“Trauma Relevance to Advocacy”
RSVP Annual Conference
Friday, September 10, 2010
9:45 a.m. - 11:15 a.m.
Pat Risser
Mental Health Activist
Trauma Specialist
parisser@att.net
This presentation will be up within the next two weeks at:
http://www.patrisser.com
Opening Joke
The psychology instructor had just finished a
lecture on mental health and was giving an
oral test.
Speaking specifically about manic depression,
she asked, "How would you diagnose a patient
who walks back and forth screaming at the top
of his lungs one minute, then sits in a chair
weeping uncontrollably the next?"
Opening Joke
A young man in the rear raised his hand
and answered, "A basketball coach?"
Socrates Rule
If you think what you have
always thought,
You will feel what you have
always felt.
If you feel the way you have
always felt,
You will do what you have
always done.
If you do what you have
always done,
You will get what you have
always gotten.
What is Trauma?
In common, everyday language usage,
"trauma" simply means a highly stressful event.
Not all stress is trauma but, all trauma is stress.
"Trauma is the personal experience of
interpersonal violence, over the life span,
including sexual abuse, physical abuse, severe
neglect, loss, and/or the witnessing of violence,
terrorism, and disasters."
From “Criteria for Building a Trauma-Informed Mental Health Service System”
(2005), NASMHPD (National Association of State Mental Health Program Directors)
What is Trauma?
1. An event (physical, emotional, sexual,
psychological, neglect, loss)
2. Beyond normal (dis)stress
3. Unavoidable; no choice(s)
Beyond normal (dis)stress
1. Effects of trauma can be cumulative.
2. Human caused trauma often has a greater
impact.
3. There is both an objective and a subjective
experience of a traumatic event. It is the
subjective experience that determines the
impact the event will have on a person.
An Event
One-time incidents
Accidents
Natural disasters
Crimes
Surgeries
Deaths
Chronic or repetitive experiences
Child abuse
Neglect or enduring deprivation
Combat
Urban violence
Battering relationships
As traumatic as single-blow traumas are, the traumatic experiences that result in
the most serious problems are prolonged and repeated. Prolonged stressors,
deliberately inflicted by people, are far harder to bear than accidents or natural
disasters. The worst situation is when the trauma is caused deliberately in a
relationship with a person on whom the victim is dependent.
Traumatic Events
Being hospitalized
Being taken into custody
Being Tasered or stunned
Seclusion or restraints (isolation and bondage)
Having your bodily integrity violated (rape,
medication injection, ECT)
Being forced or regimented (removal of choices)
Being betrayed (lies)
Having people not believe you or treating you as if
you’re stupid
Being disrespected or bullied
Beyond “normal” (dis)tress
Just because a person is depressed, that doesn’t
mean they “have depression.”
True or False:
Every emotion is a disease and every disease has
a chemical “treatment.”
Feelings and emotions are not a brain disease,
disorder or illness. Not every feeling or emotion
needs a pill.
If it all was a simple and harmless as 'staying on
our meds...' then pigs would fly.
Unavoidable; no choice(s)
In the case of abuse, choices aren’t offered or
given. This can be due to the power dynamics of
oppression.
Those people or institutions in positions of power
place severe restriction or limitations on a
person or a group who is less powerful.
The individual or group is devalued, exploited
and deprived of rights, benefits, opportunities,
privileges, dignity – even their status as a equal
member of the human race.
Scope of the Problem
Up to 98 percent of public mental health clients diagnosed
with severe mental illness have trauma histories. (Mueser,
Goodman, Trumbetta, Rosenberg, Osher, Vidaver, Auciello
& Foy, 1998).
Individuals who have lived through multiple (4 or more)
instances of adverse childhood exposure, such as abuse
or neglect, are four to 12 times more likely to experience
alcoholism, drug abuse, depression, and suicide. Those
same individuals are at increased risk for other health risk
behaviors, including smoking, multiple sexual partners,
STDs, physical inactivity, and severe obesity. (Felitti, Anda,
Nordenberg, Williamson, Spitz, Edwards, Koss & Marks,
1998).
Scope of the Problem
80% of persons in psychiatric hospitals have
experienced physical and/or sexual abuse as
children.
90% of persons diagnosed with BPD or DID
have experienced some or several forms of
abuse/neglect as children.
BPD = Borderline Personality Disorder
DID = Dissociative Identity Disorder
People labeled with Mental Illness
Trauma can result in being diagnosed/labeled/
misdiagnosed with the following:
• Medical illness and somatization disorder
• Post Traumatic Stress Disorder (PTSD)
• Substance abuse (SA) or dependence
• Borderline Personality Disorder (BPD)
• Dissociative Identity Disorder (DID)
• Self-inflicted violence (SIV)
• Anxiety/panic disorder
• Depression
• Schizophrenia
• Bipolar Disorder
• Eating disorders
• Sexual promiscuity
• Anger management
• Behavioral problems
People labeled with Mental Illness
Frequently, symptoms of PTSD can mimic those of schizophrenia,
depression, and anxiety, among others. When mental health providers fail
to screen patients for a history of abuse or trauma, the provider may
misdiagnose the problem and use treatment that is inappropriate. If
trauma is not appropriately diagnosed and treated, treatment for the
person's psychiatric issues is usually ineffective.
