Saturday, April 29, 2017

Dissociation as a root cause

As Karla Mc Laren says in her book, Language of Emotions, emotions nearly always arise in clusters. It’s rare that neat well-behaved emotions come up one at a time, patiently waiting their turn to be felt. No, life is messier than that and of course when emotions such as anger, fear and sadness come up together, we can easily become flooded, especially the younger we are, and so we leave the premises as Tara Brach says. The premises being our body and mind.

Leaving the premises is another way of saying dissociation. Currently, there are distinctions between psychic and somatic dissociation which reflects the current mind/body split. But where does psychological dissociation begin and where does somatic dissociation end? I think it’s impossible to say this person has 48% psychic dissociation and is 52% somatically dissociated. Paul Dell, for example, calls psychological dissociation, ‘clinical' dissociation and somatic dissociation, ‘animal defenses’, at least from my understandings of his writings.

Humans are animals the last I checked. These distinctions illustrate just how far removed we’ve become from our animal nature, body and instincts, which has done our nervous systems no favours whatsoever. If a wild animal does not discharge the freeze response, if they survive being eaten by a tiger, they remain in a startled and hypervigilant state which makes their chance of survival very poor. Remaining hypervigilant, they perceive threat where there is none and become less sensitised to real and present threat. This hyperaroused state also creates exhaustion, so when they do need to act, they don’t have the energy or stamina to outrun the tiger. The exact same thing happens to so-called ‘civilised’ humans that have been traumatised. Too many of us have lost our knowledge and ability to shake vigorously after receiving a shock, to howl, cry and scream when we’ve lost a loved one and so on. Many of us have had to learn to keep it all in to survive and not rock the boat.

This mind/body split is also mirrored in current measurement scales for psychic and somatic dissociation. There is the well known Dissociative Experiences Scale (DES) which measures psychological dissociation. Out of 28 questions, there is one nod to the body, question 13. Then there is the Tonic Immobility Scale* and the Somatoform Dissociation Questionnaire (SDQ20), which both measure somatic dissociation. There have been some steps forward in the field, a recent paper by Nijenhuis (2017) recommended that conversion disorders be recategorised as dissociative sensorimotor disorders in DSM-5. (He uses the terms cognitive-emotional and sensorimotor dissociation in this paper in place of psychic or somatic dissociation).

*Click on image to see larger view of Tonic Immobility Scale

I know there is debate over whether dissociation is a process or a state, I think it can be both. I haven’t yet heard a term that better describes leaving our bodies and minds and the resulting split, or splits, that can result (what Nijenhuis and van der Hart (2011) refer to as structural dissociation of the personality). I believe that anxiety arises when we’re overwhelmed by years worth of stuff, it’s a compounded state consisting of unfelt emotions (and physical sensations etc), that we’ve dissociated from, consciously and unconsciously.

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So many ‘disorders’ stem from dissociation and trauma, which is why I believe it is so important to  normalise the terms themselves and the experience of them. They are the root cause for so many so-called different ‘disorders’. Who among us hasn’t been hurt (traumatised) or wanted/needed to avoid (dissociate from) pain?  Isn’t it about time that we started looking for and healing the root cause instead of being blinded by symptoms? Isn’t that what science is supposed to do? Concepts like dissociation can really frighten people, but with education and normalisation they don’t have to.

So, where do you start on your healing journey, wherever you find yourself? You start slowly, taking one step at a time. As Martin Luther King Jnr says: A journey of a thousand miles, begins with one step. You start by being as kind as possible to yourself as you go inside to reconnect with what remains unexperienced so you can experience it as slowly and as gently as you need to. Don’t forget to resource and support yourself wherever and whenever you can. This isn’t about pushing through and going fast, in fact the more urgent you feel, I think the more slowly you should take things or you risk being overwhelmed and even retraumatising yourself.

