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Lecture for april 9

Lecture for april 9







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  • Most victims do not pursue legal/criminal avenues, and vets feel judged for political views of war.

Lecture for april 9 Lecture for april 9 Presentation Transcript

  • SWK 639 Trauma Theory and Treatment in Multicultural Clinical Practice
  • Trauma and Recovery:
    • A Forgotten History
    • Terror
    • Disconnection
    • Captivity
    • Child Abuse
  • A Forgotten History
    • The study of psychological trauma depends on support of political movement.
      • Hysteria in women linked to history of trauma. Lack of political context led to Freud withdrawing support of link between history of abuse and adult symptoms in women.
      • Shell shock connected to war experiences, now referred to as Post-Traumatic Stress Disorder.
      • Sexual and domestic violence work driven by feminist movement. After 1980 PTSD applied to survivors of rape, domestic battery, and rape.
    • Without context of political movement, it is not possible to advance the study of psychological trauma. Examples?
  • Terror
    • In 1980, PTSD added to Diagnostic Statistical Manual (DSM).
    • Three main categories of PTSD:
      • Hyperarousal – a persistent expectation of danger.
      • Intrusion – imprint of trauma.
      • Constriction – numbing response of survivor.
  • Terror, cont'd
    • Hyperarousal:
      • Elevated baseline of arousal (body is on alert for danger).
      • Extreme startle response.
      • Intense reaction to stimuli associated with the traumatic event.
      • Difficulty tuning out repetitive stimuli.
      • Sleep disturbance (longer to fall asleep, awaken more easily during the night).
      • Increased irritability.
  • Terror, cont'd
    • Intrusion:
      • Relive the event as though it were continually recurring in the present.
      • Flashbacks during waking states and traumatic nightmares during sleep.
      • Resemble memories of young children in that imagery and bodily sensations are primary, and there is frequently an absence of verbal narrative.
      • Trauma can be relived in behavior (children in play therapy; adults in risk taking behavior or therapy – exposure, EMDR, etc.).
  • Terror, cont'd
    • Constriction:
      • Keeps traumatic memories out of normal consciousness, split off from awareness.
      • In attempt to avoid reliving trauma – narrow consciousness, withdraw from engagement with others, live a more impoverished life.
      • Frozen watchfulness.
      • Perceptions numbed or distorted.
      • Out of body experience possible.
      • Disassociation (similar to hypnotic trance).
      • May accomplish numbing through use of drugs or alcohol.
      • Traumatized people restrict their lives.
  • Terror, cont'd
    • Dialectic of Trauma:
      • Oscillation between intrusion and constriction.
      • Intrusive symptoms can reoccur years later.
      • Numbing and constrictive symptoms dominate as intrusive symptoms diminish.
      • Suicidal thoughts and behavior increase in trauma populations.
  • Disconnection
    • Traumatic events impact family attachments, friendship, love, & community.
    • Traumatic events destroy individual's assumptions about safety of the world, positive value of self, & meaningful order of creation.
    • Traumatic events thwart initiative & overwhelm competence. Trust shattered, faith destroyed.
    • Feelings of guilt exist when survivor is witness to others hurt or killed (vets, trauma—natural or man-made). Survivor guilt.
    • Survivor experiences feelings of shame & inferiority.
    • Above fosters withdrawal from close relationships—survivor may go between isolation & clinging to others.
  • Disconnection, cont'd
    • Direct relationship between severity of trauma and its psychological impact.
    • Resilience matters: stress resistant individuals have high sociability (perhaps not in instances involving rape), thoughtful/active coping style, & strong perception of ability to control their destiny (internal locus of control).
    • Highly resilient people able to make use of opportunity for purposeful action w/others vs. being more easily paralyzed/isolated by terror.
    • Support essential, beginning w/building of trust (preserve attachment, assurance of safety & protection essential).
    • Survivors need support to mourn losses.
    • Social attitudes towards victims & vets impact recovery.
  • Captivity
    • Repeated trauma occurs when victim is a prisoner, unable to flee, & under the control of the perpetrator (e.g., prisons, concentration camps, slave labor camps, religious cults, brothels, & families).
    • Political captivity recognized, while domestic captivity is frequently unseen.
    • Two steps in creating captive situations: 1) psychological domination, & 2) total surrender.
  • Captivity, cont'd
    • Psychological Domination
      • Systematic, repetitive infliction of psychological trauma.
      • Instill terror & fear, & destroy the victim's sense of self in relation to others.
      • Generally unnecessary to use violence—threat of death or serious harm sufficient, & threats against others as effective as threats against victim.
      • Destroy victim's sense of autonomy (create dependency financially and emotionally).
      • Isolate victim from information, material aid, or emotional support. Destruction of attachment with others and internal images of connection to others.
  • Captivity, cont'd
    • Total Surrender
      • Occurs when victim forced to violate her own moral principles and to betray her basic human attachments (victim is truly broken).
      • Victim is forced to witness or participate in violence toward others, perhaps particularly someone close to them.
      • Two stages of brokenness: 1) victim relinquishes inner autonomy, world view, moral principles, or connection w/others for sake of survival (reversible), & 2) victim loses the will to live (irreversible).
  • Captivity, cont'd
    • Chronic Trauma Syndrome
      • Individuals subjected to prolonged, repeated trauma experience a form of PTSD that erodes the personality (Complex Trauma).
      • Continually hypervigilant, anxious, & agitated.
      • Intrusive symptoms may persist for years.
      • Constriction in relationships, activities, thoughts, memories, emotions, & sensations (adaptive in captivity, needs to be unlearned).
      • Complain of insomnia, agitation, & numerous somatic symptoms.
      • Alter consciousness through dissociation, suppression, minimization, & denial.
      • Perpetrator may be seen as savior or source of life.
      • New identity includes memory of trauma.
      • Preoccupation w/shame, self loathing and sense of failure.
      • PTSD and depression frequently co-exist.
      • Rage can become internalized with increase risk of self harm and suicidality, or external in form of abuse or homicide.
  • Twist of Faith
    • What to look for in film excerpts:
      • PTSD symptoms (hyperarousal, intrusion, & constriction).
      • Suicidal ideology
      • Impact on relationships with self, family, & friends
      • Impact on sense of safety in the world
      • Examples of survival guilt
      • Areas of resilience
      • Sources of support
      • Examples of psychological domination and total surrender
      • PTSD vs. depressive symptoms