Why Boundaries are Scary for Trauma Survivors

There is a lot to say about having healthy boundaries.  They keep us out of bad situations; help us navigate social situations; help maintain a lifestyle that isn’t overwhelming.  A lot of us struggle with boundaries.  Boundaries may be stronger or weaker depending on whether or not we are engaging with our children, parents, friends, colleagues, or the general public. Oftentimes, we tend to judge people based on how clear or strong their boundaries may be.

For trauma survivors, boundaries can be scary. Boundaries for someone who has experienced interpersonal trauma can feel like being faced with a high wall instead of a fence.  A fence can be seen through while a wall blocks all view of the world.

For many years children were not allowed to have boundaries and, in some families, they still aren’t allowed.  “Kiss your Aunt Sadie!  She is just being nice!”  “Give your Uncle Barry a big hug!”  “Don’t be so shy.  Stop it.  Just do it or else!”  “Sit on Grandpa’s lap and be a nice girl/boy!” 

Those situations may seem harmless but children have been taught early that they are not allowed to say “no” and there will be consequences if they do. 

Perpetrators look for children who haven’t been allowed to say “no.”  They also look for children who have learned that it is the child’s responsibility to manage the well-being of the family by keeping secrets and not making waves.  Children are sought after who are swimming in a vast sea of ambiguity rather than a clear defined personal space. 

The analogy for this experience is that of the Hardboiled Egg.  The Hardboiled Egg starts out with a smooth perfect shell but as time goes by the shell is cracked by the desires of the adults around it.  As it grows older it eventually has lost most or all of its shell and is now vulnerable.  Perpetrators look for vulnerabilities and it now faces the judgment of people who can’t understand why it continues to get bruised and dirty.

Trauma survivors are often judged for having poor boundaries.  “Why do you continue to date men who abuse you?”  “Why don’t you leave?”  “ Why do you continue to take that person’s calls?”  “Why didn’t you just tell them ‘no’?”  “You should’ve known better!” “You need better boundaries!”  Survivors feel that their lack of boundaries is the reason that they were hurt.  The blame ends up on them instead of on the person who hurt them. 

Boundaries are of no use to perpetrators and they work hard to make sure that a child or adult victim recognizes that they are safer without them.  “If you are nice to me, I will be nice to you and I won’t hurt you.”  “Don’t tell your mother.  This is our little secret”  “If you don’t take my calls, I will come find you.”  “If you really loved me, you wouldn’t do that.”

When I was a substance abuse counselor I was working with a woman who was trying to stay sober while staying away from her abusive boyfriend.  He lived a couple of hours away and threatened both her sobriety and her physical safety.  During a one hour session he called her cell phone at least twice and she told me that he called her at least twenty times a day.  I was frustrated because I saw this as a lack of good boundaries on her part.  I asked her why she didn’t block his calls.  I doubted her resolve to stay away from the relationship.  I was judging her.

She explained to me that if she blocked him he would start to physically look for her.  If he was able to talk to her a couple of times a day and was reassured that she was coming back (even if she wasn’t) he did not get anxious.  In addition, she informed me that she would feel more anxious and fearful if she was unable to talk to him.  She needed to know his mood and his intentions in order to feel safe staying away.  If she built the big boundary wall she would feel less safe.  It seems counter-intuitive, but to the survivor it makes perfect sense.

If a child is not is a safe and stable environment with a loving caregiver they may not be able to develop strong boundaries.  When the child becomes an adult and is confronted with the concept of boundaries they find the idea difficult to understand.  Why would you tell a person “no” if there is a possibility that they will get angry and hurt you?  Why would you stand up for yourself with a bully if there is a chance that the abuse could get worse?  Why would you leave if your partner has told you he will kill you or your children if you do so?  The world that a survivor lives in does not feel safer if they put up boundaries.

So why bother talking about boundaries?  There is a time and a place for boundaries.  However, as many trauma experts tell us, a person does not begin to heal from interpersonal abuse and violence until they feel safe and stable.  Safety and stability in mind and body are only created when there are systems in place in the community and family that provide accountability for the perpetrator and safety for the victims.  Until then, a survivor is going to do what they have learned to do in order to stay safe.  Those survival skills may include being nice to the abuser, calling the perpetrator after an assault to try and normalize the relationship, lying to family and friends about the abuse, refusing to call the police, and submitting to unwanted advances.

This feeling of safety and stability may take a long time.  It may not happen while a person is living in shelter or attending a support group or working with a counselor.  Instead of insisting that a person learn to have better boundaries (heard as “if you had better boundaries you wouldn’t have gotten into this situation in the first place”) it may be helpful to explore how these survivor skills contributed to resilience and safety.  As time goes on, when the person is ready, then other skills such as boundaries can be learned but a person should be able to celebrate how they survived the abuse without being judged.

Book Review: Missoula – Rape and the Justice System in a College Town by Jon Krakauer

Jon Krakauer is an investigative journalist who likes to embed himself in a situation to delve into the intricacies of a situation or experience.  In Missoula, Mr. Krakauer goes to Missoula, Montana to investigate the many systems and personalities that become involved when a rape allegation is made on a college campus.  I have heard interviews with Mr. Krakauer and he has stated that Missoula is not atypical.  He did not pick Missoula because it was different but because it was so similar to other college towns across the nation.

Jon does not leave any stone unturned in telling the stories of rape allegations in this college town that treats its football players as celebrities and heroes, granting the players a sense of entitlement that extends to the women who attend the college.  Mr. Krakauer interviews victims and family members and has access to interviews with the alleged rapists.  He also delves into the criminal justice system and campus investigative process and delineates how the allegations are handled differently in each setting. He is also explicitly describes the judicial process and how defense attorneys and prosecutors are often so concerned with winning that the victims and perpetrators often become pawns in the process, leaving victims to experience more trauma during and after the plea and/or trial process.

Jon Krakauer researched the impact of trauma on victims and is able to incorporate the work of Judith Herman, a clinical professor at Harvard and author of Trauma and Recovery, an important work on interpersonal violence and the trauma that occurs.  David Lisak, an expert on serial rapists and college sexual assault, is an expert witness for one of the trials in Missoula and Mr. Krakauer pulls from his research and expert testimony in order to describe the intricacies of understanding sexual assault.

Jon Krakauer’s greatest message in this book is that the refusal to hold perpetrators accountable is their greatest weapon and the justice systems’ greatest failure. 

The Egg and I - Boundaries

As many of you know, I love to use analogies when I am talking about the various effects of exposure to trauma.  These analogies will pop up at odd times throughout my day when I am not thinking about my work and when I am occupied with something that doesn’t require a lot of thought.  This is just another example of how allowing your mind to rest can help it be more creative.

The other day I was peeling hard boiled eggs for salad and I started thinking about boundaries.  Sometimes I take the egg and lightly tap it against the counter and a small break will occur where I can start peeling away the shell.  Other times I may be in a bit of a mood and I strike it harder against the side of the sink, resulting in a larger break in the shell and the pieces falling off faster.  If the egg is fresh it may be more difficult to peel but there may be more damage to the egg white as pieces of it come off with the shell.

