LISTS & SYMPTOMS

One of the good things about evidence-based counseling is that they generate a lot of definitions, check-lists, and categories.  Not everyone considers that good and they can be destructive or misleading.  But right now my attention is captured by some of them.  Provisionally.

These are supposed to be the five main signs of damage from Complex Trauma:

1.  Affect dysregulation

2.  Structural dissociation

3.  Somatic disregulation

4.  Impaired self-development

5.  Disorganized attachment patterns

Now I’ll try to translate them to plain English, though maybe not exactly as their originators would see them:

1.  Getting mad or depressed or falling in love or getting high without any awareness of the connection to events and no ability to manage the extremes.  Confusion about what happened and about reactions.  I suppose bipolar disorders might fit here.  Lack of reality checks.

2.  Sectioning off one’s internal personality so that some sides are just not admitted to -- maybe not even consciously known.  I think the explanations and mechanisms of dissociation are the weakest subject in this book and so do others who are writing IN the book!  It’s not the book, it’s the concept.  This is the sexy stuff that gets dragged into schizophrenia (which may be as much or more organic as psychological) and split personalities, which appear to be much exaggerated.  Parting out personality is much more subtle and pretty much universal.

3.  Always miserable: flu symptoms, too fat, anorexic, aching, unable to sleep, a whole series of colds, whatever.  Plus what used to be called psychosomatic but could just as easily be called somatopsychic.  Does substance abuse go here?

4.  Some people don’t live up to their potential.  Maybe they don’t want to.  But maybe it’s a worrying failure to get ahold of things.  I know that feeling.

5.  Falling intensely in love, getting close to someone, then feeling oppressed and running for the exit or demanding “space” or attacking or starting a new relationship.  Choosing impossible people.  Or simply never caring much about anyone.  Even after babyhood it is important to have secure and lasting attachments, but if one didn’t have that original anchor in the proper time to form the ability (infancy), it will be very hard.  I think that’s right.  But in today’s world it kinda gets pushed onto people.  Even ministers in some denominations are moved all the time so they don’t get “too attached.”

These five probs are the usual middle-class complaints that get taken to middle-class counselors.   People sit in comfortable chairs and talk.  But things can get much, much worse.  Though this set of essays doesn’t address the following, Courtois/Ford at least lists them:

•   Economicaly impoverished inner city ethnoracial minority persons.
•   Incarcerated individuals and their children and families.
•   Homeless persons and their families.
•   Sexually and physically revictimized children or adults.
•   Victims of political repression, genocide, “ethnic cleansing,” torture or displacement.
•   Developmentally, intellectually, or psychiatrically challenged individuals.
•   Civilian workers and soldiers harassed and assaulted on the jobs or in the ranks.
•   Emergency responders who are repeatedly exposed to grotesque death and suffering.

Not on the list are child soldiers psychically emptied by committing forced atrocities against their own families.  The list missed reservations, rural economic sumps, and illegal immigrants -- but then there’s no limit to such a list, is there?   

Courtois and Ford do at least realize that the PTSD in the Diagnostic and Statistical Manual of Mental Disorders IV still doesn’t go far enough.  They provide the acronym DESNOS:  Disorders of Extreme Stress Not Otherwise Specified.  I laugh because it’s such an et cetera category, but it probably does the job, which is to simplify and shorten the label.  Also, if you have a label to google, you might actually find something you want.  If you want to know more about the condition the acronym stands for, try this: http://www.traumacenter.org/products/pdf_files/DESNOS.pdf

Desnos also turns out to be the name of a Parisian surrealist poet who died of typhoid in a concentration camp in 1945, just AFTER liberation.  http://en.wikipedia.org/wiki/Robert_Desnos  The Holocaust can definitely give a person DESNOS !!  But Robert Desnos knew the power of the word and act.   

Susan Griffin relates a story that exemplifies Desnos' surrealist spirit:

One day Desnos and others were taken away from their barracks. The prisoners rode on the back of a flatbed truck; they knew the truck was going to the gas chamber; no one spoke. Soon they arrived and the guards ordered them off the truck. When they began to move toward the gas chamber, suddenly Desnos jumped out of line and grabbed the hand of the woman in front of him. He was animated and he began to read her palm. The forecast was good: a long life, many grandchildren, abundant joy. A person nearby offered his palm to Desnos. Here, too, Desnos foresaw a long life filled with happiness and success. The other prisoners came to life, eagerly thrusting their palms toward Desnos and, in each case, he foresaw long and joyous lives.

