January 25, 2012

Implementing Recovery-Oriented Practices

Kevin Ann HuckshornRN, MSN, CADC

Paula G. Panzer, M.D. Eric Arauz, MLER

January 25, 2012

Kevin Ann Huckshorn, RN, MSN, CADCDelaware Director for the Division of Substance Abuse and Mental Health

Paula Panzer, M.D.Director of Training and Professional Development Jewish Board of Family and Children's Services

Eric Arauz, MLERArauz Inspirational Enterprises Adjunct Instructor, Department of Psychiatry, Robert Wood Johnson Medical School New Jersey Governor’s Council on Alcoholism and Drug Abuse APNA RTP Steering and Curriculum Committees

Moderated byLarry Davidson, Ph.D.Project Director, Recovery to Practice (RTP)Development Services Group (DSG), Inc.

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Welcome

Introductions & Overview

Trauma-Informed Care: A Shift in Thinking for Service Providers

Understanding and Addressing the Impact of Trauma in a Recovery-Oriented Practice

The Trauma of Delusions

Discussion

Wilma TownsendSAMHSA/CMHS

Larry Davidson, Ph.D.DSG, Inc.

Kevin Ann HuckshornRN, MSN, CADC

Paula Panzer, M.D.

Eric Arauz, MLER

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Kevin Ann Huckshorn, RN, MSN, CADCDSAMH State Division DirectorSubstance Abuse and Mental Health

Kevin Ann Huckshorn

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Outline

What is trauma?

What is Trauma-Informed Care (TIC)?

What are the differences between a trauma-informed and uninformed service system?

Trauma assessment

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What Makes an Event Traumatic?

Traumatic Events Are

Sudden, unexpected, and extreme.

Usually involve physical harm or perceived life threat. (Research has shown perception of “life threats” is a powerful predictor of the impact of trauma.)

People experience these events as out of their control.

Certain stages of life make people more vulnerable to the effects of trauma, including childhood, teenage years, and early 20s. All presuppose a greater impact on life in adulthood.

(Tedeschi, 2011)

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Traumatic Life EventsThat Can Result in Mental Health Problems

Are interpersonal in nature: intentional, prolonged, repeated

Includes sexual abuse, physical abuse, severe neglect, emotional abuse

Includes witnessing violence, repeated abandonment, sudden and traumatic loss

Can occur in childhood, adolescence, or at any point in an adult’s lifetime depending on extent (Terr, 1991; Giller, 1999; Felitti, 1998)

The process of “becoming homeless” is widely believed to have exposed all involved to trauma; homelessness itself is traumatic

(Hopper, Bassuk, & Olivet, 2010)

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The Definition of Trauma-Informed Care

“Trauma-Informed Care is a strengths-based framework that

Is grounded in an understanding of (and on) responsiveness to the impact of trauma

Emphasizes physical, psychological, and emotional safety for both providers and survivors

Creates opportunities for survivors to rebuild a sense of control and empowerment.”

(Hopper, Bassuk, & Olivet, 2010)

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How Many People Have Experienced Trauma?

What about the people we serve?

What about people in other care settings?

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Prevalence of TraumaMental Health Population: Adults

97% of homeless women with serious mental illness (SMI) experienced severe physical and sexual abuse 87% experienced abuse in both childhood and adulthood

(Goodman et al., 1997)

90% of public mental health clients have been exposed to trauma had multiple experiences of trauma (Mueser et al., in press;

Mueser et al., 1998)

81% of adults diagnosed with bipolar disorder or Dissociative Identity Disorder (90%) were sexually or physically abused as children (Herman et al., 1989; Ross et al., 1990)

29–43% of people with SMI have posttraumatic stress disorder (PTSD) (CMHS/HRANE, 1995; Jennings & Ralph, 1997)

Image: Photo of homeless woman

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Prevalence of TraumaMental Health Population: Children & Adolescents

Canadian study of 187 adolescentsreported 42% had PTSD.