References
Bernstein, E. M. and Putnam, F. W. (1986). Development, reliability, and validity of a dissociation scale, Journal of Nervous and Mental Disease 174(12): 727-735.
Fuse, T., Forsyth, J. P., Marx, B., Gallup, G. G. and Weaver, S. (2007). Factor structure of the Tonic Immobility Scale in female sexual assault survivors: An exploratory and confirmatory factor analysis, Journal of Anxiety Disorders 21(3): 265-283.
Nijenhuis, E.R.S., Spinhoven, P., Van Dyck, R., Van der Hart, O., & Vanderlinden, J. (1996). The development and the psychometric characteristics of the Somatoform Dissociation Questionnaire (SDQ-20). Journal of Nervous and Mental Disease, 184, 688-694.
Nijenhuis, E. R. S. and van der Hart, O. (2011). Dissociation in trauma: A new definition and comparison with previous formulations, Journal of Trauma & Dissociation 12(4): 416-445.
Nijenhuis, E. R. S. (2017). Ten reasons for conceiving and classifying posttraumatic stress disorder as a dissociative disorder, European Journal of Trauma & Dissociation 1: 47-61.

Monday, April 24, 2017

Let me count the names

Can you think of any physical disease where people might have insults hurled at them just because they had the physical disease? I certainly can’t. People would think it cruel and unkind, yet it’s okay for people with mental illness to be insulted and derided. It’s even called ‘joking’ by some. The sheer amount of insults hurled at anyone who has a mental illness speaks for itself, this is a short list and it’s only in English. The name calling and consequent shaming, illustrates the fear and ignorance of mental illness (or indeed any condition related to mind and brain health such as intellectual disabilities) is still alive and kicking. Ask anyone how the stigma affects their day to day life and unfortunately, they and their families will have plenty of stories.

In the case of schizophrenia and bipolar disorder (formerly known as manic depression), people are/were called schizophrenic and manic depressive, which I think is absolutely appalling. I can think of only one physical disease in which that happens which is diabetes, people who have this condition are often referred to as diabetics. Are people their illness now, is there nothing else to them except the illness?


Many so-called mental disorders are actually caused by trauma. Just imagine stigmatising someone because they’ve been through tough times? Hard to believe that that could happen isn’t it? But maybe that’s because many people haven’t made the link between adverse experiences and poor mental health. They might still believe the outdated claim that it’s a “chemical imbalance”. So where does the chemical imbalance originate from then? You’ll get very few satisfactory answers to that simple question in mainstream medicine. Or maybe it’s because the shame of mental illness goes so deep that we prefer to deflect and project our fears that it could be us onto others. Name calling, it’s sad to say, is only part of the stigma, discrimination in all its different forms can really inflict untold suffering.

Another major cause of mental illness is inflammation, especially in our gut which is intimately tied to our brain, the health of our gut affects our brain’s health and vice versa. And what is one of the biggest sources of inflammation? Stress; biological, emotional, environmental etc. So traumatised people are especially vulnerable to any chronic disease, both mental and physical, because their stress levels are usually high, as the ACE study and many other studies have showed.

I have never heard someone with schizophrenia say “I am schizophrenic”, instead they usually say “I have schizophrenia”, it’s others who usually refer to them as schizophrenics, and surprisingly a lot of them are mental health professionals. Leaving space for who you are beyond any diagnosis or label is crucial. This isn’t about being politically correct, as that terrain is always changing, it’s about how we see people who are suffering with mental health issues and how they feel as a result. And more importantly, how they feel as a result of how they see themselves.

When I’m tapping, I often use ‘I am’ and ‘I feel’ sentences which I find really useful. Take the statements, I am bad or I feel bad, for example. Feeling bad is (hopefully) temporary, whereas I am bad, is permanent. It’s a belief, a “truth”, but not “the” truth. It’s always good to differentiate between ‘I feel’ and ‘I am’.

Monday, April 17, 2017

An important ingredient in resolving trauma

I think one of the most important ingredients in recovering from trauma is having support, and there is plenty of research to back this up. While having a sense of support and community can include animals and nature, among other things, I don’t think we can discount the importance of having the warmth and tenderness of a relational home that another human being can provide. Whatever internal and external resources we have, no matter how small or insignificant they might seem initially, we need to acknowledge and build upon all of them.

