Trauma and Post Traumatic Stress

Dr. Janet Louise Parker,B.S., M.S., D.V.M.

Medical Whistleblower

“People are like stained glass windows. They sparkle and shine when the sun is out; but when the darkness sets in, their true beauty is revealed only if there is a light within.” Elizabeth Kübler-Ross

Positive Stress (or eustress)

• Competent management• Mature leadership • Everyone is valued and supported.

enhances well-being • Enhances performance and fuels

achievement.

Negative Stress (or distress)

• Threat • Coercion • Fear • Dysfunctional and inefficient

management • Diminishes quality of life • Injury to health

Post Traumatic Stress

Post Traumatic Stress Disorder (PTSD) is a natural emotional reaction to a deeply shocking and disturbing experience. It is a normal reaction to an abnormal situation.

Who Gets PTSD

• Crime Victims• Persons experiencing death of family

member, friend, co-worker• Returning Veterans • Cancer Survivors & their family• Domestic Violence Victims• Sexual Assault Victims • Targets of Workplace Bullying

Origin is External not Internal• Any human being has the potential to

develop PTSD

• Cause external – Psychiatric Injury not Mental Illness

• Not resulting from the individual’s personality – Victim is not inherently weak or inferior

DSM-IV-TR (APA, 2000)

Impact of Trauma

• Difficulty trusting others and forming close relationships (may appear withdrawn, uncooperative, defensive or aggressive).

• Fear or concern about safety.

• Difficulty managing and expressing feelings.

• Lack of belief in self-worth and capabilities.

Hyper-arousal

• Hypervigilance• Irritability• Depression• Prone to anger• Exaggerated startle

response

• Sleep disturbance• Dissociation• Problems of concentration• Vulnerability to medical illness

Traumatic Memory

• Intrusive recollections

• Nightmares

• Emotional (somatic)

memories, actingout/

reliving trauma.

• Reenactment play • Perceptual

illusions

• Dissociation, memory retrieval

Denial

• Avoidance• Emotional numbing, • Amnesia, • Loss of active

social interpersonal

engagement,

• Substance abuse,• Social/geographical

isolation• Desexualization,

estrangement and detachment• Obsessive-

compulsive• Attention diversion

as defense

Self-concept, Ego states• Demoralization,

ego fragmentation

• Identity diffusion

• Vulnerability • Loss of spirit and

vitality, dysphoria,

• Prone to dissociation, hopelessness and helplessness

• Shame, guilt

• Misanthropic beliefs

• Faulty cognitions

Interpersonal relations:• Alienation

• Mistrust

• Detachment

• “Boundary” problems with others

• Issues of loss, abandonment

• Impulsiveness

• Self-destructive relationships

Patterns of anticipation

• Individuals suffering from PTSD live daily life as if the traumatic experience is recent, even though it may have happened years earlier.

• Triggers will cause the event to be re-experienced.

• “Isolation and paralysis of the mind”(Holter, 2005, abstract).

NCPTSD, July 4, 2007

• 32 % War experiences• 48 % Abuse (spousal, childhood,

sexual, bullying)• 19 % Crime• 18 % Accidents• 8 % Acts of terrorism• 5 % Natural disasters

Response to Chronic Stress

• Breakdown of immune system• Increased heart rate and blood pressure • Increased cortisol level • Shrinking of the hippocampus

(affecting learning and memory) • Enlargement of the amygdala

(affecting emotional behaviors)

Dissociation

• PTSD is “soul murder”

• Disconnection between the traumatic events and the meaning associated with those events

• Interferes with ability to verbalize the events and their meaning

3 Levels of Victimization1. Loss of feelings of safety, loss of

perception of an orderly world, and loss of a positive sense of self.

2. People do not believe, and deny the severity of the trauma thus blaming and stigmatizing the victim. (Ridicule and Punishment)

3. Perceiving oneself as a victim with no personal power

Daubert Standard

• Standard for admitting expert testimony

• Scientific basis for professional opinions

Federal Rule of Evidence 702 when evaluating claims of psychological injuries as authorized by the Civil Rights Act of 1991

Trauma-Informed ServicesTrauma-informed• Problems/Symptoms are

inter-related responses to or coping mechanisms to deal with trauma.

• Providing choice, autonomy and control is central to healing.

• Primary goals are defined by trauma survivors and focus on recovery, self-efficacy, and healing.

• Proactive – preventing further crisis & avoiding retraumatization.

