Postcard Project on the Culture of Foster Care

Link to "Without A Tribe"

http://withoutatribe.blogspot.com/2007/05/session-with-betty-throwing-yourself.html

Triggers and Vietnam War veterans

Some veterans from the Vietnam War were so traumatized that any loud noise similar to the sound of gunshot triggered flashbacks of the war.

Grown men rolled into a gutter in order to 'take cover' from the sound of a car backfiring. The sound triggered a full-body reenactment of the war experience.

This experience of post-traumatic stress disorder was not under the veteran's concious control. It was an automatic response when the neural network associated with the trauma of war was triggered.

Again, take note that a Harvard/Casey study has proven that foster care alumni experience post-traumatic stress disorder at a rate twice that of Vietnam War veterans.

Source:
McGraw, Patricia. It's not your fault: How healing relationships change your brain and can help you overcome a painful past. IL: Bahaii Publishing, 2004.

Learning to disconnect from thoughts, feelings and behavior

Behavior doesn't come out of a vacuum. Underneath the surface, there are deep roots from which that behaviour has grown.

When babies are born, as part of the imprinting process, a baby experiences their parents' emotions as if they were his/her own. It's an emotional merger, wherein the parent and child are meant to "attune" to one another's experience.

Ideally, the environment would be stable and safe.
Ideally, the growing child will be given words to describe his/her emotions.

In this ideal situation, a child would be secure and ensured of protection and love. This child would learn to identify feelings when experiencing them, and think about how to respond to that emotion.

But what if a child's safety and well-being are seriously threatened?
What is there is an external threat that seems frightening and insurmountable?
What if the first relationships of a child's life are broken?

Foster care creates repeated trauma. Children learn to disconnect with thoughts and feelings in order to survive.

Trauma can also create a disconnection with personal behavior: If you, or someone that you know, are involved in self-destructive behavior, over and over, examine their pasts for imprints of relationship patterns in which that type of behavior was born.

Consider a child who was sexually molested -- and ends up exploiting his/herself through unhealthy relationships or becoming a stripper or prostitute. In a sense, what this person is doing is reenacting the abuse from their past in order to make sense of it.

Numbing out: Victims of trauma often try to escape their emotional pain. They try to numb out by sexualizing events, eating emotions, drinking to dull the event, smoking to feel the buzz of nicotine or using drugs to make the situation temporarily 'disappear.'

These are survival techniques. In the face of danger, memories become fragmented, mental processes shut down and the only focus is on survival.

But emotions are basic to survival. When a person's outer life and inner life are disconnected, that person cannot heal.

It takes courage to seek help.
It takes courage to stop running and look yourself in the eye.
Even after the healing process has begun, there will be moments of uncertainty.

In post-traumatic stress disorder, fear from the past raises its ugly head and causes the body to react with fight-or-flight or freeze responses. This experience can be very unpredictable and confusing.

Here are the stages of healing, according to Dr. McGraw:

1.) Attunement to self: Take time to be aware of your emotions, including physical symptoms such as increased heart-rate. Journal about the emotions and bodily sensations that you are experiencing, as well as the thoughts and memories that emerge.

You need this time to remind yourself that your physical state and emotions are important.

Learn what your 'triggers' are... To be triggered is to reexperience an event from the past in the present. You will experience the bodily sensations and emotions of a terrifying event that happened long ago.

2.) Strengthening and stabilization: Create safe and stable life circumstances for yourself. Inasmuch as it is in your power, keep your everyday life free of crisis and chaos. Do not participate in behaviors that you have been using to avoid or act out traumatic experiences.

You need this time to give yourself a base of happier memories and safe experiences.

3.) Working through traumatic experiences: After having a base of happier memories, adults find that they are better able to deal with the past.

-This stage should not be rushed. Rushing this process can be damaging and counterproductive.

-Simply talking about a problem will not heal it. The actual events are less important than their emotional impact.

-Pace yourself. Take baby steps. If a conversation becomes too painful, end it. Revisit the problem later, when the emotional intensity has subsided.

Shocking, surprising or overwhelming yourself with emotional experiences that you are not prepared to handle will not help you heal.

4.) Acceptance and service: This is characterized by:

-No longer hiding from yourself, your past or your true feelings. See yourself within your own story with compassion and empathy. Be the hero of your own story.

-Being aware of your triggers and not letting your emotions take you hostage. Creating a strategy for coping and recovering when triggers occur.