When the egg shell is removed from the egg, the egg becomes vulnerable and we are able to do anything we want with it.  

When a child’s boundaries are broken much care needs to be taken to ensure that the crack does not result in larger pieces of the boundary being removed.  Protective factors such as family support, education, and encouragement of developmentally appropriate physically and emotionally healthy activities can help keep further exposure from happening, increasing the resilience of the child and limiting future vulnerability. 

Many adults with whom we work have had a lot of damage to their boundaries.  I have worked with women who have had so many personal attacks against them starting at an early age that they have forgotten or have never known that that they can have boundaries.  They have been exposed for so long without protection that they no longer believe that boundaries exist for them. For some of them, the idea of personal boundaries may be an alien concept or they may be fearful of setting boundaries because when they do so someone comes along and tries to break their shell again.

We don’t know what has happened to someone when we first meet them.  We don’t know if their shell was removed all at once, in large chunks, or they just have a few cracks.  However, we find out soon enough that they struggle with maintaining boundaries and they may need our support.  We can help them find the resources and strength they need to further protect themselves.  This includes modeling appropriate boundaries and respecting their boundaries.

Unlike the eggs I use for salad, with the appropriate support and building up of community and protective factors, someone who has had their boundaries damaged can rebuild their life. 

The Origins of Addiction - from Dr. Vincent Felitti and the Adverse Childhood Study

In this film,  Dr Vincent Felitti, from Kaiser Permanente presents information from the ongoing 17,000 person Adverse Childhood Experiences (ACE) Study to challenge the conventional view that certain chemicals are intrinsically addicting.  He presents the evidence gathered in the ACE study to show that “addiction is not a disease, but is an unconsciously attempted response to minimize the effects of abnormal life experiences. Addiction can be seen as the unconscious, compulsive use of psychoactive materials in response to the stress of life experiences, typically dating back to childhood.”

Dr. Felitti discusses patients, including the woman who was the first person to draw his attention to the issue of using substances (in her case food), who are engaging in behaviors normally considered harmful in order to alleviate and protect from the pain of childhood experiences.  He primarily addresses food, alcohol, nicotine, methamphetamines and heroin addiction.  They are a few of the things that may be seen as public health problems but may often be “personal solutions to long-concealed adverse childhood experiences.  Describing bad habits as self-destructive behaviors hides their functionality in the life of a trauma survivor.”

As I think about how we try to address substance abuse, the heroin crisis, and human trafficking, I am drawn to the conclusion that we will fail in our attempts to resolve the crises until we begin to talk about the long held private conditions that lead to the public problems.  “These life experiences are very likely to be lost in time, and protected by shame, by secrecy, and by social taboos against exploring certain aspects of human experience.”  So many of us were raised in families and cultures where we did not discuss shameful family secrets.  As we grew up we were seen as the problem when the legacy of adverse childhood experiences presented as addictions and mental illness.

At this point in time treatment options are few and far between and minimally address the origins of the addiction.  By failing to address the adversity experience in childhood by so many people, we fail in our attempts to treat.  When treatment fails, we blame the person instead of recognizing that by “treating someone’s attempted solution, we may be threatening and causing flight from treatment” or forcing them to find another, possibly life-threatening, solution.

When these childhood experiences are named and validated as the source of long term difficulties in adolescence and adulthood we are removing the stigma and helping persons understand that it is not about having something wrong with them, but that something was done to them.  The next steps are to assist in finding healthier solutions and recognizing the strength and resiliency that helped them find solutions in the first place and survive in the midst of extremely adverse experiences. 

http://www.albertafamilywellness.org/resources/video/origins-addiction

Please take the time to read another blog - Women. Healing. Violence.

This blog post came to my attention today and I am hoping that you will find it as valuable and compelling as I have.

Please note that this full piece is very powerful and can be triggering for some.  Please read slowly and take breaks if necessary.  

Here are a few excerpts from Is it possible to recover from rape and sexual abuse? Yes and No by Laura S. Kerr PhD on her blog "Women, Healing and Violence."  I hope you will take the time to read the full post at http://womenhealingviolence.wordpress.com/2014/11/23/is-it-possible-to-recover-from-rape-and-sexual-abuse-yes-and-no/

"...the process of healing from sexual violence is slow, painful, and expensive. And because I have worked hard for a peaceful mind and body, I am protective of them. I have a low tolerance of toxic attitudes and behaviors that might upend my recovery. But I am also quick to stand up to injustices that impact others, and I have witnessed this trait in people like myself who are committed to healing their wounds of violence and abuse. Unintentionally, we become warriors of the heart — the would-be Bodhisattvas and protectors of those less fortunate and vulnerable — those we imagine are like we were before we reclaimed our right to dignity and self-preservation, and those we imagine could become victims like we once were."

"After sexual violence, most women want to forget what happened, and return to the lives they led prior to the assault. The survivor desires to be the person she was before, and avoid perceiving herself as irrevocably damaged by the rape or sexual abuse. Confusion, humiliation, and hurt are common, and contribute to self-doubt and silence.

Consequently, women often choose a course of action that will protect them from the imagined judgment of others, including avoiding seeking help. And who can blame us? Throughout history, women have been held responsible for the sexual violence perpetrated against them. Remaining silent just may be an archetypal defense response to the anticipated judgment and shaming that across the millennia have been the common response to sexually violated women (along with forced prostitution, stoning to death, and abandonment)."

Book Review – The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma by Bessel Van der Kolk, MD, Penguin Group, New York, 2014

I am very excited about this recently published book by Dr. Bessel Van der Kolk.  Initially, I did not think that another book could be placed alongside Judith Herman’s Trauma and Recovery as a “go to” text on the intricacies trauma and its effects.  However, I am now going to refer to The Body Keeps the Score as the new, much needed, reference book for anyone interested in the effects of trauma and the varied ways to address its impact on people’s lives.

Not only is this book full of information but it is also written in a format that makes for interesting and engaging reading.  It is not written like a research paper, although the research is well documented.  I was able to read it for hours at a time, not something I can usually do with research articles.

In The Body Keeps the Score, Dr. Van der Kolk relates the history behind today’s current focus on trauma in veterans and survivors of interpersonal trauma.  He tells stories from his own years working for the Veteran’s Administration and finding that the psychotic episodes that veterans were being diagnosed as having (and for which they were heavily medicated) were actually flashbacks of experiences that had occurred in the jungles of Viet Nam.  This eventually led to post traumatic stress disorder being included in the Diagnostic and Statistical Manual when it first arrived in the 1980s.  Dr. Van der Kolk, however, does not tread lightly around the issues surrounding the DSM and its later iterations.  Instead, he is very critical of the process of creating the DSM and its subsequent use by insurance companies, something for which it was never designed. 

