their children. Before we cast stones, let us consider for one moment what it must feel like to be Kate Gosselin.

We need a kinder, gentler world where we reserve judgement. We are all human and, thus, prone to mistakes. I thank God my mistakes are not broadcast on the evening news. Can you imagine going through some of your most difficult times and having reporters capturing your entire experience? Heaven forbid you show circles under your eyes, take the kids to school without any make-up on, or publicly discipline a child who just publicly acted a fool. How different our world could be if, for even one day, we reported from a place of compassion and understanding, and refrained from reporting intrusively on other people's life-altering and personal moments. I think the best reporter of Kate's demeanor, feelings, and behavior would be Kate herself, if and when she is ever willing to share her story.

Monday, January 25, 2010

When PTSD goes AWOL (PTSD, part 2)

I think the most common and troubling PTSD I tend to see is in teens and/or adults who have experienced trauma (often multiple traumas) and has gone untreated for many years. Over the years they have developed a set of behaviors aimed at relieving their anxiety, which often includes various addictions. I also see that what began as PTSD symptoms (see previous post for a listing) has morphed into a post-traumatic stress personality. There may be minimal PTSD symptoms remaining years after the trauma(s) have occurred and in their place is an anxiety-ridden, angry monster in denial!

This is not to say that everyone who has ever experienced PTSD has his or her personality altered. And I also want to clarify that technically speaking, there is no such thing as post traumatic stress personality. This is just the name I have come up with to describe this type of personality. Typically this is a person who experienced multiple traumas, interwoven/complex traumas, or trauma that occurred repeatedly over a significant period of time. These traumas typically occurred at a young age, probably before age 8, and no one (including the child or adult in question ) has linked these past traumas to present day feelings. Usually these clients will say, "Oh, that happened a long time ago. I'm over it." This client has received no direct support, validation, or treatment related to the traumas they have experienced. The client has likely presented for treatment around age 17 due to frequent assaults on peers and teachers, chronic tension with a caregiver, inability to form attachments, and drug use. Usually these kids have been diagnosed with Attention Deficit Hyperactivity Disorder or possibly even Conduct Disorder (a disturbing diagnosis equivalent to Antisocial Personality Disorder for kids).

It is very common that these children or adults continue to have much chaos and drama in their lives, often at their own doing. Although they may no longer experience some of the acute symptoms of PTSD, the child or adult may engage in daily fights or sexual behavior that staves off the symptoms. The fighting or sexual behavior (or various other "delinquent" behaviors) have become reinforcing in themselves. They work! They keep people at a distance or get the desired attention. They provide immediate relief and maintain a certain level of required chaos. In some cases I see children or adults who seem to repeatedly re-create the original traumas. It is believed that many people do this in the desperate attempt to make right the past trauma. For example, a child who witnessed years of domestic violence may choose a violent partner as an adolescent, believing "my love will change him, this time it will be different, and I will feel BETTER." I also see adults who were victims of physical abuse grow up and have children who are abusive toward them. They have again become the victim within their own home. Another example is the child who was sexually abused who is highly sexualized as an adolescent and highly promiscuous. Particularly with sexual abuse, a child can have their internal sexual thermostat set to "high," and thus be easily aroused or sexually activated. We call this "sexually reactive."

If the adolescent or adult has developed an addiction in an effort to relieve PTSD, then treatment first has to deal with the addiction. This is very common. It is only natural that if you are experiencing intense anxiety, difficulty with relationships, sleep problems, or persistent hostility, you would want relief! Certainly you will get some quick relief from a drink or a hit of mary jane. Perhaps the addiction is one more subtle such as food, video games, relationships, or work. The addiction and the consequences of the addiction become troublesome themselves, wreaking havoc in the life of the addict. It becomes very difficult to address PTSD with someone who is afraid you're trying to take away their drug. Often clients are not open to the possibility of PTSD when the "drug" is keeping them from experiencing any anxiety. It is more likely that behavior and problems related to the increasingly dangerous addiction is what will lead this client into treatment.

