Saturday, December 24, 2005

Fell off the blogosphere....

Hi, If you have been looking for a post here this past week or so, it hasn't been happening. My partner is out of town on family stuff and I got really busy at work and the two combined have thrown me a little out of whack. Plus writing all that stuff about trauma, betrayal bonds and ptsd was sort of emotionally draining. I just kinda wanted to get that out and then didn't have anything to say for a while. So my clock is all messed up from the ptsd. Having a hard time sleeping...I get terrible nightmares as I am dropping off that then wake me up, then I start to fall back asleep and the same thing happens again. Oh well...this is probably my karmic payback for once telling someone with insomnia that nobody ever died from lack of sleep. Days have been ok though. I'm seldom alone so being by myself is a different way of occupying my world. I miss my partner bunches but I'm ok alone. With the nightmares its probably good she's not here as I often accidentally maul her (not hurtfully fortunately, just wakes her) in my sleep or wake her from yelling out in my dreams. This has been going on for several years now, but this past week has been the worst its been in a while. So I don't have any new info...there is more I want to write about...I got a couple of books that Holly posted on a while ago. I read one and will give a mini review, then look around the other blogs on ptsd and related stuff and see if I have anything to say! And Grrrr...I just found out one of my posts that has the links to all the other ones disappeared. OK, fixed it...If you have been looking for the first page of the betrayal bonds post its back up. So that's my little 4 AM stream-of-consciousness report from the front.

If I don't get to posting tomorrow, I hope you have a warm and safe holiday with people you love and that love you. G'night.

Sunday, December 11, 2005

grounding exercises for ptsd symptoms

Today I'll go over a grounding exercise I learned that was very helpful in managing ptsd symptoms. Its not a cure. At best, it makes the unbearable manageable. Sometimes when things were really bad it did not work well at all, but I did it anyway. The goal is to bring the ptsd sufferer back to the present by way of the senses, out of a flashback or intrusive memory. Anytime the symptoms of ptsd come on, whatever they are for you, is a good time to practice this exercise.

First look around and see five things present where you are, naming them -- out loud if possible (the naming out loud is supposed to help, but sometimes I would cheat and do it under my breath, too). Anyway, name specific things, in detail, as you see them. For example, I see a picture of my old dog with a wet nose; I see a black computer speaker; and so on. Then name five things you can hear, like the humming of a fan, cars passing by, the dishwasher running, and so forth. Then name five things you can feel. I had a hard time with this first, because I thought it refered to emotions, feelings, but that's not what I was supposed to be after. Its the sense of touch, so I feel jeans against the skin of my left thigh; I feel the soles of my feet on the floor, and so on. If you get stumped, its ok to repeat things, just concentrate on actually sensing them in the present. Then repeat the whole process for sight, hearing and touch four times, then three, then two, then one. You get extra bonus points if you become so wrapped up in your senses that you lose count. Generally, this would bring me back a little. I would still be miserable most of the time and in pain, but the memory part would subside and sometimes the worst symptoms of a flashback would recede.

[n.b.: updated 12/8/08 to replace broken links with new ones]
This isn't the only way to do it, just a very simple and easy to learn one that worked for me if you need it. About.com has some simple suggestions. The Mental Health Matters web site breaks it into three options: accept it and go through with it, learn to control it, or escape it. It is not always a matter of choice though. Their methods of coping are the same for whichever option you choose (or which chooese you!), including one that I tried during the worst of the flashbacks at the behest of counselors in the PTSD treatment center I was in. They had me hold two liter bottles of frozen water (ummm, I think they call it ice :), one in each hand to bring me back. I melted the ice in both and still didn't come back...they were about to send me off to the hospital, but I managed to get a handle on things after about a four hour flashback. Possibly the worst few hours of my life. Cold, the site explains, activates some reflexes that slow down the heart and exert a calming influence. Finally, you can read a more academic but still enlightening and useful treatment of coping techniques in the book Rebuilding Shattered Lives by James Chu.

What's this betrayal stuff got to do with ptsd anyway?

I already wrote a little about betrayal in the posts on betrayal bonds and the effects of trauma over time. Carnes has a whole chapter explaining the power of betrayal. He write that "Common to all is a promise. Those who betray read their victims well. They appeal to the emptiness, the unfinished, and the wounds of others." Otherwise intelligent people set aside their intuitions because the promise is so attractive. "The starting point for all trauma survivors" he says, is a complete acceptance of the betrayal." From a distance this seems obvious, but it is hard to put into effect, and I still struggle with it. Abusive parents in denial, manipulative, self-serving people fostering traumatic relationships who want to feel good about themselves -- these types of abusers have an insidious way of getting into and undermining a person's very sense of self, making me doubt my own reality.