Dr. Van der Kolk also describes how after extensive research came out about childhood trauma and its long term impacts he and his colleagues came to the conclusion that a new diagnosis of Development Trauma Disorder needed to included.  This was a request that was denied by the American Psychiatric Association in 2011 even after the results of the Adverse Childhood Experience study were made an integral part of current trauma research.  This has resulted in a loss of research and funding that would assist in addressing the needs of children who have suffered from chronic trauma and continue to be misdiagnosed and heavily medicated in lieu of much needed trauma treatment.

In addition to extensively covering the effects of trauma on children, Dr. Van der Kolk also addresses the controversy surrounding repressed memories and the misguided notions still prevalent in the psychiatric world that repressed memories are not factual.  He provides anecdotal and research based evidence that validates the experiences of people who have regained memories of childhood abuse. 

The most helpful part of this book, and it is really hard to narrow down the best part, is Dr. Van der Kolk’s review of the most helpful trauma therapies.  His devotion to body based modalities is evident and he strong advises against talk therapy as it generates activation/arousal responses that are not helpful until the person is able to trust their body’s responses.  He states that it is through body based modalities that a trauma survivor will eventually gain “self-ownership of their body.”  I am sure that many survivors with whom we work would appreciate knowing that this is a possibility.

I highly encourage anyone who is interested in the field of trauma studies and/or works with survivors of trauma to add this book to their library

Posttraumatic Growth

There has been some new research coming about on something called posttraumatic growth.  During a presentation last week I mentioned this and very few people in the audience knew about it.  It is primarily a result of resiliency studies in people who have been able to recover from traumatic incidents or even from long term interpersonal trauma.  In order to educate readers about this I have taken the following directly from the University of North Carolina, Charlotte, website.  http://ptgi.uncc.edu/what-is-ptg/

After you read this,  I am sure that you will know of people with whom you have worked who have experienced posttraumatic growth.   In fact, you may also have experienced posttraumatic growth. 

What is PTG?

What is posttraumatic growth? It is positive change experienced as a result of the struggle with a major life crisis or a traumatic event. Although we coined the term posttraumatic growth, the idea that human beings can be changed by their encounters with life challenges, sometimes in radically positive ways, is not new. The theme is present in ancient spiritual and religious traditions, literature, and philosophy. What is reasonably new is the systematic study of this phenomenon by psychologists, social workers, counselors, and scholars in other traditions of clinical practice and scientific investigation.

What forms does posttraumatic growth take? Posttraumatic growth tends to occur in five general areas. Sometimes people who must face major life crises develop a sense that new opportunities have emerged from the struggle, opening up possibilities that were not present before. A second area is a change in relationships with others. Some people experience closer relationships with some specific people, and they can also experience an increased sense of connection to others who suffer. A third area of possible change is an increased sense of one’s own strength – “if I lived through that, I can face anything”. A fourth aspect of posttraumatic growth experienced by some people is a greater appreciation for life in general. The fifth area involves the spiritual or religious domain. Some individuals experience a deepening of their spiritual lives,however, this deepening can also involve a significant change in one’s belief system.

Some Clarifications

Most of us, when we face very difficult losses or great suffering, will have a variety of highly distressing psychological reactions. Just because individuals experience growth does not mean that they will not suffer. Distress is typical when we face traumatic events.

We most definitely are not implying that traumatic events are good – they are not. But for many of us, life crises are inevitable and we are not given the choice between suffering and growth on the one hand, and no suffering and no change, on the other.

Posttraumatic growth is not universal. It is not uncommon, but neither does everybody who faces a traumatic event experience growth.

Our hope is that you never face a major loss or crisis, but most of us eventually do, and perhaps you may also experience an encounter with posttraumatic growth.

Here are some links to other articles on posttraumatic growth:

http://www.pickthebrain.com/blog/post-traumatic-growth-what-research-says-about-why-some-grow-while-others-break-in-the-face-of-adversity/

http://trauma-recovery.ca/resiliency/post-traumatic-growth/

This is an excellent blog post by Laura Kerr Ph.D. on trauma and mental illness.  Just click on the title below.

Want to reduce mental illness? Address trauma. Want to save the world? Address trauma.

Some Brain/DNA Geek Info That Shows How Our Grandparents' Trauma May Affect Us

I have been reading about epigenetics lately and then came across some great videos.Rather than trying to define it,  I thought I would share the following for those of you who may get as excited about this kind of thing as I do.   Epigenetics helps us understand how the effects of trauma can be transmitted from one generation to another.  It may cause a sense of hopelessness to realize that our DNA is impacted by the experiences of our ancestors and that our experiences impact our children and grandchildren, but if you read through the article Grandma's Experiences Leave Epigenetic Mark on Your Genes | DiscoverMagazine.com, you will see that there is still a strong case to be made for the power of strong attachment and caregiving.

The video, The Ghost in Your Genes, is a PBS Nova presentation of about 50 minutes from 2007 that can be viewed in its entirety on the ACES Connection website.  About half way through it starts to discuss how trauma impacts our genes.

And then we have this somewhat amusing but fast moving video below that gives a brief overview of what epigenetics is.

Trauma and Self Harm – When Hurting Helps the Pain

As domestic violence and sexual assault advocates we often come into contact with situations that we don’t feel equipped to handle.  Even though we understand the dynamics of power and control and receive training and education on providing empowering services that allow for the victims/survivors to make their own choices, we are often taken aback and feel powerless when we meet someone who has scars from injuries that were self-inflicted.  Unless we understand the underlying motivations behind self-harm we are at risk of over-reacting by assuming the injury is a part of a suicidal gesture or we under react by ignoring the evidence of internal pain.

According to Solomon and Farrand (1996) “the assumption is that the alternative to self-injury is ‘acting normally,’ but on the contrary . . .  the alternative to self-injury is total loss of control and possible suicide.  It becomes a forced choice from among limited options.”  In other words, when a person engages in self-injury she/he may be doing so in order to relieve the pain and anxiety and reduce the feelings of wanting to commit suicide.  “A basic understanding is that a person who truly attempts suicide seeks to end all feelings whereas a person who self-mutilates seeks to feel better (Favazza, 1998).”

Another misconception regarding persons who self-injure is that they are “attention seeking.”  Most people who self-harm are trauma survivors and experiencing extreme internal pain and ongoing activation of the flight-fight-freeze response (see my BrainTalk).  Throughout their lives they may not have had this internal pain validated.  In fact, many survivors have been accused of lying and manipulating by those people and systems that were supposed to help them.  When this type of pain is not recognized, an external expression of pain may feel necessary in order to have others see some sort of manifestation of what is happening internally.

According to Bessel Van der Kolk, “neglect [was] the most powerful predictor of self-destructive behavior.  This implies that although childhood trauma contributes heavily to the initiation of self-destructive behavior, lack of secure attachments maintains it.  Those… who could not remember feeling special or loved by anyone as children were least able to control their self-destructive behavior.”  This neglect leads to a person feeling that there are not of value and not worthy of any care or support.