Detox can be a piece of cake compared to the hard work of unraveling a PTSD personality. It is essential, however, that the client is willing to do the work of unraveling the knots of their personality if they want to prevent relapse in their addiction. I believe so many people go through drug treatment again and again, returning each time because they have never resolved the core issues of why they NEED to use to begin with. It is also very common that as clients go through drug treatment and "get clean," that they begin to experience years of repressed anxiety, grief, or anger. I'm sure this is probably not very encouraging to anyone who may be considering drug treatment, but wait! If you are at a place where you want to find true sobriety and serenity, the work of cleaning the old toxins from your soul is what will do the trick. We do not have to have our lives forever ruled by past events. We do not have to continue to suffer or engage in behaviors that stave off the pain. We may only be human, but we are strong enough to endure the work. Humans were created to both be hurt and to heal.

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Thursday, January 21, 2010

Post Traumatic Stress Disorder, Part 1

I've been thinking about the fact that I specialize in treating Post Traumatic Stress Disorder (PTSD) but have never written about it on my blog. I'm not sure why that is exactly. I think partly because I'm afraid that once I get started talking about it, I won't be able to stop! I also worry that I will begin to get long-winded and technical in my discussion of PTSD and lose many of my readers. I think it's important to begin my discussion on this and trust my ability to rein myself in as needed. Thank God for "edit posts" option. Here goes...

What is PTSD?
Well, first of all, for any of you who are unfamiliar with PTSD, let me define it for you. I'm going to define it according to "professional standards," but will put it in everyday terms. A traumatic event is one in which you fear that either yourself or another person is going to be seriously injured or killed. Many people face events like this but do not develop PTSD. Post-Traumatic Stress Disorder develops when, after the traumatic event is over, you continue to feel like you are still experiencing it. You may re-experience it through intrusive memories or flashbacks of the trauma. You may have nightmares of the event or at times literally feel in your body as if the event were happening right now. Also with PTSD you will go to extreme lengths to avoid situations or people that remind you of the trauma. It is common that we sometimes experience these types of symptoms immediately after a traumatic event, such as losing a loved one. The difference between a normal stress reaction and PTSD is that in a normal stress reaction, these symptoms tend to dissipate after one month. Also, in a normal stress reaction, you tend to maintain some level of control over your response and your life is not shattered irreversibly after the event. For example, you may face a horrifying event and be really shaken up about it for weeks afterward. Over the course of the next few months you find that you are able to leave your home, continue with work, and the anxiety does not rule your life. With PTSD, it is not uncommon for people to not experience any symptoms until months or years after the event occurred.

These are the technical criteria for PTSD:

1. A person is exposed to a traumatic event and has a response of intense fear, helplessness, or horror.

2. The traumatic event is persistently re-experienced (i.e., intrusive memories, flashbacks, nightmares, intense distress when exposed to cues or reminders of the trauma, etc.)

3. Persistent avoidance of people/situations related to the event (i.e., unwillingness to discuss the event, inability to recall details of the event or maybe extremely sharp memories of detail, withdrawal from everyday living and people in general)

4. Increased arousal, that is, "hyped-up" behavior-- you may be hyper-alert, on edge, on the watch, difficulty falling asleep or staying asleep, irritable/angry, difficulty concentrating, exaggerated startle response

5. The duration of these symptoms last longer than one month and cause "clinically significant distress or impairment in social, occupational, or other important areas of functioning."

How Does PTSD Happen?
Our brain is an intricate road map of neural pathways. There are happy and pleasant pathways in our brain and then there are some terrifying (though life-saving) pathways as well. An example of this is the fight or flight response. We've all most likely experienced having our fight or flight pathway being activated. Your heart rate accelerates. You go into survival mode. You may freeze up and feel unable to speak. You can feel every hair all over your entire body stand on end. Or you may turn into someone you don't recognize and display tremendous strength or ferocious aggression and fighting back. It's a critical part of our human make-up that we have this response. It keeps us alive in many terrifying situations and has for eons now.