-Building the capacity to develop warm, loving relationships with others. Avoid or discard harmful relationships. Seek to build new, positive connections.

-Establish a goal and direction for your life. What unique abilities do you have to offer the world?

Source:
McGraw, Patricia. It's not your fault: How healing relationships change your brain and can help you overcome a painful past. IL: Bahaii Publishing, 2004.

Poem about empty promises

He leaves
and comes back

He leaves
1 week
2 weeks
6 months
2 years

Every time it gets worse
he comes home
and with no thought of how I feel
he leaves

When he first gets home he promises
“I won’t be back in there”
as he complains to us
about the thick metal bars
foul food
and nothing to do
later I wake up and
he leaves

With no info of:
when he’ll be back
what he did
or why
he just
leaves

We communicate slightly
only through phone
his picture is a dusty memory in my mind

He says “I miss you boy”
and I say “I miss you too”
but do I really mean it
do I really miss him

“I wish you would come see me” he says
but do I want to?

so I can walk through the metal door
and see his orange suit
scruffy face
sad eyes

so now you see?
let him leave

-Shawn Hanning

Wired for survival

"Brain development begins soon after conception and continues after birth. The changes that take place in the brain in the early years of life ensure that an infant becomes highly attuned to the environment into which she was born.

"An infant raised in perilous surroundings will develop brain connections and chemical responses that are highly sensitive to signs of danger.

"Early development is for the long-term. It assumes the environment into which an infant is born will not change significantly over the span of her lifetime.

"Hence the brain connections or chemical tendencies laid down in a dangerous environment at the beginnings of life become entrenched even if an individual finds herself in a safe and secure environment in her adult years, her brain is likely to stay on constant lookout for the slightest signs of danger."

- Early Years 2: Putting Science into Action by Hon. Margaret Norris McCain, J. Fraser Mustard and Dr. Stuart Shanker

Free online classes through Child Trauma Academy

Research and study at the University of Chicago and the Baylor College of Medicine has revealed the complexities and multi-dimensional nature of the problems of childhood abuse and neglect.

The Child Trauma Academy started out as a university-based, medical model working group, but then evolved into an independent, not-for-profit "community of practice."

Their online university offers free online courses.

Right now, the courses they are offering are:
1.) "The Amazing Human Brain and Human Development"
2.) "Surviving Childhood: An Introduction to the Impact of Trauma"
3.) "The Cost of Caring: Secondary Traumatic Stress and the Impact of Working With High-Risk Children and Families"
4.) "Bonding and Attachment in Maltreated Children"

For more information, please visit:
http://childtraumaacademy.org/

Life stories to address attachment issues

Child protection: serious business.: Scrapbook Life Story Work with Kids in Foster Care.

Trauma-related beliefs and resilience

In the general public, physical abuse is likely to occur twice as often as sexual abuse.

Within the foster care system, however, the rate of substantiated allegations of sexual abuse is higher than that of physical abuse.

While there are no significant differences regarding physical abuse or neglect for boys vs. girls in foster care, studies have demonstrated that girls are at greater risk for sexual abuse within the foster care system.

Girls with a history of sexual abuse:
-Experience twice as many placement changes than girls with no history of sexual abuse
-Are more likely to be housed in a group home or residential placement

Trauma-related beliefs related to sexual abuse:
- Self-blame/stigmatization
- Betrayal
- Powerlessness
- Traumatic sexualization

84 women between the ages of 18 - 25 years old participated in a study supported by the Orphan Foundation of America.

65% of participants reported a history of sexual abuse.

Where sexual abuse takes place:
1.) Prior to entering foster care
2.) While in foster care (35% of participants)
3.) In both settings (highest rate of self blame/stigmatization)

Tool utilized in study: Trauma-Related Beliefs Scale, which has been shown to be a reliable measure of beliefs for sexual abuse survivors.

Powerlessness was found to make the most significant impact on the resiliency of foster care alumna. Recovery from sexual abuse is aided by having an internal locus of control. (See previous blog entry on attribution theory).

Source:
Breno, Anjey and Galupo, M. Paz. Sexual abuse histories of young women in the U.S. child welfare system: A focus on trauma-related beliefs and resilience, Towson University.