Without enough support and resources, our nervous system will find it too unsafe to discharge any trauma that it has been holding, which makes total sense when you think about it, after all its job is to protect us. This is especially true with early and developmental trauma, not only is support sometimes missing completely, or in part, there is often also neglect and abuse to contend with and this can and does stunt our growth and development.


However, as Peter Levine says, trauma is not a life sentence, it can be resolved. But at the same time it’s also important to acknowledge that developmental trauma is more complex than shock trauma because of the fact that our nervous system has been on high alert from a young age and our system has developed all sorts of strategies for coping, some healthy and some not so healthy. Developmental trauma affects everything, our view of ourselves, the way our brains and bodies develop, our relationships, everything, so persistence is definitely needed with resolving complex trauma.

By growing any support and resources, you can make your healing journey easier and more pleasant. You don’t have to be fixing yourself every moment of every day, that’s exhausting and depleting. You’re not broken, you’re hurt. You might feel broken but it is not your identity. Taking a break whenever you can, having fun, laughing, going for a walk, having a bath, is really important to lessen your stress load. Don’t wait until you feel overwhelmed, do something for yourself daily.

When you’re in physical and emotional pain, it can feel quite urgent to fix it or make it go away. So be kind to the part that feels that desperation to be free from pain. The great thing about tapping is that you can tap on anything and everything, just start with however you’re feeling right now. Don’t worry about being “negative” or “positive”, just be true to how you feel and tap on that, then watch your system release stress with yawns, sighs, burps and so on. Tapping on the truth of how you feel is extremely powerful.

These are some tapping phrases (see EFT shortcut diagram here) that you might start with:

Even though I feel desperate to … I completely accept how I feel

Even though I feel I don’t have any support*, I completely accept how that makes me feel

Even though I feel broken because … I accept myself anyway

*Be really specific here and look for both internal and external resources, whatever they may be; books, music, exercise. We can often feel unsupported if we don’t have close relationships with others, but support can come in a variety of ways and you can always reassure yourself that you’re moving towards connecting with others when it feels safe/comfortable enough for you.

Saturday, April 08, 2017

Tapping script for pushing through


Following on from last week's post, try this script for feeling the need to push through, sometimes at a high cost to your mental and physical health. Diagram for EFT Shortcut

Even though it’s too dangerous to stop trying, I completely accept how I feel

Even though I have to keep going because … I completely accept how I feel

Even though if I stopped trying, I fear … would happen, I completely accept this fear

Top of head: It’s not safe to stop
Eyebrow: But maybe I could take a break every now and then
Side of eye: That feels …
Under eye: I don’t trust that things will get better if I don’t keep trying
Under nose: But maybe I could try one thing at a time
Under chin: And not overwhelm myself by trying to do everything
Collar Bone: I could simplify things
Under arm: And take it easier on myself

Top of head: This urgency
Eyebrow: To get better
Side of eye: I understand it
Under eye: Because I don’t want to suffer
Under nose: But I’m suffering by struggling with too many things as well as everything else
Under Chin: I need to pare things down
Collar bone: To a manageable amount so I don’t get overwhelmed
Under arm: I’m still moving

Top of head: Just more slowly
Eyebrow: And that feels …
Side of eye: It’s ok to be kind to myself
Under eye: Or is it?
Under nose: Whose permission do I need to be kind to myself?
Under chin: Mine or someone else’s?
Collar bone: Can I get this permission?
Under arm: Because I know the value and power of kindness

Top of head: Whenever I’ve felt it
Eyebrow: It has felt good
Side of eye: Do I deserve to feel good?
Under eye: There’s no right answer here
Under nose: I can tap on however I feel
Under chin: Because it’s the truth
Collar bine: And the truth will set me free
Under arm: Even if it’s initially painful

Top of head: I know it’s more painful to live a lie
Eyebrow: I’m willing to tap on how I really feel
Side of eye: There’s huge power in honesty
Under eye: It lifts a weight from me
Under nose: And I feel freer
Under chin: To be me
Collar bone: I’m learning who I am
Under arm: And that feels …

Sunday, April 02, 2017

Why pushing through doesn’t work

In our rush to feel better, we want to go as fast as we can, which is completely understandable. But that can backfire. We often end up flooded and overwhelmed, what some might call an abreaction. But really, what’s actually happening is too much is coming up too soon and it’s too much for our system to handle.