People who self-injure do so in order to feel something or to not feel so much.  If a person is dissociating (feeling disconnected from self or surroundings) she/he may self-injure in order to be able to feel something and be able to feel grounded within the body again.  Some people may be feeling so much, the emotions are so activated, that the self-injuring may be a way to calm down and possibly reach a state where the feelings are less intense,

The following are some guidelines for responding to someone’s self-injuring:

Show that you see and care about the person in pain beyond the injury. 

Show concern for the injury, address safety (is the cut deep, has the person cleaned or treated the injury, etc.) and then move to validating the pain the person must be in to have done the injury. 

Make it clear that it is okay to talk about self-injury and convey your respect for the person’s efforts to survive.  She was doing the best that she could.

Help the person make sense of the self-injury.  When did it start?  What was happening then?  Explore how self-injury has helped the person survive in the past. 

Encourage the person to find safe ways to deal with buried feelings and seek support in order to care for herself.

Acknowledge that is frightening to think about living without self-injury and that reducing how often it occurs can be the first step.  She may need to learn there are other things that work before she can make different choices.

It is important mostly to remember that by validating the pain beneath the injury we are letting the person know that they are of value and recognized as a survivor.

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

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.

Dealing with the Effects of Trauma

A SAMHSA Publication – see below for more information




Introduction

This is a serious issue. This booklet is just an introduction—a starting point that may give you the courage to take action. It is not meant to be a treatment program. The ideas and strategies are not intended to replace treatment you are currently receiving.

You may have had one or many very upsetting, frightening, or traumatic things happen to you in your life, or that threatened or hurt something you love—even your community. When these kinds of things happen, you may not “get over” them quickly. In fact, you may feel the effects of these traumas for many years, even for the rest of your life. Sometimes you don’t even notice effects right after the trauma happens. Years later you may begin having thoughts, nightmares, and other disturbing symptoms. You may develop these symptoms and not even remember the traumatic thing or things that once happened to you.

For many years, the traumatic things that happened to people were overlooked as a possible cause of frightening, distressing, and sometimes disabling emotional symptoms such as depression, anxiety, phobias, delusions, flashbacks, and being out of touch with reality. In recent years, many researchers and health care providers have become convinced of the connection between trauma and these symptoms. They are developing new treatment programs and revising old ones to better meet the needs of people who have had traumatic experiences.

This booklet can help you to know if traumatic experiences in your life may be causing some or all of the difficult symptoms you are experiencing. It may give you some guidance in working to relieve these symptoms and share with you some simple and safe things you can do to help yourself heal from the effects of trauma.

Some examples of traumatic experiences that may be causing your symptoms include:

• physical, emotional, or sexual abuse
• neglect
• war experiences
• outbursts of temper and rage
• alcoholism (your own or in your family)
• physical illnesses, surgeries, and disabilities
• sickness in your family
• loss of close family members and friends
• natural disasters
• Accidents

Some things that may be very traumatic to one person hardly seem to bother another person. If something bothers you a lot and it doesn’t bother someone else, it doesn’t mean there is something wrong with you. People respond to experiences differently.

Do you feel that traumatic things that happened to you may be causing some or all of your distressing and disabling emotional symptoms? Examples of symptoms that may be caused by trauma include:

• anxiety
• insomnia
• agitation
• irritability or rage
• flashbacks or intrusive memories
• feeling disconnected from the world
• unrest in certain situations
• being “shut down”
• being very passive
• feeling depressed
• eating problems
• needing to do certain things over and over
• unusual fears
• impatience
• always having to have things a certain way
• doing strange or risky things
• having a hard time concentrating
• wanting to hurt yourself
• being unable to trust anyone
• feeling unlikable
• feeling unsafe
• using harmful substances
• keeping to yourself
• overworking

Perhaps you have been told that you have a psychiatric or mental illness like depression, bipolar disorder or manic depression, schizophrenia, borderline personality disorder, obsessive—compulsive disorder, dissociative disorder, an eating disorder, or an anxiety disorder. The ways you can help yourself handle these symptoms and the things your health care providers suggest as treatment may be helpful whether your symptoms are caused by trauma or by a psychiatric illness.

Help From Health Care Providers, Counselors and Groups

You may decide to reach out to health care providers for assistance in relieving the effects of trauma. This is a good idea. The effects of trauma, even trauma that happened many years ago, can affect your health. You may have an illness that needs treatment. In addition, your health care provider may suggest that you take medications or certain food supplements to relieve your symptoms. Many people find that getting this kind of health care support gives them the relief and energy they need to work on other aspects of healing. To find health care providers in your community who have expertise in addressing issues related to trauma, contact your local mental health agency, hospital, or crisis service.

If you possibly can, work with a counselor or in a special program designed for people who have been traumatized. A counselor or people leading the program may refer you to a group. These groups can be very helpful. However, keep in mind that you need to decide for yourself what you are going to do, and how and when you are going to do it. You must be in charge of your recovery in every way.

Wherever you go for help, the program or treatment should include the following:

Empowerment–You must be in charge of your healing in every way to counteract the effects of the trauma where all control was taken away from you
.

Validation–You need others to listen to you, to validate the importance of what happened to you, to bear witness, and to understand the role of this trauma in your life.

Connection–Trauma makes you feel very alone. As part of your healing, you need to reconnect with others. This connection may be part of your treatment.

If you feel the cause of your symptoms is related to trauma in your life, you will want to be careful about your treatment and in making decisions about other areas of your life. The following guidelines will help you decide how to help yourself feel better.

Have hope. It is important that you know that you can and will feel better. In the past you may have thought you would never feel better—that the horrible symptoms you experience would go on for the rest of your life. Many people who have experienced the same symptoms that you are experiencing are now feeling much better. They have gone on to make their lives the way they want them to be and to do the things they want to do.

Take personal responsibility. When you have been traumatized, you lose control of your life. You may feel as though you still don’t have any control over your life. You begin to take back that control by being in charge of every aspect of your life. Others, including your spouse, family members, friends, and health care professionals will try to tell you what to do. Before you do what they suggest, think about it carefully. Do you feel that it is the best thing for you to do right now? If not, do not do it. You can follow others advice, but be aware that you are choosing to do so. It is important that you make decisions about your own life. You are responsible for your own behavior. Being traumatized is not an acceptable excuse for behavior that hurts you or hurts others.

Talk to one or more people about what happened to you. Telling others about the trauma is an important part of healing the effects of trauma. Make sure the person or people you decide to tell are safe people, people who would not hurt you, and who understand that what happened to you is serious. They should know, or you could tell them, that describing what happened to you over and over is an important part of the healing process.

Don’t tell a person who responds with statements that invalidate your experience, like “That wasn’t so bad.” “You should just forget about it,” “Forgive and forget,” or “You think that’s bad, let me tell you what happened to me.” They don’t understand. In connecting with others, avoid spending all your time talking about your traumatic experiences. Spend time listening to others and sharing positive life experiences, like going to movies or watching a ball game together. You will know when you have described your trauma enough, because you won’t feel like doing it anymore.

