Looking Through the Trauma Lens with Self- Reflection

Understanding trauma and its impact on survivors of domestic violence and sexual assault is not only a theoretical approach but has become an important component of the way we work.  When looking at our work through the trauma lens it is critical that we look both ways.

A lot of work has been done on understanding the impact of trauma on the survivor.  We know that trauma is going to affect her willingness to reach out and engage when trust has been broken on many levels.  We also have become aware of how concentration and focus can be negatively impacted, reducing her ability to make productive decisions and use resources effectively.  Trauma responses may make it difficult for her to follow-through with appointments or she may avoid circumstances that trigger her or make her feel disempowered.  

It is also important to look through the trauma lens at ourselves and understand how trauma impacts the way that we do our work.  If we are unaware of our own responses to trauma, our own personal experiences and our responses to others’ trauma, we may find ourselves being less than who we wish to be in our interactions with survivors.  Being judgmental and critical of the choices of others, distancing ourselves, or trying to fix rather than support may be signs that we are not managing our own feelings that have arisen due to the impact of trauma. 

As advocates, we have to work with staying present and supportive of survivors even when we feel uncomfortable with their way of being in the world.  It may also be necessary to step back at times to self-reflect on what we bring to the relationship.  Even though we are encouraged to maintain boundaries in our work with survivors, we are also developing a relationship with a survivor that can either help or hinder their healing process.  The following questions from Carole Warshaw at the National Center on Domestic Violence, Trauma and Mental Health can be used in supervision or as a self-tool in order to stretch ourselves and engage more fully in our relationship with the survivor. 

What is particularly challenging for you about this person or interaction? i.e. she never shows up, she is sarcastic, she may be lying to me, I don’t like the way she makes me feel.

What are you aware of feeling?  I get angry, I try to avoid contact with her, I find I want to take her and her child home with me, I feel manipulated, and I am overwhelmed

What are you feeling underneath? i.e. I feel incompetent, I am not a good advocate, I don’t like being angry, I feel special, I feel like I am being set up

What do you think she might be feeling? Is she trying to protect herself? Is she being triggered? Are there feelings coming up in our interactions that she is having trouble tolerating?

What do you find yourself wanting to say?  What is that inner voice saying that you would not want to hear yourself say aloud?

What could you say that might be more helpful?  What would be more a more empathic or empowering, trauma-responsive approach? 

What if this is not signed up for? This may mean that you need more self-care and supervision in order to determine what steps you need to take for yourself.

Taking a look at ourselves through the trauma lens may be difficult at first, but can lead to more meaningful interactions with survivors and others in our lives.  

Three Quick Book Reviews

It felt like Christmas morning in the Coalition office yesterday when I was handed a pile of books that I had ordered.  I have had a lot of requests for books that would be suitable to recommend to trauma survivors so I had set myself on a quest to meet the need.  Here are three books that would be helpful for anyone trying to understand their own trauma responses and how to move forward toward healing.

No Comfort Zone: Notes on Living with Post Traumatic Stress Disorder by Marla Handy, 2010, Mocassa Press, Madison, WI

No Comfort Zone is a personal story told with great insight and honesty.  Marla grew up with an abusive father and a mentally ill mother.  She suffered childhood abuse and medical trauma.  Ms. Handy is able to intertwine important information about PTSD with actual stories of trauma and healing.  I do have to warn the reader, though.  As in any book that relates stories of interpersonal violence there are descriptions that could be triggering to someone with a trauma history.  However, Marla’s ability to educate via her storytelling can provide a sense of comfort to someone who feels that she is alone in her pain.  If you recommend this to a trauma survivor please let her know who she can contact for support.

The Post-Traumatic Stress Disorder Sourcebook: A guide to healing, recovery, and growth; 2^nd Ed. by Glenn R. Schiraldi, PhD., 2009, McGraw-Hill Books, NY

I would definitely recommend this book to someone who has a lot of questions as to how trauma has impacted his/her life.  The explanations of the PTSD basics including memory and anxiety are easy to understand and could be quite useful to an advocate who is looking for more ways to explain how trauma impacts the brain.  Dr. Schiraldi also discusses the necessary foundations for healing from trauma – stabilization, safety, balance and taking care of one’s health.  There is also an in-depth section on how to manage symptoms (or trauma responses).  At the end of the book he talks about transitioning to a life with less impact from the trauma and more intimacy, meaning, spiritual growth. 

Dr. Ghiraldi also gives an overview of many treatment modes used by therapists in working with trauma survivors.  It is fairly comprehensive in its descriptions of the modalities but I find that he has omitted a number of mind-body therapies.  For a more comprehensive listing of treatment modalities I would recommend ----

Healing from Trauma:  A survivor’s guide to understanding your symptoms and reclaiming your life by Jasmin Lee Cori, M.S. LPC, 2008, Da Capo Press, Cambridge, MA

Jasmin Lee Cori provides most of the information that Dr. Ghiraldi does but in a different format.  I love a chapter that is titled “Shit Happens” while still taking very seriously the impact that certain incidents can have in a person’s life.  She also does an excellent job of describing the impact of trauma on the body using wonderful examples that may be less triggering that some other books.  She also describes the impact of trauma on the body and brain and describes some interventions and tools that can be used to decrease anxiety, flashbacks, and dissociation.  She includes interventions such as trigger point therapies,  somatic therapies, and hands-on therapies. 

I was also impressed that she provided a framework for how to find an appropriate therapist, what is expected, and how to know when a person should change therapists.  She also goes more in-depth into spirituality than the above books and provides a good framework for living a healthy life beyond trauma.

I hope this is helpful as you look to make recommendations or are looking for more information for yourself. 

Book Reviews: Blackout Girl – Growing Up and Drying Out in America and Picking Up the Pieces Without Picking Up

In September of this year I attended the Office of Victims of Crime conference in New Orleans, LA.  Jennifer Storm, Executive Director of the Victim/Witness Assistance Program in Harrisburg, PA was a keynote speaker on the last day.  Ms. Storm told her story of being raped at the age of twelve and her struggles to deal with the family dysfunction, alcoholism and drug addiction that followed.  Her story was inspiring and hopeful, a narrative of resilience and determination that not only tells of recovery against all odds, but gives hope for those young women who are still struggling with the effects of trauma and its aftermath.

In her book, Blackout Girl – Growing Up and Drying Out in America, Jennifer Storm goes into great detail about her experiences.  She describes the rape, the reaction of her parents and brothers, and her subsequent fall into substance abuse.  She spent many years struggling with addiction and continued to be re-victimized in many ways including being raped again and again and experiencing intimate partner violence.  Where her book excels is in her telling of her struggles in her relationships with her mother and brothers, and how she grows into an understanding of her sexuality.  Her story is inspiring and hopeful.