(Kotlek, Wilkes, & Atkinson, 1998)

In a U.S. study of 100 adolescent inpatients, 93% had histories of trauma and 32% had PTSD. (Lipschitz et al., 1999)

A study of one State system’s child/adolescent long-term care service users (162) found 100% had documented histories of trauma. (Massachusetts DMH, 2007)

Image: Photo of young girl

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Prevalence of Trauma: Substance Abuse Population

Up to 2/3 of men and women in SA treatment report childhood abuse and neglect. (CSAT, SAMHSA, 2000)

Study of male veterans in SA inpatient unit

77% exposed to severe childhood trauma.

58% history of lifetime PTSD. (Triffleman et al., 1995)

50% of women in SA treatment have history of rape or incest. (Gov. Comm. on Sexual and Domestic Violence, Comm. of Mass., 2006)

Image: Photo of drug-injecting man

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Prevalence of Trauma: Incarcerated Women

Framingham Women’s Prison, Mass. 90% receiving mental health services or SA services have trauma

histories. (Governor’s Task Force, Comm. of Mass., 2005)

Correctional Institute for Women, R.I. 40% – Childhood sexual abuse 55% – Childhood physical abuse 53% – Adult rape 63% – Adult physical assault 34% – Lifetime PTSD

(Zlotnick, 1997; Zlotnick, Najavits et al., 2003)

Image: Photo of imprisoned women

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Prevalence of Trauma: Incarcerated Youth

93% of males in a juvenile justice (JJ) facility reported trauma history (compared to 84% females), but more females met criteria for PTSD (18% female, 11% male). (Abram et al., 2004)

70–92% of incarcerated girls reported sexual, physical, or severe emotional abuse in childhood. (DOC, 1998; Chesney & Sheldon, 1997)

PTSD prevalence data varies widely:

3–50% in JJ settings and up to eight times higher than community samples of same-age peers. (Arroyo, 2001; Garland et al., 2001; Teplin et al., 2002; Saigh et al., 1999; Saltzman et al., 2001)

Image: Photo of imprisoned man

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Trauma Prevalence

The prevalence of trauma appears to be a link or “cross cutting principle” that affects people receiving services in all human service and health care settings.

These individuals often experience depression, SA, serious mental conditions, vulnerability to re-victimization, difficulty working, and/or impaired social networks.

(Hopper, Bassuk, & Olivet, 2010)

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Pervasiveness of Trauma

“In my own case, growing up in an alcoholic home, I came to accept chaos as a normal state of affairs rather than the exception. I wound up sabotaging my first marriage simply because the calm left me unsettled and nervous; I had to create chaos where none existed because that's all I was familiar with.”

—Suzanne Somers, actress and author

Image: Photo of Suzanne Somers

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Well Known and Not-So-Well-KnownPeople Aren’t Immune from Trauma

Desperate Housewives star Teri Hatcher revealed she was sexually abused by her uncle after he was arrested for molesting another girl.

Many well known and not-so-well-known people have experienced trauma.

Image: Celebrity photos

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What Does All of This Mean?

Great question. A lot of really smart people are working on this answer. What we do know …

Most of the people served in …

MH/SA treatment settings

DOC or JJ systems

Homeless systems

… have trauma histories.

Many people served in other care systems have experienced trauma (ID, TBI, elderly).

People who are not in care settings may also experience trauma—that means our staff, too.

(Hodas, 2004; Frueh et al., 2005; Mueser et al., 1998; Lipschitz et al., 1999; NASMHPD, 1998)

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Trauma: The interface Between Exposure, Choices, and Health Status

Research has focused on the effects of childhood trauma on adult health outcomes:

Adverse Childhood Experiences (the ACE study) demonstrated the serious health consequences of trauma.

Increasing ACE scores correlated with increasing numbers of risky health behaviors as coping mechanisms in adulthood, including

eating disorders, smoking, substance abuse, self-harm, sexual promiscuity.

These behaviors resulted in

severe medical conditions such as heart disease, pulmonary disease, liver disease, STDs, GYN cancer, and early death.