Develop a close relationship with another person. You may not feel close to or trust anyone. This may be a result of your traumatic experiences. Part of healing means trusting people again. Think about the person in your life that you like best. Invite them to do something fun with you. If that feels good, make a plan to do something else together at another time—maybe the following week. Keep doing this until you feel close to this person. Then, without giving up on that person, start developing a close relationship with another person. Keep doing this until you have close relationships with at least five people. Support groups and peer support centers are good places to meet people.

Things You Can Do Every Day to Help Yourself Feel Better

There are many things that happen every day that can cause you to feel ill, uncomfortable, upset, anxious, or irritated. You will want to do things to help yourself feel better as quickly as possible, without doing anything that has negative consequences, for example, drinking, committing crimes, hurting yourself, risking your life, or eating lots of junk food.

Read through the following list. Check off the ideas that appeal to you and give each of them a try when you need to help yourself feel better. Make a list of the ones you find to be most useful, along with those you have successfully used in the past, and hang the list in a prominent place—like on your refrigerator door-as a reminder at times when you need to comfort yourself. Use these techniques whenever you are having a hard time or as a special treat to yourself.

_____ Do something fun or creative, something you really enjoy, like crafts, needlework, painting,drawing, woodworking, making a sculpture, reading fiction, comics, mystery novels, or inspirational writings, doing crossword or jigsaw puzzles, playing a game, taking some photographs, going fishing, going to a movie or other community event, or gardening.

_____Get some exercise. Exercise is a great way to help yourself feel better while improving your overall stamina and health. The right exercise can even be fun.


______Write something. Writing can help you feel better. You can keep lists, record dreams, respond to questions, and explore your feelings. All ways are correct. Don’t worry about how well you write. It’s not important. It is only for you. Writing about the trauma or traumatic events also helps a lot. It allows you to safely process the emotions you are experiencing. It tells your mind that you are taking care of the situation and helps to relieve the difficult symptoms you may be experiencing. Keep your writings in a safe place where others cannot read them. Share them only with people you feel comfortable with. You may even want to write a letter to the person or people who have treated you badly, telling them how it affected you, and not send the letter.

_____Use your spiritual resources. Spiritual resources and making use of these resources varies from person to person. For some people it means praying, going to church, or reaching out to a member of the clergy. For others it is meditating or reading affirmations and other kinds of inspirational materials. It may include rituals and ceremonies—whatever feels right to you. Spiritual work does not necessarily occur within the bounds of an organized religion. Remember, you can be spiritual without being religious.

_____Do something routine. When you don’t feel well, it helps to do something “normal”—the kind of thing you do every day or often, things that are part of your routine like taking a shower, washing your hair, making yourself a sandwich, calling a friend or family member, making your bed, walking the dog, or getting gas in the car.

_____Wear something that makes you feel good. Everybody has certain clothes or jewelry that they enjoy wearing. These are the things to wear when you need to comfort yourself.

_____Get some little things done. It always helps you feel better if you accomplish something, even if it is a very small thing. Think of some easy things to do that don’t take much time. Then do them. Here are some ideas: clean out one drawer, put five pictures in a photo album, dust a book case, read a page in a favorite book, do a load of laundry, cook yourself something healthful, send someone a card.

_____Learn something new. Think about a topic that you are interested in but have never explored. Find some information on it in the library. Check it out on the Internet. Go to a class. Look at something in a new way. Read a favorite saying, poem, or piece of scripture, and see if you can find new meaning in it.

____ Do a reality check. Checking in on what is really going on rather than responding to your initial “gut reaction” can be very helpful. For instance, if you come in the house and loud music is playing, it may trigger the thinking that someone is playing the music just to annoy you. The initial reaction is to get really angry with them. That would make both of you feel awful. A reality check gives the person playing the loud music a chance to look at what is really going on. Perhaps the person playing the music thought you wouldn’t be in until later and took advantage of the opportunity to play loud music. If you would call upstairs and ask him to turn down the music so you could rest, he probably would say, “Sure!” It helps if you can stop yourself from jumping to conclusions before you check the facts.

_____ Be present in the moment. This is often referred to as mindfulness. Many of us spend so much time focusing on the future or thinking about the past that we miss out on fully experiencing what is going on in the present. Making a conscious effort to focus your attention on what you are doing right now and what is happening around you can help you feel better. Look around at nature. Feel the weather. Look at the sky when it is filled with stars.

¬¬¬¬_____Stare at something pretty or something that has special meaning for you. Stop what you are doing and take a long, close look at a flower, a leaf, a plant, the sky, a work of art, a souvenir from an adventure, a picture of a loved one, or a picture of yourself. Notice how much better you feel after doing this.

_____Play with children in your family or with a pet. Romping in the grass with a dog, petting a kitten, reading a story to a child, rocking a baby, and similar activities have a calming effect which translates into feeling better.

_____Do a relaxation exercise. There are many good books available that describe relaxation exercises. Try them to discover which ones you prefer. Practice them daily. Use them whenever you need to help yourself feel better. Relaxation tapes which feature relaxing music or nature sounds are available. Just listening for 10 minutes can help you feel better.

_____Take a warm bath. This may sound simplistic, but it helps. If you are lucky enough to have access to a Jacuzzi or hot tub, it’s even better. Warm water is relaxing and healing.

_____Expose yourself to something that smells good to you. Many people have discovered fragrances that help them feel good. Sometimes a bouquet of fragrant flowers or the smell of fresh baked bread will help you feel better.

_____Listen to music. Pay attention to your sense of hearing by pampering yourself with delightful music you really enjoy. Libraries often have records and tapes available for loan. If you enjoy music, make it an essential part of every day.

_____Make music. Making music is also a good way to help yourself feel better. Drums and other kinds of musical instruments are popular ways of relieving tension and increasing well-being. Perhaps you have an instrument that you enjoy playing, like a harmonica, kazoo, penny whistle, or guitar.

_____Sing. Singing helps. It fills your lungs with fresh air and makes you feel better. Sing to yourself. Sing at the top of your lungs. Sing when you are driving your car. Sing when you are in the shower. Sing for the fun of it. Sing along with favorite records, tapes, compact discs, or the radio. Sing the favorite songs you remember from your childhood.

Perhaps you can think of some other things you could do that would help you feel better.



The Healing Journey

Begin your healing journey by thinking about how it is you would like to feel. Write it down or tell someone else. In order to promote your own healing, you may want to work on one or several of the following issues that you know would help you to feel better.

• Learn to know and appreciate your body. Your body is a miracle. Focus on different parts of your body and how they feel. Think about what that part of your body does for you. Go to your library and review books that teach you about your body and how it works.

• Set boundaries and limits that feel right to you. In all relationships you have the right to define your own limits and boundaries so that you feel comfortable and safe. Say “no” to anything you don’t want. For instance, if someone calls you five times a day, you have the right to ask them to call you less often, or even not to call you at all. If someone comes to your home when you don’t want them to be there, you have the right to ask them to leave. Think about what your boundaries are. They may differ from person to person. You may enjoy it a lot when your sister comes to visit, but you may not want a visit from your brother or a cousin. You may not want anyone to call you on the phone after 10 p.m. Expect and insist that others respect your boundaries.