Stuff that we’ve buried for years and even forgotten or didn’t know was there and stuff that we’re truly sick of dealing with. If we keep going fast, or pushing through, or trying to be strong, or trying to fix ourselves at all costs, or trying to do it perfectly we’ll end up retraumatised and even more afraid of the sensations that our bodies contain. A loop is created and it starts to feel like we can’t break out of it because our bodily sensations and emotions become even more intolerable. That’s why prolonged unresolved chronic stress is very often more traumatising than the original experience which caused the stress.

So, slower is better, and faster, in the long run. Not slower for the sake of it, not slower to make the practitioner more money, not slower for any other reason than the fact that you make greater progress if you take it easy and slow way down when things get too much. And while you’re at it, be kind to yourself. Treat yourself like you would a good friend. There is all sorts of research showing the power of compassion and kindness.

What I really like about pendulation (from somatic experiencing developed by Peter Levine) is that it helps us to stay in our bodies, even a small part like our little toe, and even when we’re overwhelmed. This is no mean feat when we feel flooded because leaving our body often feels like the only viable option. Pendulation helps teach us that some part of our body feels okay to inhabit, which is very calming and reassuring and helps activate our parasympathetic nervous system. It also helps us to rewire our brain, we learn that being in our bodies, or some part of it, feels ok, calm, grounding and even safe, which helps create new neural patterns. For anyone that has suffered from early developmental trauma this is an absolute life saver because dissociation is so often the only way out of intolerable pain.


Like anything, pendulation takes practice. If you can’t find a place in your body that feels good, find something else, a song, a pet, a friend. If you’re working with a therapist they can be that calm and grounded space you can go to in order to discharge any traumatic tension. Dipping in and out of the trauma, by pendulating your attention back and forth between the overwhelm and calm in your body,  helps the activated traumatic energy dissipate, and by doing so, you’re staying out of the trauma vortex according to Levine, which can so easily swamp and overwhelm you. This not only resolves trauma, it helps build resilience and hope and all the while you can tap on anything that arises too.

Sunday, March 26, 2017

How Ireland treats pregnant women

I’m writing this post because women’s rights are far from being in the bag and the abuse of women while pregnant, during birth and beyond is just disgraceful and far too common, the world over. This particular post is about how Ireland treats women while pregnant. It might not affect every woman, but if it affects even one, we should care enough to do something about it. Unfortunately too many women have been affected, so it’s really time to do something about it.

If the 8th amendment were repealed tomorrow, securing an abortion in Ireland would still be as difficult as it is now. The Protection of Life During Pregnancy Act 2013 would remain in force, untouched, regardless of what happens to the 8th. Many people seem to forget that, very conveniently in many cases. I believe it is a mistake to equate repealing the 8th amendment with abortion as abortion is such a contentious and emotive issue that divides people. And this may be exactly what the Irish state wants, so they can continue with their moral cowardice on the issue, hypocritically exporting the issue and women abroad, while keeping the fact that they hold the legal rights to the bodies of all pregnant women in Ireland, quiet. This is the case whether a woman wishes to continue with her pregnancy or not.

The 2013 Act is one of the strictest such laws in the world according to Eoin Daly, lecturer in constitutional law, NUIG. Therefore the fear that there will be abortion on demand if the 8th is repealed holds no weight whatsoever and is completely unfounded, because the 2013 Act would strictly prevent that. This fear is also an insult to the intelligence and sensitivity of women that if the 8th were repealed, they’d be having abortions right, left and centre.