(Felitti, Anda et al., 1998)

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OK. So People Who Get Services in Public Health Care Settings Are Most Likely Trauma Survivors. So What?

Calls for implementation of a TIC framework within our service settings

Just like in change theory, this is a multistep, staggered process that highlights three key focus areas:

Attitudes (of staff and clients)

Implementation (how do we make changes?)

Outcomes (How do we measure changes? May include quantitative or qualitative measures.)

(Hopper, Bassuk & Olivet, 2010)

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Implementing TIC: Outcomes

TIC service settings have better outcomes than “services as usual” for many symptoms and social issues and show a decrease in MH and SA symptoms/ improvement in engagement.

Trauma-informed services may have an improved and positive effect on housing stability (early research).

Trauma-informed services may lead to a decrease in crisis services use and a loss of housing and inpatient care.

Trauma-informed services are cost effective.

Clients respond better to trauma-informed services.

(Hopper et al., 2010)

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Implementing TIC: Starting Points

Do an organizational “self-assessment” if you feel the need to explore your agency’s readiness. Or “just do it.”

Identify and use a theory-based model as a guide. Document your organization’s beliefs/vision in writing and train staff accordingly.

Strive to avoid any practices that may be re-traumatizing in your system.

Implement universal trauma screening on admission, using standardized measures.

(Hopper et al., 2010)

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What if You Don’t Know if Someone Has a Trauma History? What Do You Do?

Staff in human service settings need to take a “universal precautions approach.”

Assume that everyone you serve has a history of trauma.

(Hodas, 2004)

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Universal Precautions

These kinds of “precautions” are aimed at preventing illness or injury before it happens.

Like hand-washing techniques to avoid transmitting germs or using condoms for “safe sex.”

In a trauma-informed setting, this means using strategies to ensure comfort: always be welcoming, avoid conflict/violence, meet needs assertively, and minimize any traumatic event that could hurt clients or staff.

(NETI, 2010)

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What Does All This Mean?

For the people we serve, the outcomes of traumatic life experiences primarily mean this:

“The loss of ability to regulate the intensity and duration of affect …” (Schore, 2003)

“A breakdown in the capacity to regulate internal states including fear, anger, and sexual impulses.” (van der Kolk, 2005)

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The Three Contexts of HealingWhen Systems Are Trauma Informed

Safety:

A core developmental need for human beings

o The defining experience of children or adults who have been traumatized is a pervasive mistrust of those “in power,” whether these are parents, caretakers, providers, police, or other officials. These people have suffered core damage to an early developmental stage called “trust vs. mistrust.” To bridge this gap, TIC systems have to first build trust.

(Bath, 2008)

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Connections:

The second pillar of TIC expects the healthy development of relationships between service recipients and their care providers.

o These are life-giving relationships that are required to bridge the distrust these victims bring to our systems of care. People who have experienced trauma bring suspicion, avoidance, and hostility to their relationships. It is what they expect. It is our role to change this.

The Three Contexts of HealingWhen Systems Are Trauma Informed

(Bath, 2008)

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The Three Contexts of HealingWhen Systems Are Trauma Informed

Emotion and Impulse Management:

The most pervasive impact of trauma is the dysregulation of emotions and impulses. The ability to regulate these is also one of the most “fundamental protective factors” for healthy adults.

o As such, all providers of human services should understand the need to teach self-regulation skills, e.g., how to learn to “self-soothe.” Active listening can help; labeling problem behaviors and their consequences is another step in this process. Practicing new strategies—with supervision—is key.

(Bath, 2008)

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What Does a Trauma-Informed Care System Look Like?

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Trauma Informed Non-Trauma Informed

Recognition of high prevalence of trauma

Life history is appreciated/recorded

Recognition of setting/culture and practices that are re-traumatizing

Lack of education on trauma prevalence and “universal” precautions

Person seen without family/social history

“Tradition of Toughness” valued as best care approach

How would trauma be recognized?