Mentalist attitudes by providers can result in a mistaken belief about
“recovery” that a quiet client who causes no community disturbance is
deemed “improved” no matter how miserable or incapacitated they may
feel as a result of the “treatment.”
Mentalist Attitudes
“A series of recent studies consistently show that persons with
serious mental illnesses in the public mental health system die
sooner than other Americans, with an average age of death of 52.”
(Colton, C.W., Manderscheid, R.W. (2006) Congruencies in Increased Mortality Rates, Years of Potential
Life Lost, and Causes of Death Among Public Mental Health Clients in Eight States. Preventing Chronic
Disease. Vol. 3(2).)
“Adults with serious mental illness treated in public systems die
about 25 years earlier than Americans overall, a gap that's widened
since the early '90s when major mental disorders cut life spans by
10 to 15 years.”
Report from NASMHPD (National Association of State Mental Health Program Directors), May 7, 2007
“What does it mean that the life expectancy of persons with serious
mental illness in the United States is now shortening, in the context
of longer life expectancy among others in our society? It is
evidence of the gravest form of disparity and discrimination.”
Kenneth J. Gill, Ph.D., CPRP
Posttraumatic Growth
Posttraumatic Growth (PTG) is defined as positive change that
occurs (after the traumatic event) as a result of the struggle
with highly challenging life crises (trauma).
[http://en.wikipedia.org/wiki/Posttraumatic_growth]
This is NOT resilience or resistance which is the ability to cope
with the event. [Tedeshi, R.G., & Calhoun, L.G. (2004). Posttraumatic Growth: Conceptual
Foundation and Empirical Evidence. Philadelphia, PA: Lawrence Erlbaum Associates.]
Just because individuals experience growth does not mean
that they will not suffer. [Tedeschi, R. G., & Calhoun, L.G. (1995). Trauma and
Transformation: Growing in the Aftermath of Suffering. Thousand Oaks, CA: Sage.]
PTG does not imply that traumatic events are good.
Posttraumatic growth is not universal. It is not uncommon, but
neither does everybody who faces a traumatic event
experience growth. [Tedeshi, R.G., & Calhoun, L.G. (1996). The Posttraumatic Growth
Inventory: Measuring the Positive Legacy of Trauma. Journal of Traumatic Stress, 9. 455-471.]
Trauma-Informed Advocacy
Event(s) - Create places of safety and give the person your
presence; listen with your heart and mind fully engaged; be
present with dignity and respect; don’t medicalize, minimize,
trivialize, diagnose or get clinical. Don’t use the language of
the mental illness system; you’re not “cool” if you talk like
them (high-functioning).
Beyond “normal” - Believe the person and don’t discount
their reality; let the person tell their story; allow the person
their feelings (including anger, fear, terror, shock, horror,
rage, grief, sadness, disgust, and shame); stay grounded to
avoid overwhelm; offer the hope of recovery; be an
advocate; take care of yourself and role model wellness;
Promote posttraumatic growth.
Unavoidable - Offer choices; always ask permission; take
steps toward prevention of possible future trauma; believe in
“first, do no harm”; help find alternatives.
Safety
• Physical - Free of violence or threats
• Psychological - Free of helplessness, shame,
humiliation
• Social - Free of mentalist attitudes, isolation, lack
of empathy
• Moral - Free of discrimination, abuse of power,
arrogance, cruelty
• Cultural - Free of class distinctions and
background disrespect
• Medical - Free of harm and given choices based
on informed consent
Empowerment Scale
(for Services)
• Level One: The person does not make any substantive decisions about their
service.
• Level Two: The person does not make any substantive decisions about their
service, but is routinely informed about the decisions others will be making on their
behalf.
• Level Three: The person is routinely asked to give advice, (i.e. is consulted), by
the actual decision-makers, about his/her personal service decisions.
• Level Four: The person begins to routinely personally make a significant minority
of the substantive decisions that constitute their personal service. A significant
minority, in statistical terms, might range from 25%-45% of key decisions.
• Level Five: The person routinely begins to personally make a significant majority
of the substantive decisions that constitute their personal service. A significant
majority, in statistical terms, might range from 55%-90% of key decisions.
• Level Six: The person is so routinely making the vast majority of key decisions
that they simply do not any longer believe that they have a meaningful
empowerment issue.
Tribal wisdom of the Dakota Indians, passed on from generation to generation, says that,
"When you discover that you are riding a dead horse, the best strategy is to dismount.”
However, in State and Federal Government more advanced strategies are often employed
such as:
1) Buying a stronger whip to urge the horse onward.
2) Changing riders.
3) Appointing a committee to study the horse.
4) Arranging to visit other countries to see how other cultures ride dead horses.
5) Lowering standards so that dead horses can be included.
6) Reclassifying the dead horse as living impaired.
7) Hiring outside contractors to ride the dead horse.
8) Harnessing several dead horses together to increase speed.
9) Providing additional funding and/or training to increase the dead horse's performance.
10) Doing a productivity study to see if lighter riders would improve the dead horse's
performance.
11) Declaring that as the dead horse does not have to be fed, it is less costly, carries lower
overhead and therefore contributes substantially more to the bottom line of the economy than
do some other horses.
12) Rewriting the expected performance requirements for all horses.
13) Promoting the dead horse to a supervisory position.