I have one caveat, however.  When I heard Ms. Storm’s story and saw her book, I had hoped that this would be one I could fully recommend.  I can only recommend it with caution.  Ms. Storm tells her story of rape and substance abuse in great detail.  If you are a person with a trauma and/or history of substance use the details in this book could be triggering. I would recommend that it be read only if you are engaged in some form of ongoing support or therapy and are engaging in self-care.  Advocates and survivors often tell me that they are looking for books to read about other women who have struggled with trauma and addiction. 

Jennifer Storm has also written a guidebook for persons in recovery who are working through victimization and the court process.  It is called Picking Up the Pieces Without Picking Up.  This book is about rebuilding one’s life after the impact of trauma.  It provides exercises for dealing with trauma and addiction, using some Twelve Step (of AA) language with a strong understanding of the impact of trauma.  It also includes a chapter on navigating the criminal justice system.  This guidebook would be a great adjunct to ongoing support through a local domestic violence or sexual assault program and/or in partnership with a recovery sponsor who is knowledgeable about trauma and recovery.

You can find out more about Jennifer Storm at www.jenniferstorm.com

Shock and Shame: The Legacy of "My Rebellious Years"

In honor of Domestic Violence Awareness month I have a guest blogger.  When I read this story by a survivor and victim advocate I asked if I could share it on the Open Doors to Safety blog and she graciously accepted.  Thank you, so much.  

Warning:  This story gives explicit details of abuse.  You may be triggered.  Please be sure to take care of yourself if this happens.  You can reach out to your local crisis center or national DV hotline for support.

 Recently, I went to court with a young girl.  Beautiful girl—delicately-featured, flawless pale skin—until I looked a little closer.  A hint of a bruise was emerging from her carefully made-up forehead, and a glance at her arms betrayed tracks of purpled fingerprints and handprints from wrists to biceps.  In the process of filling out a restraining order, she had to tell me about the hours-long assault that she endured. 

          She was trying to go to sleep—separately on the sofa, because he was yelling and screaming at her.  He ripped her off the sofa by her hair, grasped her arms, and pulled her along the hallway until he lost his grip.  She tried to crawl back into the living room, but he yanked her back by her hair or her arms—whatever he could gets his hands on—again and again.  She knew he intended to “have sex” with her, and she did not want to go into the bedroom; she kicked and screamed for him to stop.  He shoved her down to the floor, and kneeled on her neck, until—gasping for breath—she agreed to let him have “his way.”  When he let her up and she went running for the front door, he grabbed her again.  “My head smashed some mirrors in the house,” and he pushed her onto the bed…

          "Wait!  Can you back up a minute?  What did you say?!”

          "What?”

          “Do you mean that you ran your own head into mirrors in the house, or that he threw you head-first into mirrors in the house?  How many?”

           She had a vacant look about her, as if I should know the answer.  I thought I did, but I had to be sure.  “He chucked me into the hall mirror, and then I grabbed the bathroom door handle…he yanked my hands off, and pushed me into the bathroom sink, and I fell forward and hit my head on that mirror and it shattered, too.  I started feeling dizzy, and queasy, and I just couldn’t stop him.  He somehow managed to push and lift and shove me into the bedroom, and I fell into that mirror, too.  The mirror at the head of the bed.  I was screaming and crying for him to stop—I didn’t feel well—and he picked up a pillow and pushed it down over my face.  I tried to kick him off me, but he was too strong.  He said he wouldn’t take it off my face until I stopped screaming.  I felt vomit coming up my throat.  I think I passed out.  The last thing I remember was hearing my baby crying.”

          She was so matter-of-fact about all of this.  About the fact that he hadn’t taken her to the hospital, despite her symptoms of a concussion; about how he called his mother and asked for advice; about how he stood over her and made her call out of work for 24 hours, so that her injuries would have a chance to go away and he wouldn’t get “in trouble” if the police were called (in New Hampshire, the police can make an arrest without a warrant for domestic assault for up to 12 hours after the incident).  About how he took her car keys, her cell phone, then ripped the house phone from the wall so she couldn’t call for help.  The more this girl opened her mouth, the more nauseated I became.

          Her mother couldn’t understand the choices she made to keep going back.  She was frustrated.  She “couldn’t deal with this anymore,” and this better be her last time.

          This girl was about the same age as I was when I left “him,” under very similar circumstances.  My head didn’t break any mirrors that night, but the other similarities were too haunting.  And for the first time, I had a blinding flash of insight into my parent's despair as they watched me, time and time again, go back into a relationship with a less-than-manly louse who repeatedly put my life on the line.  They must have been frightened out of their minds.

          I called Mom to process this, and our conversation took us back to my sister’s wedding day, so many years ago, while I was still in high school.  My sister’s “thank-you” gift to her bridesmaids, including me, was a dainty string of pearls to wear with our gowns.  To any other woman, that gift would have been a welcome affirmation of a treasured friendship; to me, it represented danger.  “He” had given me a mizpah coin necklace for Valentine’s Day that year, with very strict instructions that if I ever took the necklace off, it would prove that I didn’t love him.  I was not to take it off.  Ever.

          My sister, on the other hand, was quite insistent that I wear her pearl string.  It was her wedding day; she had every right to expect that I would—as her bridesmaid—do as she wished.  But if you look closely at the wedding photo, there I am with the only solution I could fathom—wearing both.  After an entire morning of being bullied by “him” (because he saw me without the coin) and cajoled by her, the stress of “damned if I do, damned if I don’t” was emblazoned on my face.  A Mona Lisa smile was the best I could muster.

          After causing the morning’s drama, “he” was ordered to stay away from the wedding reception—and still he managed to ruin that day.  He parked outside the reception site, and garnered other wedding guests to retrieve me so that I could cater to his continuing demands.  Was I really going to let him go hungry while he waited outside for me?  Was I really going to dance, when he was outside miserable because he couldn’t be with me?  Was I really going to choose my family over him?  He reminded me there would be consequences to that—serious consequences.  I did the best I could to maintain a celebratory face for my sister and family, but I was close to cracking.

          With the wedding festivities over and my sister safely off on her honeymoon, somehow my parents conceded to letting “him” take me home.  The conversation in the car included his threats of killing my family, killing me, killing himself, because I chose them over him.  I cried so hard, retching, begging him to understand that it was my sister’s wedding day, and I had to be there for her.  He shoved a piece of paper into my hands and pushed me out of the car.  Utterly overwhelmed, I escaped from the pan into the fire; my parents were waiting inside to express their disgust at “his” behavior, my “rebelliousness,” the whole day’s events; and then they said the fateful words:

         “We’re done, Kath.  It’s time to choose—it’s ****, or us.  It’s him, or your family.”

          Stunned, emotionally eviscerated, I fled upstairs, stuffed what I could into whatever bag I could find, and trudged back down like a convict sentenced to death.  The note—unread—had dropped to my bedroom floor.  Grandma Grape stopped me at the bottom of the stairs.  “Ooh, but honey, where ya’ goin’?”  I choked out that I was staying with a friend, and, in her naiveté, she said, “Oh, fer neat!  See ya’ tomorrow!”  I hugged her tightly, and ran out the door, afraid of what would happen if I didn’t.  I left home, caught between a rock and a hard place, because my parents had forced me to make a choice, had given me an ultimatum.