Traumatic stress as experienced by children in the child welfare system

Here is a link to the current issue of Focal Point, which focuses on traumatic stress and children within the child welfare system: http://www.rtc.pdx.edu/pgFPW07TOC.php

Articles include the following:

Traumatic Stress and the Child Welfare System

Walker, J. S., & Weaver, A. This article defines child traumatic stress, describes some events that can cause traumatic stress, and summarizes the effects it has on children, youth, and society.

Complex Trauma in Children and Adolescents

Cook, A., et al. This article provides a core background for understanding the psychological and physiological effects of multiple traumatic stress experiences on the developing brain. Steps for assessment and treatment are also discussed.

A Real Mother's Embrace: Reflections on Abuse and Recovery

Weaver, A. The guest editor of this issue of Focal Point gives a poignant first-person account of his childhood abuse and subsequent recovery. A strong theme of Aaron’s story is the enduring support and love offered by his foster family.

Evidence-Based Treatment for Children in Child Welfare

Stambaugh, L., Burns, B. J., Landsverk, J., & Rolls-Reutz, J. This article reviews several treatment programs for children in the child welfare system who have experienced traumatic stress. The article focuses on treatments for which there is the best evidence of effectiveness.

Early Intervention as Prevention: Addressing Trauma in Young Children

Groves, B. This article focuses on the need for early intervention to address child traumatic stress in young children. The article also describes the characteristics of effective intervention.

Adapting Evidence-Based Treatments for Use with American Indian and Native Alaskan Children and Youth

Bigfoot, D. S., & Braden, J. This article describes the adaptation of several evidence-based treatments (EBTs) for child traumatic stress for use in Native American communities. The EBTs that are discussed attend to the broad cultural, historical, and intergenerational traumas that are part of the life experience of many Native American youth.

Creating a Trauma-Informed Child Welfare System

Igelman, R., Conradi, L., & Ryan, B. One role of the child welfare system is to remove children from abusive or neglectful home environments. However, the system itself can be a source of trauma. This article provides steps for reducing trauma within the child welfare system.

Child Trauma: The Role of Public Policy

Gerrity, E. This article discusses the impact that federal, state, and local government policies have in promoting increased understanding of and effective response to child traumatic stress. Analysis of current policy issues and areas for improvement is included.

Survey on Personal Boundaries

How many of these questions would you say "yes" to?

1.) I can't make up my mind.
2.) I have difficulty saying "no" to people.
3.) I feel as if my happiness depends on other people.
4.) It's hard for me to look a person in the eyes.
5.) I find myself getting involved with people who end up hurting me.
6.) I trust others.
7.) I would rather attend to others than attend to myself.
8.) People take or use my things without asking.
9.) I have difficulty asking for what I want or what I need.
10.) Some people I lend money to don't ever pay me back.
11.) I feel ashamed.
12.) I feel bad for being so "different" from other people.
13.) I feel anxious, scared or afraid.
14.) I spend my time and energy helping others so much that I neglect my own feelings and wants.
15.) I find myself getting involved with people who end up being bad for me.
15.) I feel as if my happiness depends on circumstances outside of me.
16.) I tend to take on the moods of people close to me.
17.) I am overly sensitive to criticism.
18.) I tend to get caught up in the middle of other people's problems.
19.) I feel responsible for other people's feelings.
20.) I put more into relationships than I get out of them.

*Source: Boundaries and Relationships by Charles Whitfield

Boundaries and Core Issues

Healing often occurs within community
To work through whatever core issues are most important to you, it helps to be in the company of safe people who support what you are trying to accomplish.

Early experience(s) of abandonment can lead to feelings of self-doubt and shame.
Sometimes this creates layers of problems, including compulsions and addictions.

As an adult, it's important for us to create safe boundaries in our lives, especially if as a child, those boundaries were broken. We don't want those boundaries to be too rigid, keeping love and safe relationships out of our lives. But, we don't want to allow our need for love to cause us to put up with abusive behavior either.

As adults, we can choose the that we surround ourselves with, and with whom we share our personal information. (Please note that foster care alumni often have an all-or-nothing tendency to overshare or undershare).

