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

    1. 1. SWK 639 Trauma Theory and Treatment in Multicultural Clinical Practice
    2. 2. Trauma and Recovery: <ul><li>A Forgotten History
    3. 3. Terror
    4. 4. Disconnection
    5. 5. Captivity
    6. 6. Child Abuse </li></ul>
    7. 7. A Forgotten History <ul><li>The study of psychological trauma depends on support of political movement. </li><ul><li>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.
    8. 8. Shell shock connected to war experiences, now referred to as Post-Traumatic Stress Disorder.
    9. 9. Sexual and domestic violence work driven by feminist movement. After 1980 PTSD applied to survivors of rape, domestic battery, and rape. </li></ul><li>Without context of political movement, it is not possible to advance the study of psychological trauma. Examples? </li></ul>
    10. 10. Terror <ul><li>In 1980, PTSD added to Diagnostic Statistical Manual (DSM).
    11. 11. Three main categories of PTSD: </li><ul><li>Hyperarousal – a persistent expectation of danger.
    12. 12. Intrusion – imprint of trauma.
    13. 13. Constriction – numbing response of survivor. </li></ul></ul>
    14. 14. Terror, cont'd <ul><li>Hyperarousal: </li><ul><li>Elevated baseline of arousal (body is on alert for danger).
    15. 15. Extreme startle response.
    16. 16. Intense reaction to stimuli associated with the traumatic event.
    17. 17. Difficulty tuning out repetitive stimuli.
    18. 18. Sleep disturbance (longer to fall asleep, awaken more easily during the night).
    19. 19. Increased irritability. </li></ul></ul>
    20. 20. Terror, cont'd <ul><li>Intrusion: </li><ul><li>Relive the event as though it were continually recurring in the present.
    21. 21. Flashbacks during waking states and traumatic nightmares during sleep.
    22. 22. Resemble memories of young children in that imagery and bodily sensations are primary, and there is frequently an absence of verbal narrative.
    23. 23. Trauma can be relived in behavior (children in play therapy; adults in risk taking behavior or therapy – exposure, EMDR, etc.). </li></ul></ul>
    24. 24. Terror, cont'd <ul><li>Constriction: </li><ul><li>Keeps traumatic memories out of normal consciousness, split off from awareness.
    25. 25. In attempt to avoid reliving trauma – narrow consciousness, withdraw from engagement with others, live a more impoverished life.
    26. 26. Frozen watchfulness.
    27. 27. Perceptions numbed or distorted.
    28. 28. Out of body experience possible.
    29. 29. Disassociation (similar to hypnotic trance).
    30. 30. May accomplish numbing through use of drugs or alcohol.
    31. 31. Traumatized people restrict their lives. </li></ul></ul>
    32. 32. Terror, cont'd <ul><li>Dialectic of Trauma: </li><ul><li>Oscillation between intrusion and constriction.
    33. 33. Intrusive symptoms can reoccur years later.
    34. 34. Numbing and constrictive symptoms dominate as intrusive symptoms diminish.
    35. 35. Suicidal thoughts and behavior increase in trauma populations. </li></ul></ul>
    36. 36. Disconnection <ul><li>Traumatic events impact family attachments, friendship, love, & community.
    37. 37. Traumatic events destroy individual's assumptions about safety of the world, positive value of self, & meaningful order of creation.
    38. 38. Traumatic events thwart initiative & overwhelm competence. Trust shattered, faith destroyed.
    39. 39. Feelings of guilt exist when survivor is witness to others hurt or killed (vets, trauma—natural or man-made). Survivor guilt.
    40. 40. Survivor experiences feelings of shame & inferiority.
    41. 41. Above fosters withdrawal from close relationships—survivor may go between isolation & clinging to others. </li></ul>
    42. 42. Disconnection, cont'd <ul><li>Direct relationship between severity of trauma and its psychological impact.
    43. 43. 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).
    44. 44. Highly resilient people able to make use of opportunity for purposeful action w/others vs. being more easily paralyzed/isolated by terror.
    45. 45. Support essential, beginning w/building of trust (preserve attachment, assurance of safety & protection essential).
    46. 46. Survivors need support to mourn losses.
    47. 47. Social attitudes towards victims & vets impact recovery. </li></ul>
    48. 48. Captivity <ul><li>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).
    49. 49. Political captivity recognized, while domestic captivity is frequently unseen.
    50. 50. Two steps in creating captive situations: 1) psychological domination, & 2) total surrender. </li></ul>
    51. 51. Captivity, cont'd <ul><li>Psychological Domination </li><ul><li>Systematic, repetitive infliction of psychological trauma.
    52. 52. Instill terror & fear, & destroy the victim's sense of self in relation to others.
    53. 53. Generally unnecessary to use violence—threat of death or serious harm sufficient, & threats against others as effective as threats against victim.
    54. 54. Destroy victim's sense of autonomy (create dependency financially and emotionally).
    55. 55. Isolate victim from information, material aid, or emotional support. Destruction of attachment with others and internal images of connection to others. </li></ul></ul>
    56. 56. Captivity, cont'd <ul><li>Total Surrender </li><ul><li>Occurs when victim forced to violate her own moral principles and to betray her basic human attachments (victim is truly broken).
    57. 57. Victim is forced to witness or participate in violence toward others, perhaps particularly someone close to them.
    58. 58. 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). </li></ul></ul>
    59. 59. Captivity, cont'd <ul><li>Chronic Trauma Syndrome </li><ul><li>Individuals subjected to prolonged, repeated trauma experience a form of PTSD that erodes the personality (Complex Trauma).
    60. 60. Continually hypervigilant, anxious, & agitated.
    61. 61. Intrusive symptoms may persist for years.
    62. 62. Constriction in relationships, activities, thoughts, memories, emotions, & sensations (adaptive in captivity, needs to be unlearned).
    63. 63. Complain of insomnia, agitation, & numerous somatic symptoms.
    64. 64. Alter consciousness through dissociation, suppression, minimization, & denial.
    65. 65. Perpetrator may be seen as savior or source of life.
    66. 66. New identity includes memory of trauma.
    67. 67. Preoccupation w/shame, self loathing and sense of failure.
    68. 68. PTSD and depression frequently co-exist.
    69. 69. Rage can become internalized with increase risk of self harm and suicidality, or external in form of abuse or homicide. </li></ul></ul>
    70. 70. Twist of Faith <ul><li>What to look for in film excerpts: </li><ul><li>PTSD symptoms (hyperarousal, intrusion, & constriction).
    71. 71. Suicidal ideology
    72. 72. Impact on relationships with self, family, & friends
    73. 73. Impact on sense of safety in the world
    74. 74. Examples of survival guilt
    75. 75. Areas of resilience
    76. 76. Sources of support
    77. 77. Examples of psychological domination and total surrender
    78. 78. PTSD vs. depressive symptoms </li></ul></ul>