Saturday, June 27, 2009

Sexual abuse, Trauma, PTSD

Okay team, Denice is going to host the conversation these next two weeks

12 comments:

  1. What do The Cherokee Trail of Tears, Japanese American Internment Camps, the Holocaust and The Vietnam War have in Common? Their survivors and the decendants of those survivors have suffered multigenerational trauma. These “Historical traumas” continue to shape interpersonal and community relationships in a very real way. There is no doubt that these wounds were precursors to the formal diagnostic category of PTSD. Individuals and communities continue to seek recognition, education, and healing to enhance their own resilience. Observations made since the Civil War can give us insight into our client’s experiences of trauma today and assist us in enhancing these key resiliency factors.

    How would accounts of Civil War “battlefield anxiety” and WWI “shell shock” impact your work with todays active duty survivors?

    Does voluntary military enrollment have an effect on modern military personnel experiences of trauma?

    Does the type of Sexualized Racism/ Genderized Violence first noted in the post civil war South still give us insights into sexual assault trauma and genital mutilation survival today, if so what are these insights?

    What is “Residential-School Syndrome”, and how could understanding it impact your work with Native American’s?

    What complaints might a client have, at initial presentation, that indicate the need for further assessment of PTSD?

    What are the Key Resilience Factors to trauma recovery?

    What interventions/ treatments have been most useful in healing those who are experiencing symptoms of historical trauma?

    What do monuments and museums have to do with trauma recovery?

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  2. During my work at the VA, I saw the effects of PTSD amongst many vereterans as well as active OIF and OEF. You don't have to work at the VA to see the lasting effects of these wars, all you have to do is look downtown Seattle on every street corner. Most of the homeless are veterans and many of them suffer from schizophrenia and psychosis induced from trauma they experienced while in war. I worked on the spinal cord unit and that was the breaking point for me. I couldn't handle seeing these guys (most of them around my age) come back and have their world turned upside down through paralysis, quadraplegia, and mental health issues that would haunt them forever. Once particular case sealed my deal that I was not cut out for that SW role at the VA..... he was my age, just come back from Iraq, recently married, roadside bomb took his freedom, his choices and his life. He was on a vent, quad and had so much anxiety that the psychiatrist was having a hard time figuring out the right meds for him. He didn't want to live like that. It was a huge deal, went to the top, to the CMO, lawyers etc... finally they let him choose to die. He was only 30 y.o and never wanted to go in the first place. I quit that week.
    Other than that, I have no experience or knowledge about wars and the history behind them or their victims/heros. I was never a history buff and honestly coudn't even tell you the order of wars. I think the more important thing is to understand the definition, sxs and tx of PTSD as I am sure everyone who has served in a war has that in common. The residential school syndrome is a term used for the native americans that were abused in public schools... the US/Canadians viewed it as a way to educate the native children, teach them english and submerse them in to our culture. The native tribes viewed it as eurocentric and a means to destroy their cultural beliefs and melt these children in the US/Canadian melting pot. Understanding the theory behind this could help your approach and understanding of how many native americans are still suffering and traumatized from the abuse that the Americans placed upon them. PTSD sxs include: flashabcks, intrusive and re-curring memories, nightmares and physical reactions to the memory of the event.
    I was a research counselor in a research project out of NYU looking at women with polysubstance abuse and PTSD. The group was quite interesting and the end result was that women who were taught coping skills around safety ( physical and emotional) fared better than those victims who were not.

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  3. The only experience I have with any type of miltary is my brother. My brother was in the Marines for four years (this was way before September 11).
    I know for certain my brother saw and did things that he wil remember for the rest of his life. he did not talk a whole lot about his expereinces, and he as far I can see does not have any symptoms of PTSD.
    I agreed with Katie that we can just go doenstown seattle, Everett to see the numerous verterans that have been lost in the system. They gave they have to their country and when they needed helpt he worst, many time red tapegot in the way og getting assistance. Some have families, some do not. When I so see these folks in seattle or elsewhere, it truely makes my heart break. Most have been on the street for so long, that enviroment is the only thing they really know anymore, and they are afraid to get help, because their comfort zone are the streets.
    This population would be a challenge fo me, but I think I may actually be a good expereince for me. i have worked with some vets in the hospital, but not nearly what Katie went through at the VA. Most of my knowledge abou the VA coems from my past friends in the recreation therapy field. Many of them hads their internships there after graduation. The recreation therapy departmentr at the VA use to be very highly thought of, not sure anymore, since it have been several years since then.
    There was a pt at Evergreen who was there for surgery and had a history of PTSD and had several outbursts at the hospital due to flashbacks. It was really interesting experience to see and hear about.
    Thank oyu for the posting, ti was very interesting!