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Trauma Informed Non-Trauma Informed

Power/Control is minimized—constant attention to practices

Language Counselors, Staff

Caregivers/Supporters—Collaboration

Address training needs of staff to improve knowledge, sensitivity, accessibility

Staff demeanor, not being helpful, authoritative tone of voice

Techs, Guards

Rule Enforcers—Compliance

“Client blaming” as fallback position without training

How would the service feel?

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Trauma Informed Non-Trauma Informed

Understand function of behaviors (rage, apathy, irresponsibility, self-injury)

Objective, neutral language

Peer staff employees are present to assist other staff in understanding the person’s perspective

Transparent systems open to outside parties

Behavior seen as intentionally provocative and volitional

Labeling language: manipulative, needy, gamey, “attention seeking”

Lack of Peer Supports

Closed system—advocates discouraged

(Fallot & Harris, 2002; Cook et al., 2002; Ford, 2003; Frueh et al., 2005; Jennings, 1998; Prescott, 2000)

How would people be respected?

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The Importance of Carefully Assessing Trauma

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Why Is Trauma Assessed?

A more sensitive review of someone’s trauma history should be conducted respectfully and shortly after your first contact in order to

Identify past or current trauma, violence, abuse experiences

Learn how trauma is expressed when the person is under duress

Incorporate this information into an individualized, person-specific care plan

Health care settings need to request this information from referral sources or do a short assessment themselves.

(Cook et al., 2002; Fallot & Harris, 2002; Maine BDS, 2000)

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Common Trauma Symptoms People Struggle With

Dissociation

Flashbacks

Nightmares

Hypervigilance

Terror

Anxiety

Negative auditory hallucinations

Numbness

Depression

Substance abuse

Self-injury

Eating problems

Sexual promiscuity

Poor judgment and continued cycle of victimization

(DSM IV-TR, 2000)

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Trauma Assessment Components

Type sexual, physical, emotional, neglect, witnessed domestic violence,

exposure to disaster, combat exposure, other

Age When the abuse occurred is important in terms of the impact on the

person’s development

Who Was abuser a stranger? A family member?

(Carmen et al., 1996)

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Trauma Assessment: Key Principles

Focus on “what happened to you?” instead of “what is wrong with you?”

Begin to develop a therapeutic relationship (trust, respect, caring) during this process.

(Bloom, 2002)

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Trauma Assessment: Key Principles

Information from the assessment and “positive responses” should be incorporated into service plans, or the assessment has no value.

Also, if previously disclosed, what happened? Ask if the person has ever told anyone, at all …

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In Summary…

Most people who access public services have been traumatized.

When stressed, past trauma informs current behaviors.

Troubling behaviors can often be learned survival strategies.

Try to understand the consumer’s history and how to support efforts to teach self-calming and regaining control.

Practices that take away control and choice can be traumatizing.

Watch for trauma “uninformed” practices and try to prevent, avoid, or eliminate these.

Keep asking—Is what I am doing respectful and trauma informed? Is it how I would like to be treated?

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“If you can, help others;if you cannot do that,

at least do not harm them.”—Dalai Lama

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Contact Information

Kevin Huckshorn, RN, MSN, CADC

DSAMH

Phone: 302-255-9398

Email: kevin.huckshorn@state.de.us

Joan.gillece@nasmhpd.org NCTSN.org www.homeless.samhsa.gov www.nasmhpd.org

Paula G. Panzer, M.D.Director of Training and Professional DevelopmentJewish Board of Family and Children's ServicesNew York, N.Y.

Paula G. Panzer

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Understanding trauma is notjust about acquiring

knowledge.

It’s about changing the way youview the world.

—Sandra Bloom, 2007

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Because coping responses to abuse and neglect are varied and

complex, trauma survivors may carry any psychiatric diagnosis and

frequently trauma survivors carry many diagnoses.