Things go awry if this fight or flight response gets activated when there is not actually any terrifying event occurring. Someone with PTSD who has a history of physical abuse from a parent may be triggered into fight or flight years later when someone in the grocery store bumps into them roughly by accident. A child who was sexually abused in a bathroom may continue to experience intense anxiety about going to the bathroom years later. A war veteran who saw a friend killed in combat may continue to experience a feeling of hypervigilance and anxiety at the sound of loud trucks or booms. When someone has PTSD, their brain continues to categorize many events as "danger," when, in reality, there is no present danger. This categorization is not under control of the person and happens too quickly to be stopped many times. Once the woman in the grocery store was bumped by a stranger, the brain quickly perceived this event as life-threatening and activated a neural pathway of "high alert." Once the neural pathway is activated, it's like a loop with no end. She's driving on this pathway that just goes around and around with no exit.

As you can imagine, this is a miserable way to live. Often people with PTSD are going through their everyday living being triggered by voices, scents, perceived threats or sounds. These people are unaware themselves what is happening within them, not understanding what just triggered intense anger or anxiety. Many people with PTSD have no clue that they symptoms they are experiencing have anything at all to do with a traumatic event that likely occurred years ago. Or, if they do have some suspicion that their present anxiety is related to event(s) from the past, they are not fully aware of the extent to which their very personality is being shaped by fear and a need to avoid.

There Is Hope
PTSD does not have to be a life-long disorder. There are good and effective treatments for PTSD that are backed by research. The most effective treatments for PTSD aim to help people access helpful and positive neural pathways in the brain, when triggered, rather than falling into the fight or flight loop. This is what is being done in narrative and cognitive behavioral therapies that create positive and helpful pathways then, through repetition, link them with the traumatic event and triggers of the event. Eye Movement Desensitization and Reprocessing (EMDR) is a type of therapy that literally retrains the brain through the use of eye movements to access helpful networks in the brain. I love EMDR and use it often in my practice. It often brings immediate relief to those suffering with PTSD. I have personally seen countless children and adults suffering with PTSD go bravely through treatment and lose their diagnosis. I have watched these people begin to experience relief from symptoms within weeks and months of treatment. If you have PTSD, you do not have to suffer or self-medicate for relief (this is another blog post!). There is treatment available to help you. I believe the human mind wants to heal itself and sometimes it just gets stuck. It is good to seek the assistance of a trained professional to help the broken record get un-stuck and get you back on the right track.

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Thursday, January 14, 2010

On the Wheel Again

I guess I shouldn't be surprised, and, in fact, I should probably be really happy about this-- God has put me back on the potter's wheel again! Did I really begin to think maybe I was done? I've been fully conformed now into perfection. I don't need anymore work, Lord. Thanks, you can go work on somebody else now. Actually, I've been through much more painful times (see previous blog posts if you don't believe me). This one is pretty mild, so I won't complain!

I truly, wholly, and completely love INFORMATION. I love to read it, watch it, study it, and examine it from every single aspect until I feel absorbed by the "it." Then once I am full as a tick on information, I like to lounge back in the fatness of it and be giddy. I like to slop around in the abundance of information I can find on whatever the subject of the day might be, just like a pig finds glee in a rich gooey mud hole... oh, the joy! Once I get satiated on the information-gathering, then I begin to have the burning passion to disseminate. I feel very confident in my ability to take all the information I've gathered and digested, then disseminate it to others through words. I will talk, talk, talk about it; write, write, write about it. That's one of the reasons I had to start this blog was to have another outlet for my communication passion. I'm a teacher at heart and not ashamed of this wonderful gift God placed in me at birth. It's a sweet thing He and I share, and I love to show Him what His gift can do.