• Learn to be a good advocate for yourself. Ask for what you want and deserve. Work toward getting what you want and need for yourself. If you want to get more education for yourself so you can do work that you enjoy, find out about available programs, and do what it is you need to doto meet your goal. If you want your physician to help you find the cause of physical problems, insist that he or she do so, or refer you to someone else. When you are making important decisions about your life, like getting or staying married, going back to school, or parenting a child, be sure the decision you make is really in your best interest.

• Build your self-esteem. You are a very special and wonderful person. You deserve all the best things that life has to offer. Remind yourself of this over and over again. Go to the library and review books on building your self-esteem. Do some of the suggested activities.

• Develop a list of activities that help you feel better (refer to the list in the section “Things you can do to help yourself feel better”). Do some of these activities every day. Spend more timedoing these activities when you are feeling badly.

• Every family develops certain patterns or ways of thinking about and doing things. Those things you learn in your family as a child will often influence you as an adult—sometimes making your life more difficult and getting in the way of meeting your personal goals. Think about the ways of thinking and doing things that guide you in your life. Ask yourself if they are patterns, and if you need to change them to make your life the way you want it to be. For example, in your family you may have been taught that you never tell anyone certain family secrets. In fact, it may be very important to share some family secrets with trusted friends or health care providers. Or you may have been taught that you must always do what certain members of your family want you to do. As an adult, it is important that you figure out for yourself what it is you want to do. In effect you can become your own loving parent.

• Work to establish harmony with your family or the people you live with. Plan fun and interesting activities with them. Listen to them without being critical.

• Work on learning to communicate with others so that they can easily understand what you mean. When talking with another person about your feelings, use “I” statements, like “I feel sad” or “I feel upset” rather than accusing the other person. You may want to practice good communication with a friend. Ask your friend to give you feedback on how you can be more easily understood.

• You may have lots of negative thoughts about yourself and your life. Work on changing these negative thoughts to positive ones. The more you think positive thoughts the better you will feel. For instance, you may always think, “Nobody likes me.” When you think that thought, replace it with a thought like, “I have many friends.” If you often think that you will never feel better, replacethat thought with the thought, “Every day I am feeling better and better.”

• Develop an action plan for prevention and recovery. This is a simple plan that helps you stay well and respond to upsetting symptoms and events in ways that will keep you feeling well.

Using the activities in the section “Things you can do to help yourself feel better,” make lists of things that will help you keep yourself well and will help you to feel better when you are not feeling well. Include lists:

• to remind yourself of things you need to do every day - like getting a half hour of exercise and eating three healthy meals - and also those things that you may not need to do every day, but ifyou miss them they will cause stress in your life, for example, buying food, paying bills, or cleaning your home;

• of events or situations that may make you feel worse if they come up, like a fight with a family member, health care provider, or social worker, getting a big bill, or loss of something importantto you. Then list things to do (relax, talk to a friend, play your guitar) if these things happen so you won’t start feeling badly;

• of early warning signs that indicate you are starting to feel worse - like always feeling tired, sleeping too much, overeating, dropping things, and losing things.

• Then list things to do (get more rest, take some time off, arrange an appointment with your counselor, cut back on caffeine) to help yourself feel better;

• of signs that things are getting much worse, like you are feeling very depressed, you can’t get out of bed in the morning, or you feel negative about everything.

• Then list things to do that will help you feel better quickly (get someone to stay with you, spend extra time doing things you enjoy, contact your doctor); and

• of information that can be used by others if you become unable to take care of yourself or keep yourself safe, such as signs that indicate you need their help, who you want to help you (give copies of this list to each of these people), the names of your doctor, counselor and pharmacist, all prescriptions and over-the-counter medications, things that others can do that would help youfeel better or keep you safe, and things you do not want others to do or that might make you feel worse.



Barriers to Healing

Are there any things you are doing that are getting in the way of your healing, such as alcohol or drug abuse, being in abusive or unsupportive relationships, self-destructive behaviors such as blaming and shaming yourself, and not taking good care of yourself? Think about the possible negative consequences of these behaviors. For instance, if you get drunk, you might lose control of yourself and the situation and be taken advantage of. If you overeat, the negative consequences might be weight gain, poor body image, and poor health. You may want to work on changing these behaviors by using self-help books, working with a counselor, joining a support group, or attending a 12-step program.



Moving Forward on Your Healing Journey

If you are now about to begin working on recovering from the effects of trauma, or if you have already begun this work and are planning to continue making some changes based on what you have learned, you will need courage and persistence along the way. You may experience setbacks. From time to time you may get so discouraged that you feel like you want to give up. This happens to everyone. Notice how far you’ve come. Appreciate even a little progress. Do something nice for yourself and continue your efforts. You deserve an enjoyable life. Always keep in mind that there are many people, even famous people, who have had traumatic things happen to them. They have worked to relieve the symptoms of this trauma and have gone on to lead happy and rewarding lives. You can too.





Further Resources

Substance Abuse and Mental Health Services Administration (SAMHSA)
Center for Mental Health Services
Web site: http://www.samhsa.gov/

SAMHSA’s National Mental Health Information Center
P.O. Box 42557
Washington, D.C. 20015
1 (800) 789-2647 (voice)
Web site: http://www.mentalhealth.samhsa.gov/

Consumer Organization and Networking Technical Assistance Center
(CONTAC)
P.O. Box 11000
Charleston, WV 25339
1 (888) 825-TECH (8324)
(304) 346-9992 (fax)
Web site: http://www.contac.org/

Depression and Bipolar Support Alliance (DBSA)
(formerly the National Depressive and Manic-Depressive Association)
730 N. Franklin Street, Suite 501
Chicago, IL 60610-3526
(800) 826-3632
Web site: http://www.dbsalliance.org/



National Alliance for the Mentally Ill (NAMI)
(Special Support Center)
Colonial Place Three
2107 Wilson Boulevard, Suite 300
Arlington, VA 22201-3042
(703) 524-7600
Web site: http://www.nami.org/



National Empowerment Center
599 Canal Street, 5 East
Lawrence, MA 01840
1-800-power2u
(800)TDD-POWER (TDD)
(978)681-6426 (fax)
Web site: http://www.power2u.org/


National Mental Health Consumers’
Self-Help Clearinghouse
1211 Chestnut Street, Suite 1207
Philadelphia, PA 19107
1 (800) 553-4539 (voice)
(215) 636-6312 (fax)
e-mail: info@mhselfhelp.org
Web site: http://www.mhselfhelp.org/



National Technical Assistance Center (NATC)
National Association of State Mental Health Program Directors
66 Canal Center Plaza, Suite 302
Alexandria, VA 22314
703-739-9333 (voice)
703-548-9517 (fax)
Web site: www.nasmhpd.org/ntac

Resources listed in this document do not constitute an endorsement by CMHS/SAMHSA/HHS, nor are these resources exhaustive. Nothing is implied by an organization not being referenced.

