"We all know what the world needs and those who are chained in fear. Some don't have the light in sight to see and are astray.
We all have the wisdom to cure ourselves, but most of all to feel the permission to cry and heal and not be abandoned. It's no more silence, no more ignoring including yourself"
Male survivor, initiator website, bachelor clinical psychology not active, became so confused that I got a mix of PTSD and psychosis later on in life, now for 6 years free of it. The wisdom of the heart or feelings you don't find in textbooks op psychology or psychiatry. Free yourself, takes time though. Pitty and in fact shameful that and so discarding that the effects of - mostly chronic - abuse are still a few lines in textbooks of clinical- or developmental psychology.
Cracks in my soul
A soul, a spirit abstract
Floating upon inner despair
like an orphan, without caring,
A house of soul,
inner gray and desolate
Sink into being inexpressible
A child, a boy, a silent scream
Never seen or heard, noticed
A scream silenced
No echo, no recognition.
An empty inner room
But now my mind and inner voice
talks to it, a new mother
Like a loving spirit
I let light shine inwards
on what it hoped
what it needed
what and who he was and is.
The foundation of (Complex) PTSD therapy
"Many are disturbed and confused children in search of a safe place to cry and overcome"
Good therapy means that in addition to a good diagnosis – more than PTSD - , one also acquires an impression of the seriousness, extent and start / duration of child abuse experiences. This is often possible through a structured interview. Only an experienced therapist knows how important that is, because someone who uninhibitedly goes into the depths of a client, without realizing what has been forgotten, will be surprised if people suddenly remember things during therapy. This creates crisis situations with worsening PTSD symptoms that were not seen coming. Many clients often have a range of complaints according to DSM-5 ranging from dissociation (is one of the main symptoms), depression, personality problems, fears, phobias, suicidal thoughts, but also eating disorders, addiction, auto-mutilation and more. In addition to a thorough diagnosis and impression of severity and duration, it is also important to do a physical examination. This is because much more is now known about how diabetes, arthritis / rheumatism and motor problems can play a role and are related to chronic stress and the effect on the immune system. A simple blood test for HB1-ac, fatty acids, cortisol (base-line), among others, can provide quick clarification. The crux of the matter is that the complaints are all related to the source or root of all derivatives and that is whether traumatic memories are repressed or handled emotionally and coping through dissociation through a altered – identities - consciousness. Striking are often contradictions or inner conflicts in the personality - conflicts between identities -, which is a sign of poor integration of parts of the personality as ever a defense or internalization of experienced external conflicts and traumas including the opinions and views of the abusive parent or perpetrator, but is now maintained through dissociation. This is all the more the case with clients with DID and sometimes with BPD as forms of affect splitting. Every therapist must or should adhere to the principles of Carl Rogers.
It makes little sense to only treat the derivatives or separately labeled problems. In the first place, it is important to acknowledge the client with his / her experiences in a diagnosis that fits into his / her context. One must be more and more aware of dissociative tendencies and problems. There are questionnaires for that, think of DES. (Elsevier: combined effect size: d = 1.82; N = 5.916) Many also have memory problems that people should be aware of and since they are brainareas that work together, there may be poor integration. Clients with a traumatic background move between forgetting and having emotional or visual flashbacks and sometimes fix dissociations. Persistent suicides - I know that those with severe or chronic trauma's have a twice higher risk of suicide then patients with only depression - are actually signs of powerlessness due to strong emotional distress, addiction may have started as a self-medication against the effects of stress, auto-mutilation as a problem with emotion regulation and last but not least physical consequences such as partial exhaustion - lack of support and shuffling back and forth clients - and the impact of biological stress on the body. A good therapist is familiar with psychodynamics (transference and countertransference, affect splitting), CBT and perhaps also with system theory. Psychosis should also not be an exclusion for proven safe methods, like EMDR and gradual exposure - note that the use of iso-propanolol has a reinforcive part in learning (Mw M.Kindt 2018) - and psychodynamic therapy. Unnecessarily, we have denied many good therapy fearing that it would trigger a psychosis. With a traumatic experience, it is not only important to realize what happened, but also what he/ she as a child was afraid of. What conclusions did it draw then? How should it defend itself cognitively, often alone. How did the child explain the event then in his / her mind? This fear of what could happen can be very real for the child. Unfortunately, there are clients who have been literally threatened with death or have experienced life-threatening situations, which may not always be a fear fantasy. Consider the threats or consequences that the perpetrator made clear. Thoughts about what could happen can indeed be a memory, but it is the thought of back then. It must be seen in this. It is known that during disasters people often respond to their interpretation of the environment of what happened. These thoughts can become mental images in the mind of the client. It must actually be an interpretation of the feelings and fears. With fear it is also known that expectation plays a central role.