Sidran Institute, 2010

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We Create Shared Definitions …

… to create a common understanding and language

We start with those involved in the dialogue

Consumers

Clinicians

Community partners

We define to develop policies and practices

We check in to make sure the definition is relevant

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Trauma

Traumatic Stress

Traumatic Stress Disorders

Trauma-Informed Care

Trauma-Specific Services

Shared Definitions

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Trauma Traumatization

Trauma—something that threatens

one’s psychic or physical integrity

Traumatization occurs when both internal and external resources are inadequate to cope with external threat. (Bessel van der Kolk, 1989)

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Traumatic Stress and Traumatic Stress Disorders

Physical and emotional responses

of an individual to trauma

When traumatic events overwhelm

an individual’s ability to cope and

elicit feelings of terror,

powerlessness, rage, and out-of-

control physiological arousal

Disorders related to and/or

specifically a result of trauma

exposure

PTSD

ASD

DID

…DES NOS

And then some less clearly defined

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Trauma-Specific Services (TSS)

Trauma-Specific Services (TSS) are models designed to treat the

psychological and behavioral consequences of trauma exposure.

Targeted to the period of time relative to trauma exposure (immediate,

short-term, and delayed) and to the type of reactions and symptoms

being addressed (e.g., supporting adaptive coping after a disaster or

treating chronic PTSD).

Based upon evidence for effective interventions.

TSS should be delivered in a TIC system.

TSS are recovery oriented ONLY when offered in a person-centered and

empowering manner.

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Trauma-Informed Lens and Assessment

Trauma-informed work requires use of

an informed lens.

Trauma histories and trauma

symptoms are not usually

spontaneously offered.

We must ask.

Image: Sunglasses

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Traumatic Stress Responses and Symptoms

Activation responses

Trigger response

Level of activation

Avoidance responses

Emotional numbing, dissociation, denial, thought suppression

Intrusive and incomplete remembrance

Avoidance of trauma reminders

Re-experiencing

Hyperarousal

Trauma-related, sexualized, aggressive, or oppositional behaviors

Dissociation

Unsafe behaviors

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AVOIDANCE

Many consumers won’t initiate discussion about trauma exposure because they

may fear talking about the trauma will trigger them and cause an intense and painful reaction

may feel embarrassed, guilty, responsible for, or stigmatized by experiences

trauma memories are typically fragmented and confusing

some have been rejected or further injured with prior attempts to tell

past experiences with telling have been too painful

abusers threatened retaliation if the secret was revealed

Many clinicians are reluctant to initiate discussion about trauma exposure

studies show clinicians underestimate the incidence of consumer trauma exposure and fail to ask

fear it will be too distressing for their consumers

fear the effect it will have on them, or feel they don’t have the skills to help the consumer after disclosure

undervalue the story of the trauma and overvalue their assumptions on the consumer

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Subjective Unit of Distress Scale (SUDS)

Image: “The Feeling Thermometer” chart

Therapeutic Window

4-7

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PTSD Protective Factors

PTSD is a failure of natural recovery with both risk factors and protective factors.

Social support is a key mediating factor

Believing and validating the experience

Feeling good about one’s own actions in the face of danger

Cognitive and self-regulation abilities

Positive belief about oneself

Motivation to act effectively in environment

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Factors to Consider for Treatment Planning

How trauma history is impacting current behavior

How triggers/reminders are impacting behavior

Establish purpose for a trauma-specific intervention

Be mindful of ongoing trauma and environmental risks

Consumer to establish goals

That address symptoms and function

That take into consideration the power of avoidance

That respect meaning making and coping

That start from a strengths perspective

Clear roles for consumer and clinician over the course of the intervention and the value of community supports

Image: Unlatched chest

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Risks of Not Treating Trauma-Related Disorders

Consumer not heard, valued, understood

Most trauma-specific disorders are treatable

The trauma-specific distress can disrupt functioning and exacerbate co-occurring disorders

Missed opportunity for human connections

Missed chance for meaning making

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Trauma-Specific Services

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Trauma-Specific Servicesin a Recovery-Oriented Practice

Intervention choices in response to experiencing symptoms

To prevent or minimize symptoms

To manage or overcome the disorder

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Get to Know the Treatments

Evidence-based/supported trauma tx CBT

TF–CBT; CTG–CBT

CPT

CPP

TST

STAIR

EMDR

SPARCS

TREM

Seeking Safety

PE (Prolonged Exposure)

Medication

Others?