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  4. Kasie- The rec therapists are still a big part of the interdisciplinary team at the VA (on the spinal cord unit). They were vital in these patient's recovery and transition back in to their world.

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  5. Denice, I think your posting was quite a unique angle to discuss PTSD. The posting really forces us as clinicians to reach outside of our comfort zones. And what I mean by this is we tend to approach PTSD in a very narrow minded westernized, Eurocentric way. I mean when you think of PTSD and other effects from trauma how often does our society take this multigenerational approach. I think this is the perfect way to start strengthening our clinical skills by increasing our multi cultural competency. Sure, every clinician will say this is in their tool box, but is it really? For example, Are we taking account of our own assumptions, values and biases during our assessments? Are we garnering pertinent info from our clients about their history, background and world view. And are we putting ourselves out there to make ourselves as clinicans more approachable to clients c multicultural backgrounds. I don't think we are entirely. I think if we were our assessment would reflect it. Team, I want to spend some time addressing some of these cultural issues because if we open these doors we will open ourselves to new possibilities and new approaches. I imagine that many of these issues are under-diagnosed because if our culture isn't defining these issues as problems then there is a lack of resources for them. Many people from multicultural background will present to various clinicians with other symptoms such as "ETOH isssues" and lets be honest many of our treatment options will stop at simply adressing the issues at hand rather than exploring the individuals history and culture. I think this a huge problem in our hospitals c clinicians working c Native American families. We are quick to diagnose and approach things from a very Eurocentric perspective without respecting the cultural norms of Native Americans and exploring and respecting their traditional healing practices. Families are absolutely valuable resources. Team for purposes of the test. They want you to show that you incorporate multicultural competency into your practice. It is the one area where there will be alot of recall questions about different cultural norms. I will go over them with you. Denice, I would like you to bring your experience and expertise to the group so we can integrate a multicultural approach as well as your expertise on the treatment strategies for this issues. Big RUNON sentences, I hope I am making sence

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  6. Team, I have also asked on of my colleagues Michelle Hamilton, MSW, to be a guess blogger on the topic as she has some multi-cultural expertise on the topic of Native Americans

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  7. PART 1 of 2

    Hoiyt! (Hello -short definition), My name is Michelle, I am Ojibway, from the White Earth reservation in Minnesota. I live in two very different worlds: the "white world" and the Native world. These worlds can be very different at times, and are often at odds with each other, which can cause much conflict in my day-to-day life.

    The United States has renamed my people Minnesota "Chippewa" because it is easier to speak. My mother is the last "enrollable" member of my family. What does this mean? It means that the rest of my family are no longer Native American in the eyes of the government. It means the next generations of my family are no longer supposed to claim they are Native American. My children are Aleut (Alaskan Indian). They are the last in line on their father's side. I worked as the Director of Children and Family Services at the Stillaguamish Tribe in Arlington for over three years, I was on several committees/boards in Olympia advocating for the needs of Native Americans, and I grew up on the "rez," though did not live there. I am also an MSW graduate from UW SSW.

    Derek has asked that I offer my input on your discussions around Native Americans and Residential School Syndrome (RSS), which is a more specific form of PTSD. I do not believe RSS has been listed as an official psych dx in the DSM, yet (please correct me if I am wrong). This is a huge topic and entails so much more than just the Native experience in residential schools and I would highly recommend pursuing a historical perspective on the Native American experience in order to more thoroughly understand the grief/loss/trauma associated with being a Native American. That being said, I will attempt to focus my comments/input/suggestions specifically around RSS.

    A few things I would like to clarify in the discussion:
    Boarding schools and "public schools" are two very different environments. Public schools were where non-Native children went during daytime hours Monday thru Friday. Boarding Schools were where Native children were sent to stay 24/7, often never to return home.
    The other part that was touched on states "US/Canadians viewed it as a way to educate the native children, teach them english and submerse them in to our culture. The native tribes viewed it as eurocentric and a means to destroy their cultural beliefs and melt these children in the US/Canadian melting pot."

    ....I do not feel these words were, in any way, meant to sound disrespectful, though if you were to give any Native person I know this description, much offense would be taken. Children weren't sent to boarding schools only to be educated and to teach them English...there were explicit goals/outcomes set out by the government and by the church. The goals were to destroy the Indian, this is one attempt, among many, to rid the US of an entire group of people...much like Hitler with Jews...and yes...many make this comparison...