          Never give a victim an ultimatum.  Not because they will make the “opposite” choice, but because you may not fully understand the implications of the choices she has to make.  My mother still calls this “my rebellious years.”  What she doesn’t understand is that I made a choice to save her life.

          I learned for the first time in our conversation this week what was in that note.  After I left our home on Orchard Street, never to return, my mother packed up the remainder of my belongings.  On the floor she found the note from “him,” a raging, ranting tirade about my selfishness and betrayal.  And a promise that if I didn’t shape up, someone was bound to die.  Maybe me, maybe him.  Or maybe my mom and dad.  But the only way to keep everyone safe was to choose him next time.

          The contents of the note are not surprising; those words were “his” theme song, really.  But what is utterly shocking to me was my mom’s response to that note:  she described hiding it under my mattress.  She said didn’t know what else to do with it.  And a few days later, when a family friend came over to finish helping Mom pack up my things, her friend found the note.  Matter-of-factly, my mom said to me, “and thank God she did.  She burned it.  I wouldn’t have wanted anyone else to see it.  Thank God she did that, she knew what to do with it.” 

          I was stunned.  It was clear that my mom had not even given a single thought to bringing that note to the police.  How could she not have?  And even now, I don’t even know if she showed my father or told him about it.  Was she afraid of what Dad would do if he found out?  Is that why she didn’t tell?  Or was it something deeper, bigger than that?  My mother disclosed to me many years ago that she witnessed my grandfather assault Grandma Grape, and I am sure that the expected response at that time was to sweep it under the rug, keep it quiet, that it was just “a family matter.”  But what is more astonishing to me is that, even though she KNOWS the choice I was faced with that night, she still believes I was acting out of rebellion, not love.   I felt that, rather than being frightened, my mother felt shame.  Right now, I don’t know what to do with that.

          But if you have a daughter whom you love, you NEED to know what to do.  The “symptoms” of a young girl experiencing dating violence are very similar to the symptoms of a teen who has chosen to use alcohol or drugs: 1) a change in personality, 2) becoming more secretive, 3) losing interest in friends or activities that used to be important, 4) slipping grades.  These signs are cries for help—DO NOT IGNORE THEM.  If you suspect that your child is in a relationship with a violent partner, tell her you love her, and are concerned about the changes you’re seeing.  Tell her if she does not feel safe, that you are here to help (and not judge or make decisions for her).  Give her the phone number for your local domestic violence or sexual assault crisis program so she has someone to talk to in confidence.  DO NOT GIVE HER AN ULTIMATUM.  Let her know you have every confidence in her ability to make good choices for herself, and you will be “there” for her when she is ready.  And then love her, unconditionally. 

          And if you find a @#$%^ note with specific threats to hurt her or someone she loves, take it to the police.  The years of pain you save may be hers—or your own. 

Empowerment and Success

The term “empowerment model” has long been the term used to describe how advocates work with domestic violence survivors.   It is the understanding that only the victim/survivor can be the expert on their life. Advocates provide information, support, resources and education so that victims can make the best choices possible to become safe and self-reliant.  We strongly believe that empowerment is not something we give to the survivor.  Instead, it is something that is intrinsic to the survivor and it is our task to help the person find and expand their personal power.

When a woman comes to a crisis center for assistance in changing her life, she is often unaware that she has any power at all in her life.  Through the use of power and control, the abuser has diminished her belief in herself and her capacity for growth.

If we truly believe that empowerment is something that exists within each person, what then is the role of the advocate?  In the same way that a sapling has the capacity within to become a full grown tree, a survivor contains the capacity to be a strong woman.  However, without proper nourishment and support, that sapling may struggle and be less protected from the elements.  The job of the advocate is to provide the support, resources and education to encourage the growth of the individual into a woman who has power and control over her life. 

Support takes different forms during the progression from being under the power and control of the abuser to being in control of one’s own life.  When we plant a seedling, we may provide ground stakes and support lines to help the tree stand tall until its root system has expanded deep into the soil and taken hold.  Later, we slowly loosen that support as the tree is ready to stand on its own.  Too often we worry about disempowering a woman and remove the support too early or we smother her for fear that she may make a decision that will harm her or her children. 

In many ways, our definition of success has changed over the years.  The definition of success has increasingly been defined by funders so that we are mandated to worry more about moving a person along quickly to find transitional or permanent housing, a job, etc., rather than focusing on Judith Herman’s (see Trauma and Recovery) first stage of recovery from trauma – safety and stabilization.  This is not to say that housing and employment are not valuable and necessary.  However, we tend to lose focus on the need to allow time for the person to feel safe and stable enough to be able to reduce her trauma responses and make informed rational decisions rather than emotional reactive decisions.

Because of the need to provide good outcomes to funders or other interested parties (or for other reasons), we may find ourselves looking at a person who is seeking shelter or other supports and asking “will this person be successful in our program?”  The question we should be asking is “do we have what this person needs to be successful and, if not, can we find the resources to provide it?”  Even if the resources the person may seem to need (i.e. mental health, substance abuse, housing, etc.) are not initially available, are we able to provide the support the person needs in order to feel safe and stable? Assumptions made at the start of a person’s contact with a program about her capacity for success can be self-fulfilling prophecies.  Which outcome would you rather assume?

It also becomes imperative that we take a look at our definition of success.  If success means a linear progression from abuse to safety to independence, we may be setting ourselves up for perceived failure.  Understanding that success may be more of a process of small successes and setbacks rather than a straight shot to a successful event can lessen the pressure we place on a trauma survivor and reduce our own burn out and compassion fatigue. 

When I was first working as a shelter director back in the mid 90’s there was a woman, Bonnie, in the program who had come to us seeking shelter and an opportunity to engage in substance abuse services.  She was 43 years old and had been drinking steadily since the age of 13 and had been victimized as a child and an adult.  She stayed in the shelter for three months and then left on her own.  At first I felt that not only had she failed at maintaining her sobriety and safety, but that we had failed her.  Fortunately, my mentor at that time reminded me that we had given Bonnie three months of safety, sobriety and community that she had never experienced before.  It was not the success I was hoping for, but it was a success none-the-less.  Many people would have looked at Bonnie’s history and judged her as being at risk of failing the program.  However, Bonnie left the program with more information than she had when she came in.  She also knew she could return at any time. 

Trauma survivors are also very tuned into our attitudes and expectations.  If a trauma survivors senses that we are unable to see them as individuals capable of success, they will meet those expectations or fight against them. It is important that we find ways to take care of ourselves and challenge our own assumptions about people so that we can reflect an attitude of support and an expectation of success that supports rather than questions a survivor’s abilities. 