Psychosis still have an exclusive bio- bio-cause thinking, fed and regulated by an almost global psychosis lobby involving millions and therefore interests. How many nurses and so on have such a view even - which is seemingly crippling that of no cure or recovery (professor, psychiatrist Jim van Os) In fact as he clearly stated, many clients with childhood trauma report psychosis. Emeritus professor Onno van der Hart, mentioned that those with PTSD also have brief psychosis periods in which they seem to remain some sense of reality. He is for a new diagnosis in the DSM that of dissociative psychotic PTSD. As he describes we often see a mixture of emotional and pictural/ mental flashbacks and psychosis. Even professor Mark van der Gaag mentioned that those with severe trauma, their psychosis is far less surrealistic compared to those with schizophrenia. Even in the 19e century Freud stated that subconsciously parts of trauma enters the psychotic state. In stead of the real and thus full blown psychosis of schizophrenia the can last several months untreated and the recovery takes weeks or even months. The genetically or biological standpoint is so strong or seemingly convincing and distinguished that research into psychological interventions and coherence between trauma and psychoses is almost impossible. "It is not necessary and will not produce anything because we already know the cause. Nonsense, period ...." But the thoughts of many care providers are often that recovery is a vain dream.
An example: "Suppose I feel and experience that I am healed to a greater or lesser extent, how many soon think of the fact that it is purely through the use of my medication." It is right that professor, psychiatrist Jim van Os said a depressing message of chronic thinking and have little hope or not at all in recovery. I can imagine the feelings and thoughts or prudence of many caregivers with those who have a combination of psychosis, bipolar disorder with psychosis, nasty childhood with many trauma and more, but the core must be and that also applies to the view of personality issues, what is the essence and context. The deeper and coherent context. We understand the picture and also people do not be so afraid, inspired by wrong intuition and what you think you should see or think.
Neurological insights: Many studies made clear that nerve pathways or white matter in parts of prefrontal cortex and parts of it that regulate behavior and therefore emotions have decreased, the HPA axis - the well known figth-fligt respons, but that is not correct, it should be fight-freese-flight respons - through hormones and an overactive amygdala and decrease in both gray and white matter in hypocampal structures and prefrontal regions and their connections and thus also place cells, leads to poor emotion regulation, orientation problems, increased vigilance, stress response sensitivity and more. It was always clear to me that lower brain-regions like cerebellum and others has a greater influence on our feelings, creativity and other, things we see to often as the result of the cortex. Simply said, lower brain regions take over control and prefrontal functions are inhitited. However, recent research has shown that there is an improvement in the increase in white matter and thus connectons with amygdala in parts of the prefrontal cortex and in particular Miindfullness. Yet there is a widespread academic misunderstanding about the real role of cortisol and in particular that it is a stress hormone in stead of a regulator. Many patients with PTSD have a too low base line of cortisol. As a result, the functions from working memory to long-term works less well, thus leading to poor IQ, memory - storage and recall - and so on, which is also related to glutamate change. The neurotransmitter glutamate also plays a role in the regulation and storage of memories. Recent research into glia cells in the hypocampus in rats showed a decrease and nowedays we know how they play an important role in functioning of nerve cells. Meta-analyzes have clearly demonstrated a decrease in white and gray matter in certain areas of the prefrontal cortex of ventro- and medial areas and a decrease in hypocampal structures and also in the amydala. This explains problems with emotion regulation, impulse problems, but also poor regulation of the HPA-axis and moods and even more. New recent insights into how we can open the plasticity of the brain are very promising.