Recovery happens in stages

Recovery issues might include:

1.) Grieving
- Stage 1: Identifying our losses
- Stage 2: Learning to grieve
- Stage 3: Grieving past losses
- Sign of recovering: Grieving current losses

2.) Neglecting our own needs
- Stage 1: Recognize that we have needs
- Stage 2: Identify what those needs are
- Stage 3: Begin to get our needs met
- Sign of recovering: Getting our needs met on a regular basis

3.) Being over-responsible for others
- Stage 1: Identifying boundaries
- Stage 2: Clarifying what our personal boundaries are
- Stage 3: Learning to set limits
- Sign of recovering: Being responsible for self, with clear boundaries

4.) Control issues
- Stage 1: Recognize what the control issues are
- Stage 2: Sort through what you can and cannot control
- Stage 3: Let go of some things, take responsibility for others
- Sign of recovering: Achieving more of a balance

5.) All-or-nothing thinking
- Stage 1: Recognize that it's there, and that it is a problem
- Stage 2: Consider possibilities of middle ground

6.) Trust issues
- Stage 1: Realize the importance of trusting
- Stage 2: Trusting selectively
- Stage 3: Learning to trust safe people
- Sign of recovering: Trusting appropriately

7.) High tolerance for inappropriate behavior
(often linked with dependence issues)
- Stage 1: Question what is appropriate and what is not
- Stage 2: Define what you will and will not put up with
- Stage 3: Learn to set limits
- Sign of recovering: Being able to set boundaries with others

8.) Fear of abandonment
- Stage 1: Acknowledge that we have been neglected or abandoned
- Stage 2: Talk through those emotions with a safe, trustworthy person
- Stage 3: Work through emotions and learn safe attachment within a caring community
- Sign of recovering: Willing to take the risk to open your heart to another person

9.) Difficulty handling and resolving conflict
- Stage 1: Define the conflict; put it into words
- Stage 2: List the roadblocks to conflict resolution
- Stage 3: Attempt conflict resolution
- Sign of recovering: Conflict resolution, or agreeing to disagree

*Source: Boundaries and Relationships: Knowing, Protecting and Enjoying the Self by Charles Whitfield, M. D.
http://www.markstivers.com/cartoons/

Former Foster Children and Post Traumatic Stress Disorder

Comic from Cyanide and Happiness at http://www.explosm.net/comics/archive/

According to An April 6, 2005 study, former foster children in Washington and Oregon suffer post-traumatic stress disorder at twice the rate of U.S. War veterans.
http://www.casey.org/MediaCenter/PressReleasesAndAnnouncements/NWAlumniStudy.htm

The definition of PSD is "a condition in which victims of overwhelming and uncontrollable experiences are subsequently psychologically affected by feelings of intense fear, loss of safety, loss of control, helplessness and extreme vulnerability. In children, the disorder involves disorganized and agitated behavior."

After having suffered a traumatic event, children believe that if they are vigilent enough, they will recognize the warning signs and avoid future traumas.

Researchers from Harvard Medical School, the University of Michigan and Casey Family Programs reviewed case files of 659 adults, ages 20 to 33, who had lived in foster care between 1988 and 1998. They interviewed 479 of them.

It was the first significant study of how former foster children fared over a long period of time. Most of those studied entered foster care because they had been abused or neglected. More than half reported clinical levels of mental illness, compared with less than a quarter of the general population.

Foster children, the study said, are especially vulnerable to post-traumatic stress disorder.

Peter Pecora, director of research for Casey Family Programs, said a fourth of those studied reported symptoms of the disorder -- twice the rate of U.S. war veterans. "It is a dramatic finding," he said, adding that national studies show that 12 percent to 13 percent of Iraq war veterans and 15 percent of Vietnam war veterans suffer from the disorder.

Post-traumatic stress disorder occurs in some people who experience or witness life-threatening events, such as violent personal assaults, military combat or serious accidents. They often relive the trauma through nightmares and flashbacks, and feel detached or estranged.

Identity development and self-protection among group home residents

Author's premise:
'Although it is a given that children come into foster care with multiple, complex problems that stem from traumatic experiences such as physical abuse, sexual abuse, neglect, parental substance abuse and mental illness, there is little evidence that foster care ameliorates those problems.' (Definition of ameliorate: To make a situation better or more tolerable).

I love this quote from the research study: "There is a dearth of foster care research to elicit the perspective of the child."

In studies that did interview foster youth:
-Very few were able to articulate the reason for their placmment or plans for their future
-Most articulated high levels of insecurity about the permanency of their current placements

Sample:
-Teenagers from ages 15-19 who had been in foster care between 2-11 years
-This sample was drawn from group home settings

Group homes are structured residential settings, housing several foster youth. The use of group care for teenagers is high for many reasons, including a lack of available foster homes for adolescents. Group settings are often chosen for teenagers in order to facilitate their preparation for independent living.