So, here's where the potter's wheel got rolled out on me... sometimes I need to keep my big mouth shut. WHAT?! Say it ain't so!! For the bulk of my life, God has been an encouraging and doting parent when it comes to my love for gathering information, organizing it, then sharing it with other people. Here lately, however, I'm hearing Him gently say to me, "Shhhhhhhh. Just be quiet for right now." Yesterday I finally had the insight that knowledge in itself is NOT wisdom. It's only one part of wisdom. For me, knowledge is related to the information I can talk about and do something about. Wisdom is related to what I don't talk about it and do nothing about. Knowledge is what I say, wisdom is what I don't say. If you're a communicator/teacher like me, you've probably encountered those moments when you excitedly share your new found insights and information with someone who you feel REALLY needs it, and the receiving party stares back at you with that blank, defended look. When I see that look, I usually don't stop talking. That look means I just need to find another way to make you understand! Ok, so you're not getting it, maybe I'll draw you a picture! Ok, you still don't get it, that's cool. I'll walk you through it step by step! Ok, you still don't get it. Let's just talk about it some more and I'll answer your questions. Still not getting it... ok, maybe I need to make this plain to you, since you're clearly a little dense!

I have a very hard time accepting it when someone is not receiving my information. Eventually, I will just force this on you, if I have to. I can get a little scrappy about it if I need to. I am from the hills and we know how to handle these things out behind woodsheds when needed. I'm starting to get it, however, that sometimes it's just not my place to share my knowledge with certain people. In fact, it is wise at times that I do not disseminate knowledge. I read this verse in Proverbs this morning and laughed out loud, "For the Lord gives wisdom, and from his mouth come knowledge and understanding." (Proverbs 2:6) It's funny and beautiful and just so simple! GOD gives the wisdom and the knowledge. I can share my wealth of knowledge 500 ways and some people won't get it, but when GOD disseminates it, they'll get it. Hey, I can accept that. I'll stay on the potter's wheel for awhile until this sinks in a little more. Then when He's done with me, maybe He'll be willing to impart to me how He got them to understand when I couldn't. I want to know that trick, too! Guess this means I'm not quite done spinning here.

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Tuesday, January 5, 2010

Believe? Not Sure I Can Go There

"But what if I don't believe in God?"
Long pause.
I don't know what to say to this but, "What?"

This is what someone asked me the other day-- someone in pain, someone desperately seeking recovery from addictions, someone just like me, you, and the rest of humanity. Who among us has never had, if not years, then moments of doubt about God? If it's never gotten miserable enough for you that your doubting self had to cry out in anger, "If there is a God in heaven, this would be a GREAT time to show up!!!"-- well, I guess I'd think you were lying.

I have my God, and I also have no desire to force my God on anyone else. The Higher Power is always The Higher Power regardless of whether or not I'm preaching it on every street corner or loudly protesting that MY God is the only one true God!!! The Higher Power is still The Higher Power and he will find you wherever you are just like he found me in some of my most unsavory places. I'm not worried about it. The 12 Step programs are spiritual programs. They hinge upon the hope and faith that there is a Higher Power and that this Higher Power can restore us to sanity (Step 2). We are encouraged to seek out and try to build a connection with a Higher Power (Step 11), and to trust there is a Higher Power that can care for us in a way that we cannot care for ourselves (Step 3).

Well, actually, I guess the best response to a recovering addict who says "but I don't believe in God," would be, "Great! You're on your way to recovery!" One of the founders of Alcoholics Anonymous defined addiction as a spiritual deficiency. Thus, all addicts have some level of disbelief in a Higher Power, at least in the acting out phases of their lives, when addiction is the God of their lives. Addicts are hurting people who just want to feel better. I sat with a beautiful teen-aged girl the other day, tears streaming from her sad brown eyes, while she gently stroked the fresh self-inflicted cuts from wrist to shoulder. She just wanted to feel better, and this time it took more cuts than ever before to finally get there. Because there is no secure thing or person to provide some outer evidence that she is loved and safe, these fresh cuts work for her to bring relief. For some it's a heavy dose of heroin, drinking until the pain stops, finding a man who brings love, or working into the wee hours every night so you don't have to think or feel anything. All these people just want to feel better and have found whatever outlet they can grasp onto to bring relief. There is no belief that some Higher Power could or even wants to do the job.