Carnes maps out "five main ways promises are used to betray:"
  • Betrayal by seduction: "High warmth with low intention. . . . Relationships are manipulative and exploitive. Agreements are ill-defined, unclear, or tentative. Feelings are anxious and intense. Trust depends on exaggerated or unreal promises. Rewards are in the future and are often conditional. Risk is often one-sided." Most importantly, the seducer is deceptive about all these things in order to lure the other person into the relationship. People with family histories of abuse or trauma are particularly susceptible because they have never learned to protect or take care of themselves in important ways. A traumatized person's "picker" is often broken. Trauma shame creates doubt of one's intuitions. And there is a neediness that allows the person to ignore warning signs
  • Betrayal by terror: If seduction fails, terror might work. Fear "deepens attachment" in ways that can be addictively intense, especially when coupled with seduction. Cults work this dual betrayal very well. They promise vulnerable people what they want, whether that be wealth, friends, spiritual growth, or whatever, but then withdraw support or even rip a person's life apart if they question things. This is the "love bomb" followed by the terror of abandonment. Often the result of betrayal by terror is guilt and shame on the part of the victim. According to Carnes, only seven percent of women who have been sexually assaulted, often by someone they know, report the offense. That is why Holly's work is so important.
  • Betrayal by exploitation of power: Sexual harrassment often falls under this category, where women (or occasionally men) are in a position at work where to challenge the abuse would threaten their job because the abuser has more power. Incest relations are another example. They are "exploitation by people in power of those most vulnerable to them. If you're not equal in power, then by definition you're vulnerable. And that vulnerability is critical to trauma bonding."
  • Betrayal by intimacy: In its strongest form this is emotional blackmail by someone you trust. Somebody does something wrong and the other person won't turn him in because she would be affected too. The cult abuse/'support community' that ripped up my life did this by trying to stop me from pursuing legal actions because of the ramifications it would have throughout the community.
  • Betrayal by spirit: The most publicized version of this form of betrayal has been the sexual abuse scandals within the Catholic church over the past few years. Not limited by denomination, numerous televangelists have been undone by their sexual betrayals in the past few years too. Carnes thinks the reported cases are only the tip of the iceberg. He doesn't talk about it, but somewhat amorphous New Agey cultish groups also commit these spiritual betrayals. That is part of the story of how my life got ripped apart. And outside institutional religion, "spiritual" abusers often frame what they are doing as "God's will" or some such happy horseshit ("I like to think it happened for a reason"). Whatever the source, spiritual betrayal is doubly damaging, because beyond the abuse, the betrayal cuts off a primary resource for recovery, at least in the twelve step model. Such spiritual betrayals are part of why I don't do step programs any more. Maybe my belief in spirituality was just an illusion anyway. I might be better off, less deluded and vulnerable, without it.

Again, any combination, or even all of the above may be present.

Let me know if you read this by leaving a comment, ok?

All the quotations and information not otherwise attributed above comes from Patrick J. Carnes, The Betrayal Bond: Breaking Free of Exploitive Relationships (Deerfield Beach, Fla.: Health Communications Inc., 1997), 47-72.

Saturday, December 10, 2005

The roots of ptsd: how trauma affects people over time

Patrick Carnes lists eight ways trauma affects people over time:

Most traumatized people will display some combination of these rather than just one.

The information above comes from Patrick J. Carnes, The Betrayal Bond: Breaking Free of Exploitive Relationships (Deerfield Beach, Fla.: Health Communications Inc., 1997).

Friday, December 09, 2005

betrayal bonds: trauma repitition

trauma repitition: This aspect of betrayal bonds involves reenactment or re-creation of prior traumas. Carnes calls it "living in the unremembered past." This can take several forms. Some get in abusive relationships that re-enact the original trauma. Sometimes it manifests itself in a compulsive behavior. Compulsive masturbation, for example, is usually a reenactment of a childhood trauma. Combined with shame, the person often becomes suicidal.

The key to understanding trauma repetition is that "in part, trauma repetition is an effort by the victim [or insome cases, the victim/perpetrator] to bring resolution to a traumatic memory. " It is a way of coping with old traumas, but instead of resolving the past, it creates new wounds, compounding and multiplying the problem. This is where complex ptsd comes from -- the continued repetition and compounding of some earlier trauma. For me that was childhood emotional, physical, and sexual abuse in a a family run by a raging alcoholic father and a classically co-dependent mother. It was a large family, and traumas inflicted on older siblings would then be reenacted on the younger ones.

Unfortunately, one form of trauma reenactment is "to victimize people in the same way they victimized you." While not all trauma repetition is perpetration (unless you want to count self-perpetration, which is sort of a contradiction of terms), all -- or nearly all -- perpetration is a repetition of some kind of trauma that the perpetrator also lived through. One perpetrator often victimizes many people, so the effects get spread widely. I reenacted things by somehow managing to always find relationships with abusive people, allowing both them and me to re-create traumatic experiences in a sick relationship.