“You Should Be Over It by Now”

These seven words can extend the experience of grief, guilt and shame of many survivors of sexual assault and other types of trauma.  Unfortunately, these words are often said by someone that the survivor looks to for support such as a family member or mental health professional.  Childhood sexual assault survivors have told me of instances when they were expected to engage in family activities that include the perpetrator of their abuse because the family feels “it is all in the past and you should forgive and forget.”

This refusal to accept the ongoing impact of the abuse in a person’s life can increase the shame, guilt, and sense of loneliness and isolation that a survivor feels. 

According to researchers Koss and Harvey (1991), “victims of sexual assault show very high distress levels within the first week that peak in severity by approximately 3 weeks postassault.  The distress then continues at a high level for the next month but begins to improve by 2 to 3 months.  After 3 months, rape victims do not differ from nonvictims on most symptom{s}” (p. 57).  However, even though these levels of distress will gradually diminish there are long term effects that can impact the life of the victim.  Women who have been sexually assaulted are more likely than others to experience a lifetime prevalence of clinical depression, addiction to drugs or alcohol, anxiety disorders, and post traumatic stress disorder.  (Koss & Harvey 1991 as quoted by End Violence Against Women International).

Trauma survivors may be also be experiencing long term effects of grief.  A trauma survivor is no longer the same person that he/she was before the assault took place.  The world no longer feels safe and the impact of the assault changes the persons physically, emotionally, and spiritually.  Experiencing grief at the loss of the pre-trauma person is a normal response to the horrific event.

Many victims have fewer episodes of reliving the assault as time goes by.  However, there comes a point in the recovery process where they realize they are not able to simply “get over” the trauma as easily as they originally thought.  This may be due to a crisis that floods the person with memories or (as noted above) contact with the perpetrator or someone who looks like the perpetrator. 

Many of the women that I have worked with find that their recovery from the trauma is impacted by the validation or lack of validation by important people in their life.  If a family member denies that sexual assault occurred against a young child or teen, that victim often feels as if the family has colluded with the perpetrator and/or blames the victim for any disruption to the family.  The victim then learns to suppress their emotions often leading to drug or alcohol abuse, depression, and anxiety.

When a trauma survivor asks me how long it will take to “get over” what has happened, I respond by letting them know it will take as long as it takes.  Some days will be better than others and eventually the good days will number more than the bad days.  However, the event or series of events will always be with them.  I encourage survivors to find ways to be in contact with other survivors so they know they are not alone, but I still want them to feel validated in their uniqueness.  No one likes to be told (as one woman recently related to me) that the rest of the world has problems, too.  Yes, the rest of the world has problems, too, but this woman just wanted her family member to acknowledge her pain. 

Being able to move on does not mean getting over.  The impact of the abuse will always be there.  Eventually the person does become stronger at the broken places and can transform the pain.  However, no one can predict how or when that happens.

Citations are from Victim Impact: How Do Sexual Assault Victims Respond? And How Can Law Enforcement and Other Community Professional Respond Successfully? By  Kimberly A. Lonsway, PhD and Sergeant Joanne Archambault (Ret.), May 2007, www.evawintl.org

Book Review – Strong at the Broken Places – Building Resiliency in Survivors of Trauma by Linda T. Sanford (Neari Press, 2005)

I was really surprised to find this book.  Originally published in 1990, it was two years ahead of Judith Herman’s book, Trauma and Recovery, and well ahead of its time in discussing the long term impact of childhood trauma. 

This book is full of stories from survivors of trauma and how they were able to find their inner capacity to heal and overcome the preconceptions and stigma often associated with childhood survivors.  Linda Sanfield discusses and debunks the three most harmful theories associated with childhood survivors: 1) childhood survivors grow up to be offenders; 2) victims develop learned helplessness; and 3) victims identify with their aggressor in order to gain mastery of the trauma.  Her studies, statistical analysis, and interviews tell a much different story of hope and recovery, of inner resilience, and the ability to learn lessons from one’s childhood in order to be empowered in the present.

While some of the stories may trigger trauma responses in some readers, it is still a valuable book for survivors who are searching for stories about other people who have experienced childhood trauma.  The stories tell of the abuse but also of the recovery.  The writer also explains the trauma response in a way that trauma survivors will be able identify and understand.

The chapter “Human Doings: Survivors and Their Work” is specifically written for those of us who have chosen to work for and support victims of abuse after experiencing our own trauma.  Linda Sanfield discusses how we can become almost addicted to our work as a way of proving our value; and how we can also use our work as a healthy way to heal from and make meaning out of our own experiences.   

I highly recommend this book for both advocates and survivors.

Abraham Lincoln – A Case Study in Depression, Trauma and Resiliency

 I have recently been interested in reading about Abraham Lincoln and the depression that significantly affected his life to the point of being a defining characteristic of who he was. 

I started by reading (yes, I will admit this) Abraham Lincoln, Vampire Hunter by Seth Grahame-Smith.  I doubt it was Mr. Grahame-Smith’s intent, but in knowing that Lincoln suffered from depression I found the novel to be an allegorical representation of Lincoln’s struggle against the demons of depression (and slavery).  This fight strengthened him and led to the heroic acts that defined his presidency. 

The book, Lincoln’s Melancholy, How Depression Challenged a President and Fueled His Greatest by Joshua Wolf Shenk is definitely a more serious and enlightening depiction of the life of Abraham Lincoln.  I invite you to read the first chapter and listen to the podcast at http://www.npr.org/templates/story/story.php?storyId=4976127

Mr. Shenk does an excellent job in outlining the struggles that the president experienced in his life and is able to do research that delineates the genetic heritage of depression in the Lincoln family.  Although he makes a great amount of mention to the struggles in Lincoln’s earlier life, Mr. Shenk does not seem to make the connect between these early traumatic experiences and the depth of Lincoln’s depression.

According to historians (including Mr. Shenk and James Swanson in Manhunt: The 12 Day Search for Lincoln’s Killer) Lincoln experienced the following traumatic experiences in early life:

· the death of his mother when he was nine
· frequent moves due to poor business decisions on the part of Thomas Lincoln, his father
· the death of his older sister who had been his primary caretaker after the death of his mother until his father remarried.
· raised by a distant and abusive father who had witnessed his own father being killed in an Indian raid
· Living in neglect and poverty
· The death of two children before his assassination.
· Marriage to a woman with her own trauma and mental health issues.

If we used today’s ACE (Adverse Childhood Experiences) score see http://opendoorsnh.blogspot.com/2010/07/adverse-childhood-experiences.html , Lincoln would probably score 5 or above, well within the range that leads to risky and negative consequences in life.

Lincoln also experienced two strong characteristics of many trauma survivors. After the death of a woman with whom he may or may not have had a serious relationship in his twenties, Lincoln’s friends organized themselves into a suicide watch. Lincoln himself reported that he was fearful of carrying a knife for fear of following through on his desire to end his life.