You could also contact your state consumer advocacy network/agency. Find it by looking under Mental Health in the Yellow Pages of your phone book.



Acknowledgements

This publication was funded by the U.S. Department of Health and Human Services (DHHS), Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Mental Health Services (CMHS), and prepared by Mary Ellen Copeland, M.S., M.A., under contract number 99M005957. Acknowledgment is given to the many mental health consumers who worked on this project offering advice and suggestions.



Disclaimer

The opinions expressed in this document reflect the personal opinions of the author and are not intended to represent the views, positions or policies of CMHS, SAMHSA, DHHS, or other agencies or offices of the Federal Government.



Public Domain Notice

All material appearing in this report is in the public domain and may be reproduced or copied without permission from SAMHSA. Citation of the source is appreciated. However, this publication may not be reproduced or distributed for a fee without the specific, written authorization of the Office of Communications, SAMHSA, DHHS.

For additional copies of this document, please call SAMHSA’s National Mental Health Information Center at 1-800-789-2647.

Poverty and Trauma - A Paper by Jennifer Frechette, Skidmore College

Dr. Ruby Payne states that the definition of poverty is “the extent to which an individual does without resources.” Payne (2005) states that the resources needed include financial, emotional, spiritual, physical, social support systems, and relationship resources, as well as the knowledge of unspoken social norms (p. 7). Without these, Payne states, people are at higher risk of becoming impoverished and homeless. If these resources and supports are in place the individual is more likely to find stability in others and therefore have support in times of need.


According to the National Child Traumatic Stress Network (NCTSN), homelessness results from severe poverty, the inability to find housing that is affordable, single parenthood, and lack of social supports (2005, p. 1). Those who experience homelessness have an increased susceptibility to trauma, loss of community, family, and security. Families who live in shelters are confronted by many problems such as “the need to reestablish a home, interpersonal difficulties, mental and physical problems” (NCTSN, 2005, p. 1). Homelessness makes families more likely to experience various traumas including physical and sexual assault as well as increased anxiety due to feelings of being overwhelmed and hyper vigilance pertaining to maintaining personal safety (NCTSN, 2005, p. 1). Payne (1996) outlines important things to know about poverty. Firstly, poverty is relative; meaning that it depends on your surroundings and community. Second, poverty occurs everywhere in the world. Third, economic class is ever changing. Fourth, there are different types of poverty, those being generational and situational. Generational, as defined by Payne, is “being in poverty for two generations or longer” whereas situational poverty is caused by circumstances and generally lasts a shorter amount of time. Fifth, society as a whole operates under middle class norms and finally, Payne states that in order to move from “poverty to middle class or middle class to wealth, an individual must give up relationships for achievement.”

The NCTSN ( 2005) states that children bear the most trauma from homelessness stating that homeless children get sick “ twice the rate of other children” and that they “suffer twice as many ear infections, have four times the rate of asthma, and have five times more diarrhea and stomach problems” ( p. 2) . Among these statistics homeless children go hungry twice as often as non-homeless children and are twice as more likely to have difficulty completing each grade of school, as well as are more likely to have difficulties emotionally and behaviorally in school (NCTSN, 2005, p. 2). The NCTSN (2005) states that, “half of school-age homeless children experience anxiety, depression, or withdrawal” (p. 2).

It is important for children in poverty to receive assistance from those around them, including shelter staff. But what is essential is that those that choose to support homeless families provide a safe environment which includes positive role models, positive social interaction, and equality. The NCTSN (2005) states that

By making families co-participants in establishing rules and regulations, and by housing caregivers and children together, programs can help prevent re-traumatization. Programs can also empower families by maximizing their choice and control, thereby ensuring that they constructively use services to attain personal stability and heal emotional hurt (p. 2).

Shelters are the primary safe zone for homeless families in the United States. Many shelters work closely with community health agencies as trauma specific care givers to homeless families (NCTSN, 2005, p. 2). It is important to restore stability, assess trauma within the family, and create a safe net to understand and address the trauma between family members in order to best address and assist each individual family members needs. NCTSN (2005) states that it is important to train shelter staff to understand the link of homelessness and traumatic experience by “promoting wider awareness of the role of trauma in precipitating and extending family homelessness” (p. 2). Collins et al (2010) cite Figley (1988) state that,

"Trauma can impact the family system through several distinct pathways: simultaneous exposure when all members of the family are exposed to the same event; vicarious traumatization or contagion of trauma from an exposed family member to others in the family; intrafamilial trauma when one family member is the perpetrator of the trauma; and secondary stress when traumatic distress symptoms disrupt family functioning (30).Balancing these various pathways for and of trauma can many times distance supports from the

purpose of working with family members who have been exposed to traumatic experiences. Validating each individual in the family’s experience with trauma while balancing the family’s impact or possible perpetration of that event can be difficult. However, what is important to keep in mind is that each family member has a right to be heard and each one is likely to have experienced victimization at some time or another. Balancing the various traumatizations and homelessness of families can be cumbersome; however, there are multiple other factors that play a key role in family functioning. "

Families living in poverty are at risk of facing a number of stressors including conflict within family, violence, various abuses, and neglect from society and are vulnerable to homelessness, financial disparity, and substance abuse (Collins, K., Connors, K., Davis, S., Donohue, A., Gardner, S., Goldblatt, E., Hayward, A., Kiser, L., Strieder, F.& Thompson, E. , 2010, p. 30). Putnam and Tricett (1993), as cited in Collins (2010) state that there is a concern, among impoverished, about physical safety which is found among multiple generations (p. 30).

Psychological trauma is likely among the homeless for three reasons, (1) The sudden or gradual loss of one's home, (2) the conditions in a shelter and (3) the occurrence of past sexual or physical abuse history previous to homelessness (Goodman, Saxe, and Harvey,1991, p. 1219). Goodman et al( 1991) state that learned helplessness is a potential effect of homelessness that can be prevented by creating an empowering environment around post trauma living and a rebuilding of expectations and norms within the individuals social constructs (p. 1219).

The event of losing one’s home is traumatic enough. What accompanies loss of home is loss of neighbors, community, and places the family that is in this transition in a state of perpetual stress. Goodman et al (1991) cite Shinn, Knickman, & Weitzman (1989, 1991) and Sosin, Pihavin, & Westerfelt (1991), as stating that the transition from being housed to being homeless lasts days, weeks, months, or even longer. Most people living on the street or in shelters have already spent time living with friends or relatives and may have experienced previous episodes of homelessness (p. 1219).

Collins et al ( 2010) cite Wethington et al (2008) as stating that “Although exposure to the social ecology of urban poverty carries significant risk, most children continue to function well and do not develop PTSD” (p. 13). Through supportive relationships with family and friends, these children learn and use coping and problem-solving skills that encourage positive adaptation. Problem solving, coping skills, trauma history, intelligence, supports, poor attachments, and gender of the child are some of the risks and protective factors that children living in poverty can either benefit from or limit children’s ability to adapt and grow (Collins et al, 2010, p. 13) .