According to Carnes (and I'm mostly but not exactly quoting), trauma repetition is characterized by repeated self-destructive (or destructive) behavior, usually of a repetition of some childhood trauma; reliving a story from the past, engaging in abusive relationships repeatedly (this was my pattern -- I thought abuse was normal, and couldn't even recognize it as such until I got in a non-abusive relationship and got help); repeating painful experiences, including specific behaviors, scenes, persons, and feelings; doing something to others that you experienced as an early life trauma.

All the quotations and information not otherwise attributed above comes from Patrick J. Carnes, The Betrayal Bond: Breaking Free of Exploitive Relationships (Deerfield Beach, Fla.: Health Communications Inc., 1997), 24-26.

Thursday, December 08, 2005

betrayal bonds: more on trauma shame

ReallyNotImportant has made another comment that made me make a reply that made me think things through a little more so that I am going to make it its own post instead of a comment. Got all that? Nevermind. Just think of this as part two of the trauma shame post in the series about betrayal bonds.

Really said:
I'm very conscious that you have been through a lot and I don't want to make matters worse.
I guess from reading this stuff, I have been through a lot, but don't worry, as long as people are respectful and talking about their own experience, its fine. I didn't put this stuff up for sympathy or advice so much as to wonder if other people have been through the same sorts of things with their ptsd.

I've worked through a good deal of the shame issues I talk about in the post, very much along the lines you map out. One other thing I learned was that taking on other people's shame is a way of trying to gain control of the traumatic events. If its me, I have an explanation, and maybe even a solution: If its my fault, it might be under my control to change it somehow.

Of course, this is an illusion, one that gets reinforced by 12-step work, which encourages people to always look within for the source of our troubles: The only way it makes sense is if I am just somehow utterly broken goods towards whom such behavior is natural. This was reinforced by my abusers big time (who were, not coincidentally, all associated in one way or another with 12-step forms of recovery), and opting out of that illusion has been key to getting better. It is very tempting to revert to it though, in order to have a reason for things other than that people who I trusted and believed in were malicious and untrustworthy. Its a perverse sort of way of maintaining my old view of the world and denying the betrayals that took place.

When this self-shaming takes place now, I am usually aware enough to take a step back, separate myself from my abusers, and recognize that I am trying to make sense of things in a self-destructive way. The betrayals and abuses were real, and they are not mine. As you say, that then leaves me more freedom to deal with the strong emotions connected with the events, which though they may not be pleasant, they are at least somewhat healing.

I guess sometimes I still shy away from dealing with these emotions because when they all came out at once, it was totally overwhelming and destabilizing, so I need to have support and stability to let go of the shame. While it may be a dysfunctional and ultimately self-destructive way of coping, I needed to recognize that coping is what it was about, not some defect on my part, which of course would only reinforce the shame.

Tuesday, December 06, 2005

betrayal bonds: trauma shame

trauma shame: This aspect of betrayal bonds was huge for me. "when the victim feels defective, or even worse, at fault, there is traumatic shame. . . . Trauma can also leave a feeling of being defective or flawed. . . . People who become shame-based have core beliefs that they are unlovable, that if people knew what they were really like they would leave." Reading this was like a light going off. I still struggle with feeling defective. The last worst abusers in my life basically convinced me I was "a damaged self" that deserved being just discarded. I responded to these feelings by folding in on myself, sort of imploding. I got lost in compulsive use of internet porn to kill the pain and suicidal thinking. The porn (and the compulsive masturbation that went with it) made the shame worse, as in principle I think it is violent toward its subjects.

In the non-traumatic reltionship I had managed to get in, I was sure that if my partner found out about the Internet porn she would leave. She did find out...I finally told her when I thought I was going crazy. It really hurt her, but she immediately saw the connection with trauma that I couldn't and basically stayed with me, even as my mental health went completely to hell. That was a real lesson...she could see things in me that I could not and thought I was worth sticking around for. I figured I had better start to see some of those things in myself too, and I am slowly learning. Releasing myself from the shame and secrecy also undid the hold the compulsive acting out had on me. I started to deal with what had actually happened instead of my shame-distorted views of a whole series of traumatic events that stretched back to childhood.

Trauma shame tends to make some people overcompensate with unrealistic goals followed by more shame at failure in a classic binge/purge cycle. For people with ptsd, all experiences are tend to be processed by the brain as extremes, all black or white, with no grey. The loss of "the ability to operate in a balanced way...further adds to shameful feelings." Shame based people also have a tendency to re-create childhood traumas in adulthood. This was certainly my pattern anyway.

