Resilience and Recovery during CV19 in Victoria

As a psychotherapist writing about and witnessing the emotional and human toll of CV19 in Victoria, I have been asked my thoughts on “resilience”. Helen Clark co-chair of the WHO’s Independent Panel for Pandemic Preparedness and Response, recently stated that the recovery may be delayed by up to two and a half years.

To sustain positivity and resilience during this time seems a huge ask. This is not going to be a “think positive” situation for many people, and It seems disrespectful to ask people who are struggling to be resilient right now. Honouring and dignifying their real suffering and distress seems more appropriate at this moment.

However as a psychotherapist specializing in helping people recover from complex trauma and PTSD, I do know that there is a lot people can do to nurture, soothe and support themselves, and to enable resilience and recovery even from the most complex of situations over time. Some of the suggestions below may be surprising.

First: become more “selfish”. The very first thing to collapse when people are highly stressed is self- care. Many people tell themselves “I’ll take better care of myself when I’m less tired, stressed, busy, anxious or depressed. I will drink more water, eat healthier food, do some exercise then”. Unfortunately, this does not work- though many of us have tried it. Instead, the stress or symptoms typically get worse over time if we are not somewhat “selfish”. This applies to those working at the front line of this crisis, but equally to others who are feeling the stress of being locked down or cut off from usual supports. So go on, try being more selfish and do self-care even if you don’t really “feel like it”. Remember the oxygen mask drill on the plane and take care of yourself first.

Second: Avoid too much avoidance, get real. Studies have shown that avoiding uncomfortable feelings or situations builds up and makes things worse over time. A healthier approach would be to take a leaf from the sixties and “keep it real man”. When friends or family call to see how you are, be real with them. Don’t wallow in self-pity, just be as honest and straightforward about how you are really going as the relationship allows. If the relationship doesn’t allow much authenticity, maybe it’s time for an upgrade? Or speak to those one or two that you really trust? Or even seek out a new tribe to belong to?  You have time during lockdown to research this!

Third: You only have to get through one day at a time Yes, I know this is stolen from AA, but it works during CV19 too… I don’t think they would mind us borrowing this solid gold idea.

Fourth: Build more scaffolding, structure or resources into your life. Scaffolding can be people, creative outlets, pets, nature, studying something, having more time off, or having a timetable. Scaffolding can also simply be your body or posture, think of Amy Cuddy’s TED talk on experiments with lengthening the spine for two minutes. Think about what you need to get out of Groundhog Day, to feel stronger, more resourced or braver. Everyone needs more scaffolding when times are tough.

The mind-body connection

Image from The Developing Child, Harvard, 2020

Fifth: Avoid too much stimulation/distraction with screens. The brain and nervous system need to “rest and digest” every day, otherwise cortisol levels keep rising in the body throughout the day and peak at night, disrupting sleep quality. Screens also emit the wrong sort of light visually into our brain and decrease the natural production of Melatonin which makes us sleepy. Try to avoid screens for at least two hours before bed, reading a book is ok, and listening to things like the Calm App sleep stories has helped many a poor sleeper get better sleep.

I hope these ideas point toward how we can better care for and protect ourselves during these trying times in Victoria. Remember, the suffering is real. Let’s not minimise what we are going through together right now, but be tender, respectful and caring toward ourselves and others in the midst of the great fight of our lifetime.

Feeling Too Little and Addictions

In the previous blog I illustrated some of the symptoms following complex trauma, including  feeling too little, the topic of today’s blog. Today I discuss the role of addictions in helping people to survive or numb out emotional pain, and offer some ideas on how to support the healing of addictions.

Firstly, healing addictions requires a lot more than just stopping the habit or pattern. The work of healing addictions includes a developmental/behaviour component to be healed, for example the “Puer Aeternis” (eternal youth) first described by Jung over a hundred years ago, which from a structural dissociation perspective would include the “collapse” and “flight” fantasy self- state.

Mills and Teason (2019) report that a history of trauma is almost universal among people with addictions using AOD services. Some theories suggest that self- medication of trauma symptoms like anxiety may play a role in the development of addictions. Other theories suggest that addictions are part of the magical thinking and “flight” of the younger parts of trauma survivors, helping them to escape unbearable pressure or emotions. Another idea (generated by observations within my work) is that sometimes the addictive habit or pattern is an unconscious attempt by a younger part to find an idealised “attachment” figure, (the addiction for example to cigarettes or alcohol) perhaps offering an alternative or fantasy “friend” to relate to, where they can have a special relationship, gain significance, or just find solace from everyday life. Some of these ideas are contained in the Puer Aeternis character pattern described over a hundred years ago by Carl Jung.

So if the addiction offers the fantasy escape from pain and suffering, it stands to reason that people with addictions will need to add other supports and skills to replace the “escape hatch” of the addictive substance or behaviour. We cannot expect people to give up substances and habits which they believe are vital for their survival. Addictions may be the best method the person has for surviving at first! Janina Fisher illustrates why additional “scaffolding” is needed below.

The worst part of addictions are that in the long term they damage the relationships that could powerfully help to heal trauma symptoms, cause health problems and shorten life expectancy. Worse, over time the addiction can become a “substitute relationship” while real relationships are sidelined, making the person increasingly cut-off and lonely.

 

Whatever the reason for the addiction, recovery from addiction and feeling too little takes time and work. Simply stopping the addictive pattern eg via willpower is not enough, although its a start. Significantly, work is needed around the trauma and the individual factors that hold the addiction in place, as well as building more supports and skills. This work is best done with a therapist or group that is well trained in contemporary trauma theory as well as addictions. You can also contact organisations like Odyssey for more information.