If you want to be free from addictions and you don't believe there is a force somewhere in this universe that is stronger, wiser, and has more resources than you, then how do you believe you will get better? Do you believe your addicted mind can heal your addicted mind? I really love how this is described in the "Big Book" for Sex and Love Addicts Anonymous, "We came to realize that this disease of sex and love addiction so subtly and thoroughly permeated our best-intentioned and most fervid plans to reform ourselves, that even our ability to think clearly was undermined. There could be no such thing as a self-powered cure. Too many of us had tried this and had failed repeatedly. It was not that our logic, motives or intents were wrong. Rather, our very ability to see the problem clearly, and our wishes to change ourselves, were themselves systematically distorted by the addiction. That part of our mind which at least intermittently recognized our sickness was itself not immune, and could not be solely relied upon to guide us to health." (The Basic Text for the Augustine Fellowship, Sex and Love Addicts Anonymous, p. 74).

There comes a time for addicts, if you're lucky, when life and the consequences of addiction have become torturous to the point of death without actually dying. It is at this point when we place our first toe on the path of recovery and a tiny flicker emerges within us. Within this tiny flicker is the realization I am totally powerless over this thing. For many of us, there were a few expletives before and after this revelation, but I'll spare you that here. When you really GET it, I am powerless, there might be a moment of intense panic or maybe relief. This is the beauty of recovery. It's like a computer program that, once it starts running, it has its own course that doesn't require my wisdom to keep it going. That tiny flicker of self-preservation within me that admits powerlessness is the same healthy flicker that naturally says, Well, if I have no control over this behavior, dear God, I have to believe there is something or someone in this universe that is willing to help me!

Hold on to whatever vague notion of a Higher Power you can conjure. It may feel ridiculous and assaulting against your reasoning, but believe it anyway. Just fake it, if you have to. Step 2 says, "We came to believe that a power greater than ourselves could restore us to sanity." We came there over time. We muddled it over, tinkered with it, or fantasized about it. We began to hope it with all our hearts, for our own sake and that of our loved ones. There has got to be some force out there stronger than me that can restore me. Day One of living out of this new belief looks like this-- turn your life and your will over to the care of this God, as you understand this God to be (Step 3). Whereas we would typically rise out of bed and begin living from our own sick will, Day One-- turn your will and your life over to the care of a Higher Power. If you make it through that sober, then congratulations, it's a good start! If you did not make it through Day One sober, yet you're still alive, congratulations, it's a good start! Day Two looks like this-- turn your will and your life over to the care of God as you understand God. Day Three-- turn your will and your life over to the care of God as you understand God. You will watch in wonder as this Higher Power does for you the work of healing that you could not do for yourself, and through this process, you are coming to believe.

There are many people struggling with addictions who also struggle with turning their lives over to a Higher Power. Too many of us have been abandoned, neglected, or abused by those in power over us and have vowed to never lose ourselves to another's power again. Isn't it ironic that the venoms of abuse, neglect, and abandonment created a fear of surrender? And that surrender itself is the cure to these venoms? If you don't believe there is a Higher Power, your Higher Power already knows why you don't and doesn't judge you for it. If you can surrender your precious life to life-altering dramas and chaos, drunks, drugs that kill, the needle, the bottle, or abusive relationships, then why not give a loving Higher Power a shot at it?

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Saturday, January 2, 2010

Leah in Love

Leah's womb swelled and pushed
seven times
seven children before she knew beyond
her head-- the pale infant
sucking at her breast had nothing
to give. She lost
another porcelain tooth and Jacob's
back was hard, cold as
the gray stone graves of fathers.

Wrinkled newborn babies did not cry his name,
only Leah.
They brought breath and
warm flesh to every unfulfilled
desire beating in her chest.
Larger and longer they came
seven times--
the space between husband and wife--
till they reached the length of
a self

where a woman could lie
perfectly along them, know
beyond her own head
who she really is.

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