Traditional Approaches

• Problems/Symptoms are discrete and separate.

• People providing services are the experts. Trauma Survivors broken, & vulnerable.

• Primary goals are defined by service providers and focus on symptom reduction.

• Reactive – services and symptoms are crisis driven and focused on minimizing liability.

Understanding Trauma

• Understanding trauma response and its triggers.

• Anxiety causes traumatized individuals to have difficulty in processing information.

• Recognize behaviors as adaptations.

• Identify and reduce triggers to avoid re-traumatization.

Poor Support – Intensifies Damage When an individual

suffering from PTSD is unable to resolve issues related to the trauma he/she is unable to establish a new baseline of biopsychosocial functioning.

Secondary Re-Traumatization• The loss of human potential is

incalculable.

• Society has a tendency to blame the victim for not being able to simply “get over it” and this cultural lack of support can be classified as secondary wounding and promotes a victim mentality, thus keeping the problem going.

“Human beings, like plants grow in the soil of acceptance, not in the atmosphere of rejection.” John Powell, S.J.

Re-Experiencing Trauma

• Re-experiencing original trauma (symbolically or actually).

• Trauma Survivor responds as if there is danger even if it is not actual danger.

• Triggers may be subtle and difficult to identify.

“One of the most courageous things you can do is identify yourself, know who you are, what you believe in, and where you want to go.” Sheila Murray Bethel

Trauma Victims Disposable?• Our society views many objects as

disposable and when an object is tarnished or dented the tendency is to deem its value gone, throw it away, and rush to the stores to replace it.

• Humans are not objects, and the growth potential available though the healing process is infinite.

From Vulnerability to Strength

Celebration – Self ActualizationOvercoming Vulnerability – Recognition Compensation – Self Esteem Needs

Sharing with Others (Sense of Belonging)

Exploring Protection Needs Identifying Safety Needs Denial of Vulnerability Elimination of Danger Vulnerable

Promoting Safety• Because PTSD is “soul murder” and splinters

the sense of self, and creates acute mistrust in the individual’s environment .

• Provide a safe physical environment.

• Provide emotional safety: tolerance for wide range of emotions.

• A Sense of Safety is Critical to relationship building.

Build Trust – Long Term Process• PTSD changes the diagnosed

individual’s life and greatly impacts the lives of those with whom they are close and regularly interact.

• Trusting relationships are essential to combat the dehumanizing effect of trauma.

Supporting Control,Choice & Autonomy

• Trauma survivors feel powerless.

• Equalize power imbalances.

• Recovery requires a sense of power and control.

• Relationships should be respectful and support mastery.

• Trauma Survivors should be encouraged to make choices.

Communicating Openly “If I can listen to what he tells me, if I

can understand how it seems to him, if I can sense the emotional flavor which it has for him, then I will be releasing potent forces of change within him.”

Carl Rogers

• Respect Trauma Survivor’s right to open expression.

• Discourage withholding information or keeping secrets.

Integrating Care

• Because of the dehumanizing nature of trauma it is important that care approaches deal with the client holistically as opposed to treatments designed solely to reduce symptoms.

• Trauma Survivor’s symptoms and behaviors are

adaptations to trauma.

• Services should address all of the survivor’s needs rather than just symptoms.

Fostering Healing• Humans are not objects, and the growth

potential available though the healing process is infinite.

• Instilling hope.

• Strengths-based approach.

• Future orientation.

• Cultural Competence

Inward Reflection

• Trauma causes individuals to look spiritually inward.

• The “healed self that was once traumatized can project itself into the future with joy, serenity, and a measure of wisdom.” Walsh (1985)

According to Wilson et al., 2001

Individuals, once healed, are

“potential guides, healers, teachers, and may be subjects of scientific inquiry concerning resiliency, salutogenesis, and self-efficacy”

UPSIDE to Trauma?

Inspirations “Great minds have purposes, others have

wishes. Little minds are tamed and subdued by misfortune, but great minds rise above them.”

Washington Irving

“Sometimes I think that the main obstacle to empathy is our persistent belief that everybody is exactly like us.” John Powell, S.J.

“The deepest craving of human nature is the need to feel appreciated.” William James

“Great Things are not done on impulse but by a series of small things brought together.” Vincent van Gogh

Contact:

Dr. Janet Parker DVMExecutive Director

Medical Whistleblower P.O. Box C

Lawrence, KS 66044MedicalWhistleblower@gmail.com