Identity development, according to Erikson, is the process by which a teenager develops a concept of his/herself. It includes the recognition of personal capabilities and limitations.

This process involves:
-Coming to terms with past experiences
-Accepting a realistic self-definition
-Manifesting a future direction (*educational disruptions don't help)

Self-identity is socially bound: A person's sense of self emerges, in part, through their interactions with others. Therefore the social context of living in a group home has a critical influence on the residents' developmental process.

Group home residents experienced:
1.) Development of a stigmatized self-identity (*culture of foster care)
2.) Self-protection

--Institutionalized: Group foster care was described by residents as being 'like an institution.' Despite being based on a familylike philosophy of care, group homes were perceived to be overly restrictive and to lack individual consideration or respect.

--Pathologized: Furthermore, caregivers interpreted normal teenage behavior, when expressed by group home residents, as psychopathological or devient.

--Stigmatized: Entering group care conferred a new status on the child. Being labeled a 'foster child' or a 'group home kid' was experienced as a diminished social status. Other people assumed that the teenager was delinquent or disturbed.

Impersonal treatment and disrespect: These assumptions were communicated to group home residents in everyday social interactions, and, in effect, devalued their personal worth.

Negative stereotypes followed them in both their living situations and their larger social world, and were widely held by adults and peers in their neighborhood and school environment. This resulted in biased assumptions and behavioral expectations.

Internalizing the stereotype: In time, the negative views that other people held and communicated through interactions with the teenager were interalized into the teenager's self-view. This led to self isolation and limited future aspirations (lowering the bar of self-expectations).

Process of self-protection
When a child in foster care endures recurring assaults on his or her developing identity, defenses must be developed in order to prevent additional harm. Foster care is rife with uncertainty.

Self-protection is the process by which a child develops those defenses and strategies to protect self from further disappointment, rejection, loss or trauma. This process may begin prior to foster care placement, when a child experiences major losses, neglect or ongoing abuse.

The self-protective process is often accentuated in foster care due to:
-Multiple placement transitions
-Unstable caregiving
-Further episodes of mistreatment within foster placements

1.) The illusion of normality: Upon first entry into foster care, many children are given the illusion that they will be placed in a 'homelike' setting, that they will be safe, and that the people will be like a family. For many of us, this turns into broken promises.

2.) The unpredictability of foster placements is that they so often involve many transitions. Children are often left without a stable core of caregivers. The faces change, at school, in the foster placement. Even permanent foster homes end when a teenager is emancipated, which "terminates" the placement.

Each time you move, it's harder to get close to people: Trust diminishes. Most participants in the study could idenify at least one previous caregiver to whom they have felt close. The loss of that individual had been disappointing and painful. The repeated transitions underscored the original losses or rejections that had caused the young person to enter foster care.

3.) Personal loss and disconnectedness: Quote from participant in the study, "When you move, you always leave a little something behind that was yours"
-Multiple moves
-Difficulty maintaining relationships with siblings, relatives and friends
-Learning how to live without those relational connections

Strategies for self protection
1.) Creating a fictional self to conceal their foster child status: Forethought and selectivity before sharing personal information with another person. First measuring the risks of disclosure, trustworthiness of the person and potential changes in the relationship.

2.) Maintaining a defensive posture about foster care status: Apathy, "I don't care who knows" or defiance, "If they don't like it, it's their problem!" Might involve setting up fronts or barriers to avoid involvement with others or distancing themselves through antisocial behavior.

Quote from participant: "I keep my problems to myself and I solve them in my own mind. That's the way I handle things."

3.) Keeping relationships superficial: Nearly all the study participants reported making a conscious decision not to get too close or make attachments to other people.

One participant said, "I'm not really close to anyone that lives here (the group home). Oh, I'm nice to them, like when I need to borrow something. So I basically just use this place like a motel."

Underlying themes for self-protective strategies:
-"I can and must take care of myself"
-"Others can hurt you"
-"I don't need anyone"

The key defense was a veneer of self-reliance, giving the appearance of self-confidence, competance and independence. This is accomplished by using one's internal resources to combat or cope with external conditions that have a real or potential impact on the self.

It's basically a barrier to protect self from further harm.

Source:
Kools, Susan. Self-protection in adolescents in foster care. Journal of Child and Adolescent Psychiatric Nursing, Vol. 12, No. 2, pp. 139-152.