The guards became visibly disoriented. Minutes before, they were on a routine mission the outcome of which seemed inevitable, but now they became tentative in their movements. Desnos was so effective in creating a new reality that the guards were unable to go through with the executions. They ordered the prisoners back onto the truck and took them back to the barracks. Desnos never was executed. Through the power of imagination, he saved his own life and the lives of others.

This strikes me as being on the boundary between the therapeutic and the spiritual, the liminal place where a leap to vision can change events.  In a few  of these counseling essays there is mention of spiritual factors that help people comfort, protect, and control (they say “modulate”) their trauma.  I haven’t seen this before and it is an important link for “The Bone Chalice.”  A liturgy, for either a single person or a holding community, scripted or extemporaneous, can have enormous power in this way.  

Professional counselors, no more than the general public, have a very limited understanding of how to use these resources.  Most people think that spirituality is a supernatural force that descends on lucky people, esp. those who have an inclination towards New Age captures of unfamiliar cultures.  Some are too eager to accept any magic that comes along and others will scoff and denigrate anything that isn’t concrete and proven.  Both extremes are unhelpful, but it’s tough to get people to the “meta” level where they can see past their own lives.  This specific task is an item on some of these lists of goals.

"INTERNAL FAMILY SYSTEMS THERAPY"

Psych treatments tend to form around some assumption about humans, then to “handbook” them into certain techniques, and in the crowning moment convert their description into an acronym, which then becomes a “brand” to promote in YouTube, at conferences, and in certifying protocols.  That’s just the way it works.  Of all these in “Treating Complex Traumatic Stress Disorders,” a book of essays about these systems, the one I would sign up for is “Internal Family Systems Therapy.”   (IFS)  It’s the one that rings true with my own experience both as counselor and counselee.  And there’s the least new vocabulary to learn.  

Devised by Richard C. Schwartz when working with anorexic women, you can find YouTube vids at the links I’ll append.  I like to see the faces of these people and Schwartz does not set off my bullshit detector -- some of these guys do.  (Even some of the fans do.)  He seems a quiet, earnest man, a little younger than most, at least in this vid, and describes clearly how he came to his ideas.  Standard family therapy has always seemed sensible to me, even the account of a therapist who called in the whole crew including the family parakeet -- these people had gotten in the habit of addressing each other indirectly by talking to the parakeet.  I’ve known people who only talked to the dog.

His ideas about the inner “parts” seem to me to line up well with both the brain thought-processing theories of a guy like Damasio or Gazzinaga.  Also they’re easy to reconcile with Freud’s “ego, superego, and id or libido.”  The ideas are entirely practical and even familiar.  How many times have YOU been accused of being “two people?”  Only TWO people??  Parts is parts and most of us have many.  They say you can see them form and re-form on an fMRI as the person goes from one attitude to another.  (They may exaggerate.)

But Schwartz is walking perilously close to the skitzy and flammable notions about possession, multiple personalities and all the voodoo juju encouraged by movies.  “Three Faces of Eve” and “Sybil” have been revealed as semi-hoax, pretty much invented by the patients to please beloved therapists.  Oh, let’s say “reframed” since “hoax” is another media trigger for rabble-rousing.  But IMHO Internal Family Systems Therapy would have helped both Eve and Sybil.

I was entirely enthralled by the patient/therapist transcription in this IFS chapter, much more than by the wooden accounts of other chapters.  Schwartz was working with a Vietnam combat veteran with intense PTSD.  Asked to describe in an image what his inability to end the grief was like, the man said he had a “shrouded heart.”  When asked to imagine the terrifying memories and feelings that constantly attacked him -- but safely thinking of them confined in a room and looking at them through a window -- he said they were dark spirits swirling everywhere.  Just like Harry Potter.  You think screenwriters and novelists don’t know about this stuff?  But it’s mythic in its power.

So Googling revealed that at least one person with vulnerable and disowned parts, acting out possession and fantasizing the Devil in classic witchy fashion, attacked one Schwartz (not Richard) with a lawsuit.  Far from being either an attacker or a suppressor (familiar “parts” of many institutional leaders) Richard Schwartz admits that he did damage in his early pursuit of results.  He pressed the “vulnerable parts” -- “the exiles” -- too hard, which brought the defending Maenads screaming for his head.  Anorexics are notoriously resistant to help.  Freud might call them hysterical, which isn’t particularly helpful.