What would happen if the 8th is repealed, is that the legal right to bodily autonomy would be restored to all pregnant women, which is not a step forward, it just brings us in line with most of the rest of the world and about time at that. The right to make our own medical decisions and informed consent and refusal would legally rest with the woman while pregnant. I don’t know how anyone could object to that. Do we honestly need to hold women legal prisoners of the Irish state while pregnant so they don’t ‘misbehave’?? Are we still in the dark ages in this country when it comes to women? It seems so.

Ireland took 30 steps backwards when article 40.3.3 (the 8th amendment) was added to the constitution in 1983. Of course this addition was reflective of the culture in Ireland towards women at the time which was just 30 years ago. Magdalene Laundries were still in existence, pregnant girls were still being thrown out of their homes with nowhere to go, pregnant teachers who were single were losing their jobs, pregnant teenagers were still hiding their pregnancies because of fear and shame. But this is 2017 and where are we now in Ireland? Have we changed in our attitudes to women?

No, we haven’t, at least collectively. In fact the Irish state has taken even more steps backwards in relation to women’s rights. In 2013, the 8th amendment was added to the national ‘consent’ guidelines for pregnant women by the HSE. The relevant section states that:

“Section 7.7.1 Refusal of treatment in pregnancy
The consent of a pregnant woman is required for all health and social care interventions. However, because of the constitutional provisions on the right to life of the “unborn”, there is significant legal uncertainty regarding the extent of a pregnant woman's right to refuse treatment in circumstances in which the refusal would put the life of a viable foetus at serious risk. In such circumstances, legal advice should be sought as to whether an application to the High Court is necessary”.

Why, after 30 years, were the consent guidelines amended? In my view, it was a financial move to limit liability. The obstetric bill is the biggest in the state claims agency. After bailing out the banks, there’s not much money left in the coffers. There are too many women coming forward, standing up for themselves, speaking up, taking cases, fighting for their rights and the Irish state doesn’t like it one bit. What better way to shut them up than by explicitly mentioning the 8th and the high courts in the consent guidelines, even if it’s ‘just’ to scare them into silence and obedience. Bullying is endemic in Irish society, particularly in our institutions and government.

In 2014, Ciara Hamilton was told by a judge that she was not the person entitled, authorised or qualified to make decisions about her own body while pregnant, her midwife was. Can you believe that? In 2013 and 2016, two women were brought to the high court by the HSE who sought orders for forced sedation and forced caesareans. I don’t know about you, but the possibility that this can happen in a so-called modern and progressive country sends shivers up my spine.

Miss Y was given a “termination” after being raped in her home country and sought an abortion at 8 weeks because she was suicidal. She was pushed from pillar to post until she was 24 weeks pregnant and given this “termination” in the form of a caesarean. So she was abused and raped all over again by the Irish state. She wasn’t even afforded the status of being an incubator as I’m sure the actual machines get better care. Her baby was then taken into care. I am sure both were extremely traumatised by the ‘care' they received. Another woman who suffered a brain tumour, had numerous infections with her body failing, was kept on life support because her 15 week old baby still had a heartbeat, against her family’s wishes. And so the atrocities continue …

These are just some of the desperately sad cases that I know about. I’m sure there are many many more. Are there good individuals working in the HSE? Yes, there are. But we are talking about national policy here, not the random luck of the draw of getting a good health care provider. It should not come down to luck, respect should be guaranteed along with evidence based care and when it’s lacking there should be adequate, accountable and transparent procedures that can be accessed and properly and thoroughly followed through.

Sunday, March 19, 2017

Safety

We can’t talk ourselves into safety, we either feel safe or we don’t. There is no quick fix when it comes to feeling safe, it takes time to rewire our systems from being primarily in flight, fight or freeze; responses which are supposed to be temporary, not permanent. If the situation in which we find, or have found, ourself is chronically and repetitively threatening (very common in early developmental trauma which often leads to complex traumatic stress syndromes), these survival responses become essential, we don’t have the luxury of turning them off, they are needed for our very survival.  However, when they are employed long term they take a huge toll on our systems. Learning how to feel safe again is about being able to determine a real threat from a perceived or imagined threat. Both threats feel very real and have the same responses in our organism but usually only the real threat requires immediate action. When we internalise a threat, or threats, that’s trauma.