Does foster care affect boys differently than girls?

*External locus of control: An individual believes that his/her behaviour is guided by fate, luck, or other external circumstances.

*Internal locus of control: An individual believes that his/her behaviour is guided by his/her personal decisions and efforts.

The sample:
56 foster children from a public metropolitan social service area and 56 nonfoster children from the same community completed an external/internal locus of control scale and a brief demographic questionnaire. The male-female ratio of both groups was 28 boys and 28 girls.

The tool:
The Nowicki Strickland Internal-External Locus of Control Scale

The results:
Results indicated that female foster children experience a significantly higher external locus of control orientation. This difference was present regardless of the number of years in foster care.

Relationship between achievement and locus of control:
Other studies have demonstrated that high achievers are significantly more internal in their locus of control than comparison groups.

Please note that internal locus of control, or belief in one's one effectiveness can co-exist with low self esteem.

Speaking personally:
I have a high internal locus of control.

Speaking collectively:
Reading this research study made me concerned for other female alumni of foster care, who might think that their lives are governed by fate or chance, and because of that belief, sit idly rather than working proactively to make their lives better.

Sources:
Jackson, Sonia. Reducing risk and promoting resilience in vulnerable children. IUC Journal of Social Work, 2001/2002.
Wiehe, Vernon (2001). Locus of control in foster and nonfoster children. Journal of Genetic Psychology, 148(2), pp. 183-187.

Cognitive Effects of Trauma and PTSD

Typical cognitive effects after a traumatic experience:
-Recurring intrusive thoughts
-Flashbacks
-Memory lapses
-Difficulty with focus, concentration and sustained attention

It is difficult for a person who is traumatized to learn new things. There is a sense of being scattered, distracted and unable to focus on work or daily activities. Making even simple decisions might seem overwelming.

Feeling overwhelmed: It can be difficult to sort out relevant matters from the daily bombardment of information.

Negative perceptions: The world seems threatening after a traumatizing experience. Partly this is due to flashbacks and environmental triggers. There is also a bias toward noticing things that are worrisome or frightening.

Recurring memories and nightmares replay the same experience, over and over again. Research by Bessel van der Kolk observed that the content of the nightmares of veterans with PTSD stayed the same for 15 years.

Unlike normal, narrative memories, which fade over time, traumatic memories remain fixed, timeless and contemporary, delivering the same dramatic punch every time.

Why do our brains work this way? The flood of hormones in response to trauma both gives us the energy to fight/flee danger and imprints the memory of that trauma in order to create a once-and-forver learning experience. It is a survival mechanism, so that if a similar danger comes again, we will be wired to instantly react.

Traumatic memories are processed and stored differently than memories of ordinary events. "Normal" memories are encoded verbally, and thereby can be verbally communicated to others afterwards. But traumatic memories are experienced as emotions, sensations and physical states.

The trauma survivor faces an odd contradiction. The memories are so vivid, rich with emotional and sensory details. Yet it's difficult to put words to these experiences, to make cognitive sense out of them.

The phrase "speechless terror" is not a hyperbole; people literally cannot talk when affected in this way. PET scans demonstrate the physiological basis of this phenomenon: during flashbacks, oxygen levels and the verbal centers of the brain are affected.

Source:
Naparstek, Belleruth. Invisible Heroes. NY: Bantam Bell, 2004.

Physical effects of PTSD

In post-traumatic stress disorder, the cycling back between fight/flight and freezing continues and becames a self-sustaining feedback circuit. The cycle takes on a life of its own.

This pattern becomes imprinted in the neural networks, initially underground but eventually as a self-perpetuating system. If left unchecked, symptoms become increasingly entrenched, and often worsen.

PTSD can be immediately triggered by:
-Spontaneous memories
-Flashbacks
-Nightmares

PSTD might become activated from even vaguely related cues of the initial threat, such as a loud noise, a reminiscent smell, a movement from the corner of the eye, a familiar building or the shadow of a person approaching from behind.

Constant activation of the body's alarm system can lead to several physical complaints. Because these conditions are generated in the brain stem, peripheral forms of treatment provide only temporary relief.

This is why, for the PTSD victim, it's difficult to distinguish between physical compaints and their psychological underpinnings.

Source:
Naparstek, Belleruth. Invisible Heroes. NY: Bantam Bell, 2004.