For my “Bone Chalice” manuscript, I’m interested in the notion of “parts” or “aspects” of a person’s “Core Self” in two ways.  One is the idea that when one inhabits that Core Self what emerges is a kind of spiritual confidence and centeredness.  Consider this quote from Schwartz at: http://www.selfleadership.org/the-larger-self.html

But even those clients, once they experienced a sense of their own core, began to take over and acquire what looked like real ego strength on their own, without my having to shovel it into them. And yet, almost no Western psychological theories could explain where this newfound and quite amazing ability to contain and understand their inner turmoil had come from.

The more this happened, the more I felt confronted by what were in essence spiritual questions that simply couldn't be addressed in the terms of problem solving, symptom-focused, results orientated, clinical technique. I began my own novice's exploration into the literature of spirituality and religion and discovered a mother lode of esoteric writings by sages, holy seekers, wise men and women, who emphasized meditative and contemplative techniques as a means of coming to know their Self. ("Esoteric" here means not exotic or far out, but derives from the Greek esotero, which means "further in.") Though they used different words, all the esoteric traditions within the major religions – Buddhism, Hinduism, Christianity, Judaism, Islam – emphasized their same core belief: we are sparks of the eternal flame, manifestations of the absolute ground of being. It turns out that the divine within – what the Christians call the soul or Christ Consciousness, Buddhists call Buddha Nature, the Hindus Atman, the Taoists Tao, the Sufis the Beloved, the Quakers the Inner Light – often doesn't take years of meditative practice to access because it exists in all of us, just below the surface of our extreme parts. Once they agree to separate from us, we suddenly have access to who we really are.

I recognize this place.  We're back home in the Perennial Philosophy,  [http://books.google.com/books/about/The_Perennial_Philosophy.html?id=l1fs25HbCY0C ] that dependable resource for Sunday sermons.  We've arrived from far places, seeing the ideas new as if for the first time!   Protectors, persecutors, vulnerabilities, flights of fancy and screaming banshees all sitting at the Core Self’s table asking for someone to please pass the insights.  It's up to the therapist to prevent the table from being overturned.

Just because it’s not new 

Doesn’t mean it’s not true.

We shall not cease from exploration, and the end of all our exploring will be to arrive where we started and know the place for the first time.

 -- T.S. Eliot

But as Schwartz points out with considerable emphasis, the therapist as the host had better get there first so his or her own Core Self is clear and relaxed so as to pick up on what’s cookin’.  That’s why I wanted to see who was talking on these tapes with my own eyes.

http://www.youtube.com/watch?v=E88q5z7WvSo&feature=youtu.be

http://www.youtube.com/watch?v=vNLs2A1URhw&feature=related

http://www.youtube.com/watch?v=ibMlGs6Q4kk&feature=endscreen

EVIDENCE-BASED HELP FOR TRAUMATIC DISTRESS

Every time I find a new “school of thought” about psychology, I think I’ve found the Grail at last and this time the world will be healed.  That lasts a day or so.  Then I begin to research and discover what’s really useful and what is just dreck.  This time around it is “Evidence-Based” treatment, which applies to both medical and psychological cases.  It arises out of several forces, one being the amazing brain function research of the NIneties and the other coming from the “best practices” movement.  

Brain function research is something that can be demonstrated, quantified, replicated in a scientific manner, and researched further.  “Best practices” is measured by results.  Whatever works, regardless of theory schemes.  The motivation for driving towards better goals with better results in counseling comes in large part from the need to address complex traumatic stress disorders arising from war, from poverty, from substance abuse, and from confused families.  Not only do the trauma-causers seem to be increasing, we are much more aware of them than in the past.  PTSD and child abuse seem to be everywhere.

The historical sequence of waves of psych theory --  Freudian forces of sex and death grappling in the darkness; Jungian Celtic figures producing universal narratives; Skinner’s cogs and levers; the Third Force thinkers offering peak experiences, and New Age notions of imports from other cultures -- mixed with a host of people wanting to be healers -- have created a Great Chaos that sometimes has deadly consequences and certainly discredits the whole weaving of moonbeams that psych counseling can seem to be.