In a letter to John T. Stuart, his first law partner, Lincoln wrote:

“I am now the most miserable man living. If what I feel were equally distributed to the whole human family, there would not be one cheerful face on the earth. Whether I shall ever be better I cannot tell; I awfully forebode I shall not. To remain as I am is impossible; I must die or be better, it appears to me.”

Secondly, Lincoln had what is known as a ‘foreshortened sense of future,’ which in hind sight was definitely prophetic. He often commented having a sense or dreams of his impending assassination. Given the politics of the time and his position, it is understandable that he may be fearful but this started much earlier than his rise to the national political stage.

Abraham Lincoln had tremendous resiliency. He was able to take each negative experience and eventually turn it to his advantage. Even his backwoods poverty served him well in connecting to the constituency that eventually elected him to office. Lincoln also was able to attract people into his life that enhanced his abilities and balanced his deficits.

In understanding Lincoln’s history and theories of attachment, it can be seen that four people nurtured Lincoln’s innate resilient nature: his mother, Nancy; his sister, Sarah; his stepmother, Sarah Bush Johnston; and his friend, Joshua Speed. I encourage you to read more about these relationships, but I wish to particularly note that it was his stepmother who encouraged his love of learning even in opposition to a father who believed that reading anything other than the Bible was frivolous and lazy. It is my opinion that this relationship was the most stabilizing influence of his life and greatly offset the mercurial relationship he had with his abusive and distant father.

It is very apparent that Lincoln was a great politician with high ideals. His desire to be of service and to make meaning of his life was a component of his strength and resiliency. Abraham Lincoln was a man of conscience who was determined to leave this world better for his being in it and he succeeded, not in spite of his depression, but because he was able to use his struggles to his advantage. Unfortunately, a person with the same history of mental illness would probably be unable to rise to the status that Abraham Lincoln did due to stigma. However, I think that those of us who struggle with depression and the effects of childhood and adult trauma can find Lincoln’s story enlightening and inspiring.

Trauma and Relationship

Often, when I am consulting with advocates about working with a domestic violence or sexual assault survivor who has complex needs, an advocate will state that he/she is not trained or equipped to work with a survivor who has mental health issues. An advocate may feel that only a person who is trained in one of the alphabet interventions (EMDR, DBT, CBT, TF-CBT, etc.) has the skills necessary to provide what the survivor needs. Fortunately, the field of counseling/psychology is learning what grass roots advocates have known for years. It is the quality of the relationship between the survivor and the counselor/advocate that determines the person’s satisfaction with the intervention or contact.

Back in the 1950s and 60s Carl Rogers developed humanistic psychology and was considered to be at the forefront of understanding the need to develop therapeutic relationships. Here are the tenants of humanistic or client centered therapy as outlined in Rogers’ books Client Centered Therapy and On Becoming a Person:

The therapeutic relationship consists of a non-judgmental attitude, mutual respect, empathy, and unconditional positive regard.
The client has the answers.
The therapist’s job is to lead the client toward this self-knowledge.
The therapist’s opinion is unimportant.

Do these sound familiar? They should. They are the basics of empowerment based advocacy.

Carl Rogers’ work was well-respected until the mid 1990s when managed care companies began to require the use of evidence based interventions with measurable outcomes that could be a part of brief therapy (usually 6-8 sessions). Since it is difficult to measure attitudes and the value of a therapeutic relationship that develop over time, Rogers’ theories were set aside. Unfortunately, these new evidence based interventions did not necessarily meet the needs of clients and many dropped out of treatment.

Barry Duncan and Scott Miller, co-founders of the Institute for the Study of Therapeutic Change have authored and edited numerous professional articles and books. They have done research over 40 years to determine what really matters in the day to day work of a therapist and found the following:

The client's view of the relationship [with the therapist] is the 'trump card' in therapy outcome... Clients who rate the relationship highly are very likely to be successful in achieving their goals. Despite how chronic, intractable or 'impossible' a case may appear, if the client's view of the relationship is favorable, change is more likely to occur." From The Heart and Soul of Change: What Works in Therapy by Mark Hubble, Barry Duncan and Scott Miller.

In Judith Herman, M.D.’s book Trauma and Recovery, she outlines three stages of recovery from trauma – safety, remembrance and mourning, and reconnection. Advocates provide the safe place for all three stages. Advocates provide the means for a victim to obtain safety if she chooses and creates the safe relationship within the survivor can tell her story and reconnect and develop a trusting relationship. This does not need to be done through the use of evidence based interventions. It just takes being willing to connect and maintain a safe and trusting relationship.

What about someone with severe mental illness? In the community mental health system, the person who has the most contact with a person with a severe and persistent mental illness (the persons whom most advocates seem to feel unprepared to work with) is the client’s mental health case manager. In my experience as a case manager supervisor I found it was not what interventions that were used in working with a client, it was the relationship of trust and respect, non-judgment, and positive regard that predicted success for the person with the mental illness. Case managers are not necessarily trained therapists. Most have the same education and training as domestic violence advocates. They meet with persons with paranoid schizophrenia and psychosis in the clients’ homes and assist them in managing their daily lives. They may have some basic knowledge of an evidence based practice such as DBT (dialectical behavior therapy), but it is the quality of the relationship that is the basis for success as defined by the client.

Abused teens show mental scars

This article by Michelle Hackman, staff reporter for the Yale Daily News (Tuesday, January 10, 2012)
 was forwarded by Susan Blumenfeld of the National Center of Domestic Violence, Trauma and Mental Health.


Adolescents who experienced abuse or neglect as children have fewer brain cells than teens who did not undergo childhood maltreatment, a new Yale study finds.

A study conducted by scientists from the Yale School of Medicine, published in the Dec. 5 edition of Archives of Pediatric Adolescent Medicine, found that adolescents who were exposed to maltreatment as children showed a reduction in gray matter in areas of the brain that control emotions and impulses, though they had not been diagnosed with a psychiatric disorder. It found that the specific brain areas affected may differ according to whether adolescents reported experiencing abuse or neglect, whether the maltreatment was physical or emotional and whether they were male or female. Experts cautioned that the results of the study were only an association, and longer-term studies were needed.

“Though these kids do not have a diagnosable psychiatric disorder, they are still showing physical signs of maltreatment,” said Hilary Blumberg, associate professor of psychiatry in the Child Study Center and the senior author of the study. “The results could explain possible difficulties in school or future depression or behavioral issues.”

Forty-two adolescents filled out questionnaires that measured their perceived exposure to physical and emotional abuse, as well as physical and emotional neglect as children. Structural MRI scans found reductions in the prefrontal cortex, important in emotional and behavioral regulation, across all cases of maltreatment. Other areas affected depended on the type of maltreatment reported.

Those who reported physical or emotional neglect, for example, showed reductions in the cerebellum, which controls motor functions and regulates pleasure and fear. Those who had been exposed to physical abuse in particular showed reductions in the insula, an area that controls self-awareness ¬¬— which may explain why so many people who have been abused as children report out-of-body experiences, Blumberg said.