Physical Effects of Trauma

Bear with me here... In my next series of blog entries, I will explore the physical, cognitive, emotional and behavioral effects of trauma and PTSD, one by one. Then, I will share some helpful techniques.

Physical effects of trauma:
1.) Immediate response: Restlessness, hypervigilance, sleep issues, generalized anxiety, inability to relax, shallow breathing, fatigue and an exaggerated startle response at trigger events, sudden noises and/or unexpected touch.

Can also include headaches, backaches, TMJ, skin complaints such as itching or rashes and unintentional weigh loss.

2.) Weeks following a traumatic experience: Body remains on alert, reacting to neutral cues in the environment as if they are dire warnings, threats of annihilation.

3.) If chronic post-traumatic stress sets in: Survivors often manifest functional diseases such as chronic fatigue syndrome, irritable bowel syndrome, fibromyalgia, interstitial cystitis, and myofacial, lower back and pelvic pain.

What happens to the body during a traumatic event?
1.) Blasted by biochemicals: The body has a built-in reaction to physical threat.

A small structure within the brain called the amygdala is the storehouse of emotional memory, and it is instantly activated when we sense danger. Interestingly enough, laboratory rats with surgically-removed amygdala are fearless. They are also vulnerable and reckless, with very short life spans.

The amygdala does not wait for instructions from the conscious, thinking portions of the brain to act. It has an enormous capacity to commander our brains, and override the neocortex (which is designed to analyze detailed information and formulate an apporopriate response).

The amygdala jolts the hypthalmus, which produces a hormone called CRF, which signals the pituitary and adrenal glands to flood the bloodstream with stress hormones: epinephrine, norepinephrine and cortisol.

This results in hyperalertness, a flood of energy and the "fight or flight response."

Endorphins are released as well. These are our body's pain-killing neurotransmitters. They ensure our physical survival by making sure that pain doesn't interfere with our ability to act immediately.

2.) Freeze response: This is the immobility response. When an animal is overtaken in the wild, fight-or-flight seems pointless and there is nothing proactive that can be done to save the day. So, the animal collapses and becomes limp, even before it is seized.

At this point, the body receives even more pain-killing endorphins to inhibit wound-licking and other behaviors that could interfere with one last-ditch, life-saving effort on the animal's part.

The body has rebounded from the tension of alarm to its polar opposite: the state of near-paralysis. Tense muscles relax, blood pressure takes a step dive and the racing heart slows down to a crawl.

In the wild, this can help the animal by "playing possum" or by preventing a painful death. If the animal (or person) survives, this biochemical overload has an aftereffect. Almost all animals start to shudder and tremble, to perspire for several minutes and then to take a series of short deep breaths.

Rabbits can do this several times in one day, and shake it off afterwards. People differ from animals in that we don't automatically discharge the biochemicals. It's been hypothesized that we humans don't shake, perspire or take enough deep breaths afterward.

3.) Disassociation: When people freeze, they also disassociate. They "flee the scene" psychically by becoming emotionally disconnected from what is happening.

Afterwards, people tend to blame themselves for their detachment, and assign a negative meaning to it.

Source:
Naparstek, Belleruth. Invisible Heroes. NY: Bantam Bell, 2004.

Lack of predictability and loss of control

We all structure our lives based on certain assumptions. When children enter foster care, this creates a sense of loss of safety, where "nothing makes sense anymore."

Consciously or unconsciously, a child might cling to ideas like, "If I do A, then B will happen." For me, it was, "If I am smart enough, pretty enough, talented enough, then maybe my father will come back for me."

This makes sense, because our self esteem is bound up in our belief that we can impact the world. Watch an 18-month old child knock over a tower of blocks; he will be compelled to do it again and again, because he's discovering that he is prime mover; he can make things happen.

Because it is built into our hard wiring to love ourselves for being able to make things happen, the converse is also true; we lose self-regard when things happen that are out of our control.

Rational or not, we can't help but feel it's a reflection on our worthiness when a terrifying event comes, and we are unable to prevent it, escape it or fix it. If the trauma is somehow our fault, then the world still makes sense. As a result, we feel guilty and ashamed.

Trauma creates a sense of helplessness, powerlessness and inadequacy.

Left unchecked, that sense of inadequacy can haunt a person (off and on, at intervals) for the rest of their lives.

Sources
Naparstek, Belleruth. Invisible Heroes: Survivors of Trauma and How They Heal. NY: Bantam Bell, 2004.