What got me excited about “evidence-based” practice in the first place was brain research.  The main thing is the disproving of the idea that brain cells are never renewed and that after age 37, it’s all downhill.  QUITE to the contrary, brains are living, changing, processing complexes of organs that adapt to whatever happens to the whole body.  A person who is blinded re-allocates the brain space to hearing.  A person who takes up golf or piano playing, will “grow” a whole new area of the cortex for storing the new skill.  No one knew this, because it was undetectable with the instruments of the past, though people demonstrated it all the time.

In fact, specialized CELLS -- not just organelles or complexes of connections or processing centers -- but one-by-one specialized brain cells are being found (spindle cells, pyramidal cells, mirror cells), features only found otherwise in elephants, toothed whales, and some apes.  The cells seem to endow empathy, social cooperation, and the like, which the scientists speculate are due to evolution -- not to the benefit of the individual so much as related to the survival of the species which is the real location of evolution.  Not every human has these cells, though there have not been surveys of large numbers of people since it’s so expensive to find individual cells.  It’s not hard to think of people who seem to have no empathy.

Which brings us to the next revelation: that there are certain periods on the time-line of human development that are crucial to the brain.  Most of us by now realize that a baby must have basic physical safety and care to survive, but few have really absorbed “attachment theory.”  Attachment to one human who is dependable, attentive, and responsive is the foundation of everything else in life.  Combined with the genomic potential that it helps to unfold, being able to form an attachment gives the baby the power and motivation to explore the world.

Some reseach suggests and can show on an fMRI, that there are two “modes” in which the young brain operates:  the “learning” mode is when curiosity and exploration are the main motivators.  If the baby is hurt, scared, traumatized, it goes into a second mode: “defensive.”  All energies convert over to watching for danger and taking self-protective measures like fight, flight, freeze, or hide.  The way the person sets these up in his or her brain will govern relationships for the rest of that person’s life.  Even being able to see oneself convert back and forth -- one writer compares this conversion to the sea anemone opening up and closing down -- or learning late in life to be more trusting, will always be in terms of the background of those first early lessons.

There are two more well-described periods of brain growth and elaboration, one at adolescence and one between 17 and maybe 24, the years of college or military service.  What keeps stumping me is why the period they label “adrenarche” -- 6 to 9 -- when long bones grow, adult teeth come in, and sexual organs begin to grow into their functions (though they aren’t operational yet), is not considered a time of brain development.  Freud called it latency.  But those are the years of accumulating identity and reaching the age of reason in terms of legal standing.  I suspect that this is the time of life that the specialized cells are developing rather than more easily perceived organs and connections.

I’m drawing on a book called “Treating Complex Traumatic Stress Disorders: An Evidence-Based Guide.”  Googling brought up a rebellion on the committee that is supposed to be rewriting the DMSO-IV which guides psych people and the insurance industry.  It’s the book that says what is and what is not a psychological problem.  It has to be rewritten all the time because ideas change so much.  You’d be shocked to look at an historic overview.  Anyway, all the European shrinks on the committee felt unheard and disrespected, so they left.  I’m not surprised.  The earlier counseling theory empires are hugely powerful and make a LOT of money, much of it in the US.

This book includes essays by people I would avoid, but Christine Courtois is a person whose thinking I value.  She’s worth searching on YouTube.  I’ve got this book, which she co-edited, on Interlibrary Loan from the Veteran’s Administration Center in Seattle.  The pocket card shows one borrower per year for the last two years.  Maybe counselors can afford to buy their own copies.  It is a compilation of essays by practicing psychologists.

There is nothing about criminality.  The word they use is “forensic,” though traumatic stress disorders are very much entwined with prisons and phenomena like mass murder, to say nothing of domestic abuse.  There is nothing about physical safety when people are after you with bad intentions, though safe houses for abused persons are crucial.  There is nothing about substance abuse, though one writer notes that “self-treatment with drugs and alcohol” can work to the point of being life-saving.  Nothing about sexwork at any age or at any social level from street to penthouse.   Nothing about therapy for those who impose trauma.  One of the most intriguing chapters is that about “vicarious trauma,” which is like second-hand smoke -- trauma to the witnessing healer.  Wasn’t that an HBO series?  “In Treatment”?  I”m just about to the end of “Oz.”  If I survive it, maybe I should try “The Sopranos” to see what that therapist does.