The study also found gender differences in the grey matter losses. In girls, the reduction was concentrated in areas important in regulating emotion, while in boys, the reduction was seen in areas important in impulse control. Because depression is associated with an inability to regulate emotions, this finding highlights the fact that the rate of depression is much higher in women than men, according to Jennifer Pfeifer, an assistant professor of psychology at the University of Oregon, who wrote an editorial on ScienceDaily.com, a major science news website, critiquing the study.

Blumberg said that despite the physical symptoms of childhood maltreatment, some adolescents in the study remained more resilient than others. Pfeifer and her colleague Philip Fisher, also of the University of Oregon, speculated two possible reasons for this apparent resilience in their editorial. The structural decreases may have left adolescents vulnerable to future psychological problems — which just haven’t occurred yet, or the adolescents tested have found alternative mechanisms to adapt to their difficult surroundings.

Because it only shows correlation, the study cannot prove that childhood maltreatment precipitated any structural changes in the brain, said Everett Waters, professor of psychology at the State University of New York at Stony Brook.

“It is also possible that brain problems led to the kids being abused,” Waters said, “or more likely, that some third factor led to both the brain problems and the abuse.”

Waters and Pfeifer both emphasized the importance of conducting a longitudinal study that would track children from infancy, in order to better understand the development of structural differences in the brain. Linda Mayes, a co-author of the study, said she will continue to track this group of adolescents and monitor them to see if they develop psychiatric disorders.

The research was funded by the National Institutes of Health.

Book Review: Enhancing Resilience in Survivors of Family Violence

 Anderson, Kim M. Enhancing Resilience in Survivors of Family Violence. New York: Springer, 2010.


Kim Anderson Ph.D., LCSW of the School of Social Work at the University of Missouri has written a book that provides advocates and mental health professionals a common language in meeting the needs of survivors of family violence. She states that“resilience research, posttraumatic growth literature, and strengths-based social work practice contribute to a helping framework that optimizes human potential while counterbalancing a more traditional vulnerability/deficit model in mental health practice” (pg. 17).

Advocates have been doing strength-based work under the empowerment model for years and this has often led to a mistrust of the mental health community in which a victim is often pathologized rather than commended for having the skills she needed to survive the abuse. “A pathology model of trauma leads practitioners, who lack the ability to understand the full meaning of victimization and its consequences, to interpret the pain and hurt expressed by survivors as evidence of psychopathology. To label as pathology rather than acts of resistance and signs of creative survival obscures and denigrates courageous efforts in the face of immense adversity. Therefore, mental health assessment tools that highlight survivors’ capacity for agency, resistance and resilience are necessary (Gilfus, 1999)” (pg. 82).

This book is not just for mental health professionals. It is an excellent guide for advocates in assisting trauma survivors in recognizing how their actions (or even inactions) were a sign of strength and resilience in the face of extreme adversity. Through the use of case studies and transcripts of sessions with survivors, Dr. Anderson provides examples of how survivors can be guided to recognize their own strengths. She also includes a number of assessment tools that could be used and discussed in the context of support groups.

Dr. Anderson also recommends ways in which to lead the survivor in creating a self narrative of “strength, purpose, and possibility” using Photo Story 3 (a free download from Microsoft) to create a self narrated story board. See http://www.silencespeaks.org/ (The DVD from this website will soon be in the NHCADSC library.

Exploration of a person’s spiritual connections also is discussed as a means for a person to find meaning in their suffering which not only leads to an experience of psychological relief but also a greater life purpose. Many survivors who are trying to understand their experiences blame themselves for their actions or inability to leave or change their circumstances. Self forgiveness and compassion towards self helps the survivor move forward and begin to “embrace the ‘broken places.’” Dr. Anderson also discusses the some faiths’ desire for the survivor to forgive the abuser. “In the author’s experience, forgiveness of one’s perpetrator does not necessarily provide wholeness and resolution in the same vain as self-forgiving. It is helpful to shift self-blame to its appropriate owner, the abuser, and hold him accountable particularly as family and legal systems often fail to do so” (pg. 123).

I also found the chapters “Recommendations from Survivors to Other Survivors” and “Recommendations of Survivors of Violence to Helping Professionals to be enlightening and validating of the work that domestic violence and sexual assault advocates do. There is also a chapter on vicarious trauma and compassion fatigue to assist the worker in managing their own reactions to the stories that they hear everyday.

I highly recommend this book to anyone working with survivors of violence.

Compassion Fatigue and Our Role as Advocates

As advocates we spend a lot of time discussing vicarious trauma. It is easy to see how hearing other people’s stories of abuse and trauma can negatively effect our beliefs and relationships. However, we often forget that we also are very susceptible to compassion fatigue. Compassion fatigue and vicarious trauma can overlap and often look quite alike. It is almost as if one is the flu and the other is a bad cold. A little hard to tell what is happening at the time, but both seriously affect our ability to be objective and compassion when working with victims of domestic violence and sexual assault.

The website http://www.compassionfatigue.org/ states the following about caregivers who are experiencing compassion fatigue:

“Studies confirm that caregivers play host to a high level of compassion fatigue. Day in, day out, workers struggle to function in care giving environments that constantly present heart wrenching, emotional challenges. Affecting positive change in society, a mission so vital to those passionate about caring for others, is perceived as elusive, if not impossible. This painful reality, coupled with first-hand knowledge of society's flagrant disregard for the safety and well being of the feeble and frail, takes its toll on everyone from full time employees to part time volunteers. Eventually, negative attitudes prevail.”

One side affect of compassion fatigue that often occurs is decreased lack of empathy towards those whom we are working to support. Often I will begin to hear comments about victim/survivors such as “this person doesn’t seem to be trying hard enough,” “she is using too many of our resources,” “she ‘should’ be ____________ (whatever it is the advocate feels that she should be doing, rather than what the victim/survivor feels empowered to do).”

In the article Changing the Script: Thinking about our relationships with shelter residents by Margaret Hobart at the Washington State Coalition Against Domestic Violence http://www.wscadv.org/resourcesAlpha.cfm?aId=D00E1151-C298-58F6-025BBD925C7F8AF8, Ms. Hobart ask us to take a look at the type of relationships we may develop with shelter guests (and other victim/survivors). When we fall into one of the less productive relationships such as parent/child, teacher/student, drill sergeant/recruit, employer/employee, or rescuer/victim it is often because we have become overwhelmed by the needs of the survivor or we have created our own agenda of what we feel should be her focus. We forget about recognizing strengths and helping the person find their inner power and we become directive rather than collaborative in helping the woman move forward. Or, we may able to put our own agenda aside and be collaborative but we still end up being resentful and disappointed because she did not follow through on suggestions we made.