Non-trauma-specific EBTs and non-EB treatments often used with traumatized consumersDBT

MST

FFT

STEPPS

PCIT

Somatic treatments (sensorimotor, somatic experiencing, yoga, etc.)

Psychodrama therapy

Narrative Therapy

IPT

Others?

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Commonalities of Phased Trauma Treatments

1. Safety and stabilization—preparatory phase; purpose is to restore and/or strengthen consumer’s sense of safety and coping skills, and can include the following. Elements of phase will be repeated and reinforced throughout the next two phases.

a) Skills for affect and interpersonal regulation

b) Learning and practice of coping, relaxation, and grounding techniques

c) Psychoeducation

d) Cognitive coping techniques, thought stopping, and attention shifting

e) Provides opportunity for consumer and clinician to build a therapeutic alliance

f) Makes use of spirituality and safe connections

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Phase One: Safety and Stabilization (cont’d)

Managing Emotions

Affective education and regulation

Grounding techniques

Breathing retraining

Progressive muscle relaxation

Imagery

Self-talk

Containment and distraction

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Phase One: Safety and Stabilization (cont’d)

Feeling Identification

Identification of affect and intensity

Labeling feelings

Identification of connection between feeling, thoughts, and behaviors

Identification of how consumers experience distress, such as

Body: where the distress is located in their bodies. (Those who dissociate don’t necessarily experience distress this way.) Sense of body in space.

Racing thoughts

Grounding

Necessary first step for affect regulation and active coping

Early, temporary way to manage and contain overwhelming feelings by focusing on a specific sensory pathway for containment

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Commonalities of Phased Trauma Treatments

2. Remembrance and mourning—provides some form of exposure therapy whereby traumatic events are recalled and cohesively assembled. This phase helps end cycle of PTSD (and is done when it is POST trauma). Exposure can include the following

a) Creation of trauma narrative

b) Processing and integration of traumatic experiences

c) Desensitization through repeated telling of trauma story and/or exposure to fears or aspects avoided

d) Addressing 1 & 2 distorted cognitions

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Commonalities of Phased Trauma Treatments

3. Reconnection—emotions and cognitions revealed during the exposure phase are examined; treatment moves beyond trauma experience and is connected to consumer’s interpersonal life

a) Identification and modulation of cognitive distortions

b) Meaning making

c) Processing and integration of trauma experience

d) Preparation for returning to daily life

e) Coping with real losses as a result of the trauma(s)

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Shared Characteristics of EB and Promising Practices

Function as service components within systems of care

Are provided in the community

Utilize natural supports and partner with families, with training and supervision provided by those with formal training

Operate under the auspices of all systems serving children, adults, and families

Integrated with other treatment interventions

Recovery-oriented focus

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Secondary Traumatic Stress (Overview)

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Secondary Traumatic Stress

Secondary Traumatic Stress is a natural, normal, potential effect of empathic engagement with a traumatized person.

Doing our job puts us at risk for secondary trauma.

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Different Levels of Effects

First order Effects—Lower level

Belief systems

Personal control and invulnerability

Personal competence

Live in a just and benevolent world

Goodness of others

Higher level—Effects mimic typical PTSD symptoms

Re-experiencing

Numbing/arousal

Hyperarousal

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Risk Factors

Degree of Exposure—(thought to be the primary risk factor)

qualitative and quantitative/cumulative

Intensity of work demand/stress overload

Personal history of trauma

Lack of social support/isolation

Punitive work environment

Lack of appropriate and supportive supervision

Exposure to acts of terrorism and violence outside of work

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Protective Factors: Systemic, Professional, Personal

Self-awareness

Self-nurturance

Escape (not trauma avoidance!)