    When boarding schools were first implemented, the general consensus was to "kill the Indian, save the child." Children were forcibly removed from their homes, often as young as 2-3 years of age, and sent to schools far away from their family, their culture, their language, and their religious ceremonies. There are grandmothers and grandfathers alive today who can tell you about children (or themselves) being snatched from down by the river, never to be seen again. Our elders are only now beginning to share the atrocities bestowed upon them in these schools.
    ....

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  8. PART 2 of 2

    Many things occurred upon arrival at these schools which ultimately caused culture shock: All their hair was cut off, which goes against many spiritual beliefs. In my culture, our hair holds a lot of spiritual meaning/power. In many tribes, we do not cut our hair unless a loved one dies. Boys would braid their hair and cut it off to send with the family member on their journey to the spirit world. Hair that falls out is often burned in ceremony.

    Their bodies were washed down with lye soap as Natives were considered to be lice/flea infected savages. Their own clothes were taken from them and they were all given uniforms to wear. Anything "Indian" was taken from them...including their names.

    The children were forced to take on an "American" name. They were no longer able to speak their own language, sing their own songs (which is a large part of our cultural identity), worship Creator ("God" to others) in the ceremonies that were handed down for generations, and they were completely cutoff from their families.

    Many children were experimented on & girls were forcibly sterilized in a massive governmental effort to "rid the United States of the Indians." By annihilating an entire population, the government would not longer be expected to uphold the treaties which were entered into with Native Americans.

    Most boarding schools were run by the church and were given little, if any, restrictions on how to care for the children. This left the doors wide open for abuse of all kinds. Abuse that, if the child survived, lasted for years. The children were never taught how to love or be loved. They were never taught coping skills or boundaries and once they aged out of the residential system, they had no where to go -no connections left.

    The ones who returned home were unable to communicate with their family/community in their own language & often turned to drugs/alcohol to survive the pain they carry with them on a daily basis. Many commit suicide (NA teens have an extremely high suicide rate), others became the abusers or the abused. These children grew up to become parents/aunties/uncles with no ability or knowledge on how to function in a healthy way, let alone raise children.

    The grief and loss and anger these residential school children grew up with continues to be handed down through the generations. This is where we run into inter-generational trauma.

    The information noted above is only a brief overview to, hopefully, make you more aware of, and sensitive to, the special circumstances around working with Native Americans. There have been many suggestions through the years on how to treat Native American's...and, given the historical background, how do we, as Social Workers address the needs of the Native American community in a way that is representative to the needs of an entire culture?

    I look forward to seeing your responses and urge you to ask questions and offer your insight. Much can be gained for the good of many when dialogue occurs!

    OhSiem! (Thank you!)

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  9. I wanted to comment on Michelle's post- in no way was I meaning to be disrespectful in my description of the RSS. What I was meaning was that Americans abused and exploited the Native American children in many ways. So I am not sure how that sounded offensive, but I did not mean for it to. I was merely pointing out how we had alterior motives behind sending them to these schools,(as was pointed out in the previous post) and it was not for the children or for the cultures own benefit or good.

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  10. Katie, I know that you were not being disrespectful...I have seen you in action and have no concern regarding your sensitivity to oppressed populations. I was trying to point out that, often, the experiences of Natives are minimized by the way we speak...Trying to offer insight to people who have not lived the experiences Native Americans have lived, so that when we do work with a Native person/family, we are more aware of the words we speak, as words are strong weapons that have been used against us for many years, and are often taken at face value...often with much sensitivity...
    All too often I hear people say..."they should just get over it...That all those things the US did was a long time ago and should not be taken into consideration when dealing with Native people." We have been forced to try to ignore the pain we all walk with because others do not want to acknowledge that the last boarding schools were closed down within my lifetime...that people are alive today to share their horror stories from the boarding schools they were sent to.
    How can we begin to heal when we aren't even allowed to speak out about the pain we carry? In my experience, when we try to share our journey with non-Native people, I find the non-Native person getting defensive and I see the Native person begin to shut-down...over and over.
    It's all about being sensitive to the path of others, and I used your posting in an attempt to help others see words from the eyes of the oppressed (Native Americans in this case).
    Another thing to keep in mind is that it is spoken amongst the elders that it will take 7 generations before the healing can be complete. Some families have only just begun their 2nd and 3rd generations....

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  11. Thank You all for the healthy discussion

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