Self care, of course, needs to be a priority and there are many resources that talk about compassion fatigue and vicarious trauma and self care. I would also like to suggest that when you are feeling the effects of compassion fatigue i.e excessive blaming, bottled up emotions, isolation, complaining, compulsive behaviors and poor self care, that you take time for self reflection using Margaret Hobart’s article and determining if your expectations of victim/survivors are based on the role you are playing in their life or on a collaborative/team approach to support and advocacy. Being aware of our own perceptions and triggers is also very important in managing compassion fatigue. Are you having difficulty working with survivors who have mental health or substance abuse issues because of feeling overwhelmed or unequipped? Has your agency lost personnel and you are feeling overwhelmed by your workload and it is impacting your attitude toward victims and co-workers? Or are you spending so much time in a care-taking role that it may be time to look at your professional boundaries and the impact it has on you and your relationship with victim/survivors?

Being aware of how compassion fatigue affects us and the people for whom we advocate is vital to our continuing to be effective in our jobs and the community.

Human Trafficking in New Hampshire - Guest Post by Jennifer Durant

    Jennifer Durant is the public policy specialist at the New Hampshire Coalition Against Domestic and Sexual Violence.  She has been responsible for bringing awareness of the issue of human trafficking to New Hampshire and working very hard for the passage of NH's human trafficking law (see below).  The following was written for Human Trafficking Awareness Day in 2011.

January is nationally recognized as human trafficking awareness month. Human trafficking is modern day slavery that involves the sexual and labor exploitation of millions of men, women, and children worldwide. Human trafficking has no borders. Victims can be abused within their own communities or moved throughout the world to avoid detection, forced to live a life of servitude.

It is estimated that about 800,000 to 900,000 individuals are trafficked across international borders worldwide. In the United States alone between 18,000 to 20,000 victims are trafficked into or within this country every year. Sadly, approximately 80% of these victims are children.

New Hampshire is certainly not immune to human trafficking. While human trafficking is very difficult to quantify or count, there is evidence that New Hampshire has experienced both labor and sex trafficking. In fact, ALL 50 states have reported seeing some form of human trafficking. New Hampshire was the location of the second labor trafficking case in the nation brought under federal law in 2003. Timothy Bradley and Kathleen O’Dell both of Litchfield, New Hampshire were convicted of human trafficking for withholding promised wages and refusing to release passport and legal travel documents of four Jamaican men.

There has also been evidence of sex trafficking in New Hampshire. Over the past few years NH’s domestic and sexual crisis centers have worked with several victims of sexual exploitation, who have been forced into street prostitution or forced to work in brothels.

Almost all of New Hampshire’s border states have experienced human trafficking, indicating that this crime clearly exists in the Northeastern region of this country. In Vermont police invaded a brothel where Asian women were forced to work as sex slaves. Experts say the Vermont case fits the pattern of a problem that is reaching into the smallest corners of the country.

In Kittery, Maine, Russell Pallas, a former lawyer and one-time chairman of the Kittery Town Council, was convicted in 2005 of operating a brothel that was disguised as a health club where women and children, as young as 13 years old, were forced to work as prostitutes.

In East Boston, Brighton, and Allston, Massachusetts police made nearly 100 arrests in 2006, posing as johns and then arresting suspects allegedly operating brothels in apartments and houses tucked away on quiet residential streets.

If this problem is prevalent in our border states, then New Hampshire is certainly vulnerable to such activities. These highly publicized cases serve as examples of trafficking taking place in our area but it is important to remember that many cases of trafficking go unnoticed. Most are invisible victims because of their uncertain position of either being undocumented immigrants or seen as social degenerates who voluntarily enter the sex industry.

What can you do?

*Become familiar with our laws…

-In August 2009, Governor Lynch signed HB 474 into law, the first comprehensive human trafficking law in New Hampshire. Human trafficking is now defined in NH’s Criminal Code, making it a class A felony with enhanced penalties for trafficking someone under the age of 18.

*Talk about human trafficking in your community and ask others to educate themselves

-Invite a speaker from a local organization to talk to your group

-Read a book, hold a documentary screening, or write a blog

-Continue to educate yourself and others on the growing crime of human trafficking

Ratified in 1865, the 13th Amendment abolished slavery and outlawed involuntary servitude. And here we are today nearly 150 years later and there is a need for me to be writing this in 2010, for National Human Trafficking Awareness Day. While the term human trafficking is fairly new, the act itself is clearly not. Until we effectively identify victims and provide them with the services they need; until we hold traffickers accountable in a meaningful way for their unspeakable crimes; and until we adequately prevent human trafficking from happening in the first place, the fight will continue – throughout the world, throughout the nation, and throughout the state of New Hampshire.



New Hampshire’s Human Trafficking Efforts

During the 2007-2008 Legislative Session, NHCADSV’s Public Policy Department helped drafted legislation that formed the Interagency Commission to Study the Trafficking of Persons Across Boarders for Sexual and Labor Exploitation to research the issue of human trafficking in the state. Public Policy Specialist, Jennifer Durant, organized the Commission, served as the group’s clerk, and authored a 50-page report setting forth recommendations for the legislature during the 2009-2010 Session. Jennifer has worked in collaboration with several state and social service agencies, law enforcement, and community members to garner support for this legislative effort.

As the result of her work on the Statewide Interagency Commission (SB 194, Chapter 122:1, Laws of 2007), Jennifer then became the primary author of an 8-page bill and lobbied for the passage of the first-ever attempt to criminalize human trafficking in New Hampshire. Signed by Governor Lynch in August 2009 and just in effect since January 1, 2010, it is now a class A felony to traffic a human being for labor and sexual exploitation. The law also allows the state to convict a trafficker with enhanced penalties if they exploit someone under the age of 18.
After two years of legislative successes on human trafficking NHCADSV continued to work with the state’s top leaders to train first-responders and create a statewide protocol to address human trafficking in New Hampshire. Jennifer became the State Coordinator for the newly formed New Hampshire Coalition Against Trafficking (NHCAT), a statewide Coalition that is part of a 2-year project operating with 4 other New England states. This Coalition was made up of key members and organizations in the work against human trafficking. Through NHCAT Jennifer worked to (1) increase awareness of the issue of human trafficking, (2) train providers to work with trafficking victims, (3) identify victims of human trafficking within the New England region, and (4) link trafficking survivors to needed services.

From 2009 to 2010 Jennifer organized and implemented one of the largest trainings on human trafficking for NH’s law enforcement, held on January 20, 2010. The January 20th NH statewide law enforcement training on human trafficking was a successful event in which attendance ranged from NH Prosecutors to State, County, Local, and Federal Law Enforcement officials. A total of 95 Law Enforcement officials attended the training. A little over 70% of attendees came from local police departments (65 officers).

The 8-hour training curriculum included detecting and investigating cases that involve human trafficking. The training was designed to help police officers understand, identify, and investigate human trafficking cases in New Hampshire

Informational pocket cards were created for the January 20th law enforcement training that were designed to be useful in other disciplines. The cards contain information on red flag indicators, as well as who to contact locally if it is believed that someone is being trafficked in the state.