Humor

Active Coping

Connection—Support

Meaning Making

Transformation

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Enact Balance

Outlays of Energy

… Balanced by …

Replenishment of Energy

Image: Balance scale

(Mary Jo Barrett, 2009)

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Personal Self-Care Within the Workplace

Pacing—time management skills

Build in time to talk to colleagues and have a collegial support system in place

Build a personal sense of safety and de-stress: take breaks—even for a few minutes at a time, eat lunch, walk, breathe, don’t answer every call immediately, flowers in office, music you like

Utilize supervision and crisis help

Managing and tolerating the strong effects raised in the course of this work

Review your caseload—how many consumers have trauma histories? Can changes be made moving forward?

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Personal Self-Care Outside the Workplace

Consider therapy for unresolved trauma, which the therapeutic work

may be activating

Practice stress management through meditation, prayer, conscious

relaxation, deep breathing, and exercise

Keep in contact with trusted others

Engage in hobbies and enjoyed activities

Get quiet time

Develop a written plan focused on maintaining work–life balance

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Contact Information

Paula G. Panzer, M.D.

Jewish Board of Family and Children’s Services

New York, N.Y.

Center for Trauma Program Innovation

Martha K. Selig Educational Institute

ppanzer@jbfcs.org

www.jbfcs.org

Eric Arauz, MLER Arauz Inspirational Enterprises

Eric Arauz, MLER

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The Trauma of Delusions

Image: Pablo Picasso’s “Guernica”

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Image: Man being attacked by shark

…this led to a lifelong phobia of sharks.

While in a manic episode, a man had a recurring delusion of a shark attack…

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The Blasphemy of Mania

Image: “Man of Fire,” Jorge Orozco

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Religious Feeling Emulates Sickness

Mental illness has stolen God from me …

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Recovery

“The patient must find the courage to direct his attention to the phenomena of his illness. His illness must no longer seem to him contemptible, but must become enemy worthy of his mettle, a piece of his personality, which has solid ground for its existence, and out of which things value for his future life have to be derived.” —Sigmund Freud (from Trauma and Healing, Dr. Judith Herman)

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“Art, not psychology, is the language of emotions.”

Critique of Religion and Philosophy (1958), Walter Kaufmann

Image: “The Madhouse,” Francisco de Goya

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Language of Madness

Language of the heart: addiction

Alternative to clinical language

Feel versus logic

Subjective versus objective

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Frankenstein (1818), Mary Shelley: Created by doctors; conscious of his otherness to society; stigmatized as monster

Diary of a Madman (1835), Nikolai Gogol: Narrative of delusions; elucidates the progression of madness

Hamlet (1603), William Shakespeare: Duality of mind; aware that thought may not be sound

The Metamorphosis (1915), Franz Kafka: Experience of turning into something your family fears and does not understand; what it can feel like after hospital

“Freak on a Leash” (1998), Korn: “Something takes a part of me, Something lost and never seen, Every time I start to believe, Something’s raped and taken from me, from me”; hyperarousal of biological disease

Resources for Practitioners

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President, Arauz Inspirational Enterprises LLC

Adjunct Instructor, Psychiatry: Robert Wood Johnson Medical School

Special State Officer, N.J. Governor’s Council on Alcoholism and Drug Abuse

New York Times Contributor

International Trauma Trainer

2009 SAMHSA/U.S. Department of Health and Human Services “Voice Award” recipient for National Advocacy

Lecturer at SAMHSA, NASMHPD, Yale University, Purdue University, Bristol–Myers Squibb, etc.

Featured on ABC’s Good Morning America “Now–Mind and Mood” special

Keynote 2010 American Psychiatric Nurses Convention in Louisville, K.Y.; numerous national keynotes

Disabled American veteran who served in U.S. Navy in Operation Desert Shield

Eric Arauz, MLER

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Contact Information

Eric Arauz, MLER

www.ericarauz.com

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Q&A, Discussion, and Summary

To ask a question, click on the Q/A tab and type your question in the window that opens, or press *1 for the operator, who will take your question in the order in which it is received.

Larry Davidson, Ph.D.

Project Director, Recovery to Practice

DSG, Inc.

ldavidson@dsgonline.com

Thanks for joining our Webinar today!

Image: Photo of Larry Davidson, Ph.D.

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