Our brain always remain plastic in part even until death. This plasticity is nothing more than the formation of dendrites and new synapses. Memory researchers now know through research on molluscs that learning is based on the formation of dendrites and therefore synapses and that this is controlled by the DNA in the neuron via mRNA that is somehow leading the way the dendrite shapes. We are our brainwiring, pathways we often use get more structured - our brain is stimulated by often dopamine and thus rewarding - and those used less get lost. But it is more than ions creating electric signals but also creating electric fields which in turn get influenced by extra-cellular electric fields (CalTech). In fact each created electric field influence other nerve cells. I suspect that epigenetics plays a role in this and also amino acids through receptors. Opening the doors to more plasticity can improve the poor development of neuronal areas. Herein lies the crux of therapy and therapists should take a look at why Mindfullness in particular contributes to this. But also like Mrs. Reinders from Kings College using AI in neuroimaging as a means of diagnosis and to have a better diagnostic tool. Personality is the emergent result of many underlying networks of nerve cells and thus connections with other brain areas and a decrease of nervecell connections in the prefrontal cortex and connections with amydala and other deeper brainregions, also affects personality and behavior. We must accept that personality is shaped by memory and thus experiences witch is no more than the way our brains are wired. Nature and thus the brain even adapts without cause or purpose the way it can adapt. So it all starts at a very very low level and that is quantum-mechanics and its present fields - even in the moist and warm brain - and thus molecules, thus aminoacids, thus RNA, thus DNA, thus living cells and thus more and more emergent complex processes. That is trying to act against more entropy. But even though nerve cell wiring and synaptic connections is important it is not the whole picture, but also how according to DNA, receptors and epigenetics is in fact the centre of it. Mind blowing is it not? But when you see it is some how simple and so elegant and meaningfull.
Characteristic of both BPD, DID and (complex) PTSD are dissociation, fragmentation or splitting of ego functions - read identities - and or affect, reduction in the size of hypocampal structures, resulting in less feedback and regulation through the HPA axis of emotions and depression. Anti-depressants such as SSRI and NSRI have a positive influence on this. Emotion regulation problems can be related to a significant decrease in white - the many dendrites and axons - and gray matter in the ventro- and medial structures of the prefrontal cortex and orbitofrontal cortex. We can distinguish three main areas, namely trauma processing or PTSD desensitization by means of EMDR and gradual exposure, emotion regulation and interpretation of situations and therefore behavior resulting therefrom. Attachment style should be checked - the disorganized is clearly an indication of abuse and often the foundation of DID, among other things - must also receive attention and is fairly easy to treat, because without trust it is actually mopping with the tap open. Some are so anxious or defensive that they are almost therapy-resistant.
However, therapeutic adminision of oxitocin or recently investigated glutamate inhibitors can also be used and last but not least iso-propanolol. Finally, every psychiatrist knows that with extreme mourning, PTSD, KZ syndrome and depression, psychosis can occur, which is not seen as a schizo-disorder. You could say that mourning is about the loss of someone and therefore acceptance and that trauma treatment is about finding back the self and the feelings, the being of the client. So not just to point to and pay attention to symptoms, but to emotional and intellectual integration. Finally, something about establishing safety and measures. The only thing that needs to be determined is the actual and real safety. So what is the danger of violence - war and political refugees should be acknowledge in their real danger of foreign powers and their widespread influence in their daily lives. (political assassination, torture) from perpetrators and their influence. This can be quickly resolved by vice squad or in case of political refugees - fi even foreign journalists - by Intelligence Offices, after the client has also reported the abuse to the police. Isolating or locking up clients is questionable of whether this creates emotional safety. Get them out of their victim role, provide support, information and offer therapy. Work on resilience, acceptance of feelings and apologize. It would be good if psychiatric wards had special (C) PTSD units, in which workers are used to providing emotional support. Participating in special (C) PTSD groups with fellow sufferers can mean a lot.
In men, we sometimes unconsciously strengthen their imaginary link that their struggle is emotionally related to weakness. I also know a lot of social workers and especially men who treat themselves like that or have such an attitude. Women hold this view much less, but there are also women who in the first instance also want to see this from male patients and therefore expect it. Men soon think that they have failed, should have been more resilient when they are in fact powerless. As a result, they lose the awareness that they were and are victims. This restrains acceptance and being open to feelings. An emotionally permissive attitude and empathy and making it clear that you don't have to be strong is necessary and fight against your feelings. Men thereby build a (rational) armor around them, a defense against impotence, being or have been humiliated and try to compensate for this with an attitude of decisiveness that does not match their inner experience. A counselor who has been brought up himself in such a way and therefore expects this from other males should also look at himself and his way of thinking about gender roles, sexuality, being a victim and so on. Traumas have nothing to do with not being a real male.
Author : webmaster April '19