Children are the most susceptible to traumatic experience and this susceptibility only increases when they are faced with displacement of home. Goodman et al (1991) state that those that are homeless experience trauma from the process of being homeless but also are traumatized by lack of safety and loss of control in the shelter system (p. 1219) . For many children, stability means going to school each day where their friends are and going home at the end of the day to their family to their bedroom and their space.

One of the most traumatizing experiences that the homeless have is that of leaving the societal norm of what is considered normal for housing and entering into something that is viewed as less than desirable by society. (Goodman et al, 1991, p. 1220). Bowlby ( 1969, 1973) as cited in Goodman et al (1991) states that humans need intimate and long lasting attachments and for homeless children the loss of safety and autonomy makes creating secure emotional attachments difficult (p. 1220). Van der Kolk( 1987) as cited in Goodman et al ( 1991) proposes that “psychological trauma is the perceived severance of secure affiliative bonds, which damages the psychological sense of trust, safety, and security” (p. 1220). Trauma victims that are placed in an unknown and perceivably unsafe living situation often exacerbate their trauma and this often causes distrust and isolation from the social supports of the traumatized, homeless victim ( Goodman et al, 1991, p. 1220). Goodman et al (1991) state that homeless individuals who are able to enter into shelters in their own communities are better off because they can maintain already established connections; otherwise, those made to move out of their neighborhoods many times experience difficulty maintaining ties to that community. Goodman et al (1991) states that, “Physical distance may engender a sense of psychological distance that increases the sense of isolation. Shelter providers should encourage and help homeless residents maintain social networks, thereby building on strengths rather than focusing on deficits” (p. 1222).

By becoming homeless, the individual can often no longer continue their normal routine or functioning extending to work, friends, and otherwise. They lose control over their personal space and their needs which they are forced to rely on others for. Goodman, Saxe, and Harvey (1991) state that the homeless, “may depend on help from others to fulfill their most basic needs, such as eating, sleeping, keeping clean, guarding personal belongings, and caring for children” (1221) . Many shelters separate families, women and children go into one shelter and men in another making what is a stressful situation even worse by further fragmenting families and taking away natural supports put in place within the family as well as removing a potential “safe person” for each individual in the family.

The victimization experienced by homeless women in New York City ranged from 43% being raped by a member of their family, 74% reporting physical abuse, and 25% were robbed (D'Ercole & Struening, 1990 as cited in Goodman et al, 1991, p. 1222). Bassuk and Rosenberg (1988) compared homeless and housed mothers in Boston and found 41% of homeless compared to 5% of housed experienced physical abuse during childhood, and 41% of homeless and 20% of housed had experienced intimate partner violence in their adult lives (Goodman et al, 1991, p. 1222). Collins et al (2010) found in a national study that “50% to 90% of adults in the United States have experienced one or more traumatic events; and 10% to 20% of those exposed will develop all of the symptoms necessary to establish a diagnosis of PTSD” ( p. 21) . Wilson( 2005) cited Newmann and Sallman’s ( 2004) finding that women who experience child abuse are at much higher risk to develop disorders such as anxiety, and substance abuse than women who did not experience child abuse. It was also found that women who experienced sexual abuse as a child ran a higher risk of developing mental health problems such as depression, anxiety, posttraumatic stress disorder among others.

Many of us, when thinking about the poor, automatically turn to third world countries; however, the statistics regarding American children are astounding. According to Collins et al (2010), “49% of American children in urban areas live in low-income families” and that “Families constitute two-fifths of the U.S. homeless population.” (p. 4). 83% of inner city teens have experienced at least one traumatic even and that in that same population, 59%- 92% who are involved in the mental health system report traumatic experiences and urban females are four times more likely to develop severe traumatic stress (Collins et al, 2010, p. 4).

In order to assist those traumatized by and in the homeless and poor communities it is important to keep in mind the family system and structure as a whole. What is important, is treating the family as a whole while recognizing past, present, and future traumas as a whole as well as the various trauma modes experienced by each individual and how that impacted each individual in the collective. Evans & English (2002) and Esposito ( 1999) as cited in Collins et al (2010) state that “There are few well-developed, standardized and empirically supported family therapies for treating family systems impacted by trauma” ( p. 2), meaning those treating family systems in impoverished communities face even a more difficult time finding a successful treatment regime. It is important to understand the effects of trauma and poverty on different family members and among familial relationships, as well as understanding the full range of family members’ responses to trauma and poverty, is critical to improving outcomes.

Collins et al (2010) states that the traumatic context of urban poverty has pervasive effects that slowly erode parent and family function and affect outcomes. Contextual risks of urban poverty (meager resources, crowded conditions, trauma, etc.) affect everyone exposed, but effects on children are exaggerated by reduced parental well-being and family functioning (p. 6).

Understanding the risks of poverty and supporting families, children and parents alike, is essential for actions by parents on children’s problem behaviors (Collins et al, 2010, p. 6).

Goodman et al (1991) states that by viewing homelessness as a psychologically traumatic experience has a number of implications for psychologists and other mental health practitioners. Given that the presence and severity of psychological trauma depends in large part on community response to victims and the overall environment in which they function (see, e.g., Green et al., 1985), improving the psychosocial conditions of shelter life could mitigate or even prevent the development or exacerbation of psychological trauma (p. 1222).

Homelessness in of itself is traumatic. The relief that supports in shelters and social services can provide victims of homelessness is insurmountable.

Homeless children and families experience trauma by virtue of losing their home, community, and stability. Homeless and impoverished people are more likely to experience other forms of trauma as well, such as physical and sexual abuse. What the homeless and impoverished need is support in finding stable employment and housing as well as assistance in addressing their past traumatic experiences. What can assist with decreasing trauma caused by homelessness is support from the surrounding communities and a willingness from society to accept poverty as a reality while breaking down barriers caused by economic status. These actions need to be taken to fully address the trauma the homeless and impoverished experience daily in the United States.


Works Cited:
Collins, K., Connors, K., Davis, S., Donohue, A., Gardner, S., Goldblatt, E., Hayward,

A., Kiser, L., Strieder, F. Thompson, E. (2010). Understanding the impact of trauma and urban poverty on family systems: Risks, resilience, and interventions. Baltimore, MD: Family Informed Trauma Treatment Center.

http://nctsn.org/nccts/nav.do?pid=ctr_rsch_prod_ar or

http://fittcenter.umaryland.edu/WhitePaper.aspx

Goodman, L., Saxe, L., & Harvey, M. ( 1991). Homelessness as psychological trauma: Broadening perspectives. American Psychologist, 46( 11), 1219- 1225.

National Child Traumatic Stress Network: Homelessness and Extreme Poverty Working Group

( 2005) . Facts on trauma and homeless children . www. NCTSNET. org.

Payne, R.K. (1996). Understanding and working with students and adults from poverty. Instructional Leader 4(2).

Payne, R.K. (2005). A framework for understanding poverty.Highlands, Tx : AHA! Process inc.

Wilson, D. ( 2005). Poverty and child welfare: Understanding the connection. Northwest Institute for Children and Familes.