Somewhere along the line we started distancing ourselves from our instincts in order to appear more civilised, many humans forgot how to discharge the freeze response (tonic immobility), and as a result, these responses often become the enemy, or the threat. This is why saying that trauma is in the past is just not true. Traumatised people live with a present and current sense of internalised threat which can be excruciating as brain research shows.



Just like love might be our ultimate goal, so might safety. But there are stepping stones on the way to these bigger goals that can empower us and make us feel good on our journey. We don’t have to have 100% safety or love in order to feel ok. For example, when tapping you might ask yourself where in your body do you feel calm, grounded or neutral. What you’re looking for is to find a place that feels safe enough to go to if there are other sensations in your body that are too much for you right now leading to overwhelm and flooding. Peter Levine calls the movement of our attention from a place of overwhelm to one of neutrality or calm, or contraction and expansion, pendulation, and it is a really great resource to use at any time.

Try tapping on:

Even though I feel a lump in my throat, I also notice that my left knee feels quite calm and I’m going to move my attention back and forth between the two

Even though it feels better to let my attention rest on my knee for now, there’s a part of me feeling I must pay attention to my throat too, I completely accept how I feel

Even though there’s a part of me that feels I have to fix this feeling in my throat or make it go away, I’ll let my attention rest on my knee for now and see what happens

Even though I don’t feel safe (how do you know this, on a scale of 0 to 10 where are you?), there are places in my body that feel calm/grounded/neutral and this makes me feel …

Even though I don’t love myself right now, I can accept and even like some parts of me and that feels …

Monday, February 27, 2017

Tapping on trauma

Have a listen to the recent podcast from Sounds True with Bessel van der Kolk talking about trauma.


Try the following tapping script and as always, customise it for your unique situation and feelings, tapping diagram:

Even though I don’t want to (it doesn't feel safe to go inside etc.) go inside and feel these feelings, I completely accept how I feel

Even though I just can’t tolerate these physical sensations right now, I completely accept how I feel

Even though some parts of me (my feelings, my sensations) have frozen in time, I acknowledge those parts

Top of head: These feelings are in my present
Eyebrow: Not my past
Side of eye: They have frozen in time
Under eye: Because at the time I couldn’t deal with them
Under nose: And that’s ok
Under chin: It was just too much
Collarbone: Sometimes it’s still too much
Under arm: That’s why I need to go slow

Top of head: Even though I want them over and done with sometimes
Eyebrow: I want to go as fast as I can
Side of eye: So I can get rid of them
Under eye: Because they feel excruciating
Under nose: And that’s ok
Under chin: I need to feel them bit by bit
Collar bone: Because there’s an accumulation of them
Under arm: I just couldn’t feel at the time

Top of head: So I’m learning how to be with my difficult feelings and sensations
Eyebrow: And not run from them
Side of eye: And not fight them
Under eye: And not freeze them
Under nose: They need to be experienced
Under chin: Slowly, surely and safely
Collar bone: Preferably with someone safe
Under arm: I might not take this journey alone

Top of head: I might not want to
Eyebrow: It’s ok to reach out for help
Side of eye: It’s safe to reach out
Under eye: To the right person
Under nose: Who feels right to me
Under chin: It’s scary to reach out
Collar bone: I’ve done it before
Under arm: And it hasn’t worked out

Top of head: It’s hard to trust
Eyebrow: That I’ll be held
Side of eye: In all my pain
Under eye: When all I want to do is run from it
Under nose: Maybe others will feel the same
Under chin: And maybe they won’t
Collar bone: Maybe they’ll understand
Under arm: How I feel ... it's worth the risk to reach out again