 

Co-Dependence and Addictions

In Codependence, relationship and life problems become worse over time.

These roles of victim, rescuer and persecutor are often caused by intergenerational trauma or unfairness. What holds these three roles together is denial. At some level, Persecutors have convinced themselves they are right to do what they do to the Victim and refuse to see their actions as abusive or manipulative. Victims wonder how they ‘always end up in this situation’ and feel both powerless and blameless. Rescuers tell themselves they ‘are just trying to help’ and are ‘good people’, when really they get to control by keeping Victims helpless or feeling needed. Davis and Frawley discovered that there is also a fourth position called the passive or neglectful bystander. All of these roles are interchangeable, and none of them are healthy.

To heal this relationship pattern, we need to practice doing the opposite of what we normally do.  The opposite of the destructive-fuelled by control, guilt and enmeshment, as in the co-dependence pattern above, toward a better way of loving that honours us and the people in our lives.

An honest look at the behaviour patterns we’re engaged in is often helpful. But don’t expect those around you to want to change the pattern even if you do! This pattern is often called the Drama Triangle!

Things to be curious about

  • When you were growing up, what sort of role did you play in the family?
  • What aspects of self-did you or others -have to deny, in order to play that role?
  • Do you still play the same role today, or have you adopted other roles?

To escape the co-dependence pattern I suggest that you start by learning positive skills and boundaries for yourself and others as illustrated below.Interdependence the solution for codependence

I hope this blog evokes curiosity and perhaps even a moment of clarity and self compassion. More help with changing patterns is available through CoDA or Al Anon, or via a trauma therapist on sites such as the Blue Knot Foundation or addiction therapy groups via organisations like Odyssey. 

 

 

An Alternative Framework for Mental Health

For many years I wanted a better framework for best practice than the current bio-medical model which pathologizes symptoms of complex trauma as a “disease” and “biological” state-without evidence! Apart from the disrespect inherent in putting labels on people who have already suffered multiple adverse experiences, it doesn’t make sense that this reductionist way of supposedly helping people is often causing more harm, leading to ongoing Royal Commissions that never seem to address the underlying structural problems in mental health care.

In Australia, the structural problems – including professional “language” and treatment approach for mental health- are driven by the DSM- the Diagnostic and Statistical Manual, revised and produced every few years by the American Psychiatric Association.  Within DSM criteria, people with complex trauma are often misdiagnosed or given labels like borderline personality disorder, Bipolar disorder, depression, generalised anxiety disorder, causing many kinds of mistreatment and mismanagement (Benjamin, 2019)

DSM started as a valiant way to understand mental health issues, developed by  Americans who didn’t like the flowery language of the existing International Classification of Diseases (ICD). However since then it has been largely taken over by white, middle-class US psychiatrists closely aligned with big Pharma. Since the eighties, Big Pharma has been gradually expanding the range of conditions classified as “disorders” in order to sell more drugs (Moynihan, 2018)

Hospital/service funding and practice now follows from these un-validated and unreliable labels, implying that one just needs to tip the right chemical into a brain to “sweeten” it. Those that can’t be “sweetened” chemically are called “outliers” by the system, or stigmatised for being “treatment resistant”, treated harshly in EDs or discharged prematurely even though very unwell or at risk. Psychotherapy is considered only as a last resort. Some of these people become the homeless that wander our street, mistrustful of the very services they have earlier turned to for help.

International trauma experts like Dr. Bessel Van Der Kolk struggle to be heard over the vested interests who find profit and convenience in the current DSM system. Multiple inquiries into mental health over decades show this system is not working. Marginalised groups such as mental health consumers seem invisible to DSM oriented practitioners. It is faster, easier and more profitable to offer drugs like “Quietipine” (to quieten the patient), than to sit beside those who are suffering or try to understand trauma systemically.

A huge shortcoming of the DSM model is that it locates the problem solely in the person, and ignores the systems and environment that created the problem in the first place. As identified by the Division of Clinical Psychology (DCP) of the British Psychological Society:

“The DCP is of the view that it is timely and appropriate to affirm publicly that the current classification system as outlined in DSM and ICD, in respect of the functional psychiatric diagnoses, has significant conceptual and empirical limitations. Consequently, there is a need for a paradigm shift in relation to the experiences that these diagnoses refer to, towards a conceptual system not based on a “disease” model.” (DCP, 2013, p. 1)

Indeed, the DSM system is so low in research validity and reliability that two of the largest international research funding bodies have stopped allowing DSM criteria as the basis for medical research. However organisations that promote DSM are very powerful and influential, with deep pockets and ongoing political lobbying.

The Power Threat Meaning Framework developed by members of the British Psychological Society offers a new and compelling alternative to the DSM, that appears to have a more valid and ethical way of making sense of trauma symptoms without “labelling” of symptoms including mental distress, unusual experiences and problematic behaviour. It was developed over a five year period in the UK, by researchers who looked for an evidence base for best practice in working with trauma – supported by what we know from decades of research about the causes of trauma, which are often transgenerational and systemic.

Trauma is exacerbated by disrupted early attachments and imbalances of power and the inherent inequalities that lead to abuses of power and privilege. They assert that the many symptoms of trauma are simply a survival-based adaptation to the original situation, for example hypervigilance or dissociation originating from having to survive an unpredictable or unsafe environment. This view is shared by many international trauma experts including Bessel Van Der Kolk, Janina Fisher, Pat Ogden, Lou Cozolino and Judith Hermann.

Recently the Australian Childhood Foundation sponsored the author of the new framework to speak to professionals and consumers about this model. More information about this model can be found here in power threat meaning framework intro 2018, written by the authors of the study.

The authors