Just to name a few, NHCADSV has worked closely with and has received support from the NH State Liquor Commission, NH State Police, NH Chief’s Association, Manchester PD, Nashua PD, NH Police Standards & Training, NH Sheriffs Association, NH Attorney General’s Office, U.S. Attorney General’s Office, Immigration and Customs Enforcement (ICE), and Department of Children, Youth and Families (DCYF).

After 2 years of work, the NH Coalition Against Trafficking (NHCAT) officially cae to a close in Spring 2011. .

Thanks to the work of NHCAT, a little over 4,300 materials on human trafficking were distributed throughout the state, either at trainings, awareness events, or fundraisers.

Thanks to the work of NHCAT, a little over 400 individuals were trained on human trafficking issues throughout the state of New Hampshire. These trainings covered a wide-range of disciplines including law enforcement, victim advocates, medical professionals, or professionals working in the child protection field.

NHCADSV continues to raise awareness on human trafficking throughout the state. On August 15, 2011 NHCADSV collaborated with a non-profit called Sex + Money - A National Search For Human Worth. The NH screening of this important film on child sex slavery here in the United States brought out 170 NH residents to the event.

Ellen Pence - Why Gender and Context Matter

The following is Ellen Pence's Keynote from the Batterers' Interventions Services Conference in November 2010.  Ellen was one of the early leaders in the violence against women movement and she will be sorely missed. She passed away after a long fight with cancer earlier this month.  This video shows her wit, wisdom, and passion for the movement.

The Traumatic Effects of Stalking

January is Stalking Awareness Month. This is a good time to take a look at the long term impact that stalking can have on the person being stalked. There have been a number of studies done on this issue and I will review some of the conclusions here.


In "Stalking – An Overview of the Problem" [Can J Psychiatry 1998;43:473–476], authors Karen M Abrams and Gail Erlick Robinson write:

"Initially, there is often much denial by the victim. Over time, however, the stress begins to erode the victim's life and psychological brutalisation results. Sometimes the victim develops an almost fatal resolve that, inevitably, one day she will be murdered. Victims, unable to live a normal life, describe feeling stripped of self-worth and dignity. Personal control and resources, psychosocial development, social support, premorbid personality traits, and the severity of the stress may all influence how the victim experiences and responds to it… Victims stalked by ex-lovers may experience additional guilt and lowered self-esteem for perceived poor judgement in their relationship choices. Many victims become isolated and deprived of support when employers or friends withdraw after also being subjected to harassment or are cut off by the victim in order to protect them. Other tangible consequences include financial losses from quitting jobs, moving, and buying expensive security equipment in an attempt to gain privacy. Changing homes and jobs results in both material losses and loss of self-respect."

Surprisingly, verbal, psychological, and emotional abuse have the same effects as the physical variety [Psychology Today, September/October 2000 issue, p.24]. Abuse of all kinds also interferes with the victim's ability to work. Abrams and Robinson wrote this [in "Occupational Effects of Stalking", Can J Psychiatry 2002;47:468–472]:

"… (B)eing stalked by a former partner may affect a victim's ability to work in 3 ways. First, the stalking behaviours often interfere directly with the ability to get to work (for example, flattening tires or other methods of preventing leaving the home). Second, the workplace may become an unsafe location if the offender decides to appear. Third, the mental health effects of such trauma may result in forgetfulness, fatigue, lowered concentration, and disorganisation. These factors may lead to the loss of employment, with accompanying loss of income, security, and status."

Mullen and colleagues have done extensive research on stalking impact in Australia. (Mullen, P.E., M. Pathe, and R. Purcell. Stalkers and Their Victims. (Cambridge University Press, 2000).Their 1997 survey of 100 stalking victims found that stalking resulted in significant activity changes for its victims, including the following:

• Major lifestyle changes or modification of daily activity for 94 percent of victims
• Curtailment of social activities for 70 percent of victims
• Decrease or cessation of work or school attendance for 50 percent of victims (due either to absenteeism or stalker invasion of work or school site)
• Relocation of residence for 40 percent of victims
• Change of workplace or school for 34 percent of victims.

The researchers also found important psychological problems resulting from the stalking, including these:

• Increased anxiety and arousal for 80 percent of victims
• Chronic sleep disturbance for 75 percent of victims
• Recurring thoughts or flashbacks to the stalking, resulting in distress for 55 percent of victims (often triggered by ordinary events such as a ringing telephone or doorbell)
• Appetite disturbance for 50 percent of victims
• Excessive tiredness, weakness, or headaches for 50 percent of victims
• Numbing of responses to others, including feeling of detachment for 38 percent of victims
• Nausea before going to places associated with the stalking for 33 percent of victims
• Increased alcohol or cigarette use for 25 percent of victims
• Contemplation of suicide for 25 percent of victims.

The researchers' analysis of these findings suggested that most of the stalking victims experienced at least one major symptom associated with Post-Traumatic Stress Disorder (PTSD). The authors explain that this is not surprising because "stalking possesses many of the features that may produce chronic stress reactions and related psychological sequelae."Those features include persistent, repetitive trauma; loss of control; state of persistent threat with associated symptoms that may far outlive the actual duration of the harassment; and loss of social supports normally available for crime victims because of mistrust and fear generated by the stalking itself. While many factors affected the specifics of the stalking impact on the victims, there was not one victim who did notexperience some level of harm "that in some cases amounted to profound deterioration in functioning."

It is also important to note that the impact of cyber stalking has the same affect, if not greater, than physical stalking.

According to the Iowa Rape Victim Advocacy Center (www.rvap.org), cyber-stalking can consist of a variety of activities, but it is generally defined as the continued and deliberate harassment, threatening behavior, or unwanted advances towards a person through the internet or other forms of on-line and computer communications. Cyber-stalking does not include occasional junk mail, but it does include any methodical or deliberate attempt to harass the victim.

Cyber-stalkers can find their victims through chat rooms, online communities, discussion forums, e-mails, or through a random search. Even people without access to the internet can be victims of cyber-stalking. All the stalker needs to do is find out personal information about the victim and they can then use that to impersonate the victim and solicit meetings with strangers without the victim ever getting on to a computer.

Cyber-stalking can take many forms, some of which are below.

• threatening or obscene e-mails
• spamming or e-mail bombing- sending large amounts of email to shut down the victims e-mail from working
• live chat harassment
• "flaming"- online verbal abuse
• leaving obscene or threatening messages in guest books or on message boards
• sending electronic viruses
• sending unsolicited e-mail
• tracing computer and internet activity
• impersonation of the victim to solicit sex acts
• identity theft

Cyber-stalking can escalate to physical danger for the victim. If a stalker obtains personal information, such as an address or phone number or even the social security number of the victim, this information can be used to stalk and harass the victim even after the cyber-stalking has ceased.