Trauma shame can result in obsessive self-hatred, worse than feeling unlovable or depressed, which can lead to self-destructive, even suicidal thinking and behavior. I made an attempt, but failed, and ended up in a loony bin for three weeks. Never got near addressing any of the causal issues and left basically promising myself not to make another attempt -- I had had my chance -- but still feeling suicidal. I felt suicidal for the next nine years, obsessively self hating and managing to stuff all my feelings, and the memory of traumatic events until everything just fell apart.

In the paragraph that follows, my comments are in parentheses, the rest is quoted from Carnes. Some signs of shame, according to Carnes, are: "feeling ashamed because you believe trauma experiences were your fault; loneliness and estrangement from others because of trauma experiences; self mutilating behaviors such as cutting or burning (when things were at their worst for me, I would literally rip chunks of flesh out of my stomach, the backs of my hands, and other places, I still have problems with self harm sometimess but not as bad); self destructive behaviors, enduring physical or emotional pain that most people would not accept, avoiding mistakes at any cost; feeling that you should be punished for the trauma event and being unable to forgive yourself (I experienced this as the result of cult abuse, where they ripped apart my life and then blamed me for it); feeling bad when something good happens (good things happening still make me anxious); having suicidal thoughts, threats, and attempts; possessing no ability to experience normal emotions such as sadness, anger, love and happiness (one thing I learned was not to trust anything. I couldn't feel anything but a ripping feeling in my stomach and a lump in my throat for a long time, then rage as I realized what had really happened. Slowly I've gotten some of my emotions back, but I have difficulty trusting happiness or anything good, even today -- its just asnother setup, I think); having a deep fear of depending on people (my partner said I tested her all the time, trying to figure out if she was dependable); feeling unworthy, unlovable, immoral, or sinful because of trauma experiences; perceiving others always as better, happier, and more competent (I saw this as a problem with envy. My abusers got off scot free with ripping up my life, and even seemed to benefit from it and it drove me mad for a while); having a dim outlook on the future; avoiding experiences that feel good, have no risk and that are self-nurturing. "

I would have never made the connection between trauma and shame without help, including Carnes' book. I had basically repressed memories of the traumatic events and just thought I was a crazy, no good mixed up, broken person, even as my life on the outside appeared to be very successful. Learning the connection between trauma and shame was a real life-saver for me, making sense of something that seemed utterly senseless to me.

Another thing I learned along the way is that there is a healthy role for shame. When someone does something bad, shame is an appropriate response. What happens in trauma bond situations is -- and let me just shift to first person here -- I took on my abusers' shame. They are the ones that should have felt shame, but in a trauma bond situation, perpetrators shuck it off onto their victims, compunding the abuse. Learning that this shame was somebody's, but not mine, was healing.

  • A little more on trauma shame is here.

All the quotations and information not otherwise attributed above comes from Patrick J. Carnes, The Betrayal Bond: Breaking Free of Exploitive Relationships (Deerfield Beach, Fla.: Health Communications Inc., 1997), 21-24.

betrayal bonds: trauma abstinence

Trauma abstinence: The underlying problem causing this aspect of betrayal bonds is a core belief in one's unworthiness. Self denial is followed by out-of-control sprees. There is an aversion to good, healthy, or nurturing things for the self. Bulimia and anorexia would fall into this category. Often the trauma at the heart of this behavior is family neglect. Children become comfortable with it and become self-neglectful as adults. Coupled with "high arousal events such as domestic violence and sexual abuse and you have a neurochemical cocktail that is hard to beat. . . . the only way to control survival becomes to freeze...Ask nothing. Do nothing. Attract no attention. Yet fear mobilizes the body...In a constant state it can become addictive." Trauma abstinence "occurs especially around memories of success, high stress, shame, or anxiety. . . deprivation is driven by terror and fear" which have powerful effects on the brain.

Carnes talks about trauma abstinence in conjunction with addiction, saying the two go hand in hand. I experienced this as getting one area of my life under control only to see another part go out of control. To me its like that game in the amusement park where you swat at gophers as they pop up out of holes. A soon as you get one, two more pop up and they are never under control...which of course is the "rush" of the game.

What are some of the behaviors associated with trauma abstinence? Carnes says (and I'm mostly quoting him with my own thoughts thrown in): Compulsive debtors, people who deny basic needs like groceries, avoid any sexual pleasure or feel extreme remorse over sexual activity, hoard money and avoid spending it on legitimate needs, work in under-achieving jobs and make unwarranted sacrifices at them, spoil success opportunities (this is the one I relate to most), have periods of no interest in eating (for a while when things were bad I didn't eat hardly at all. I'd eat a little because my partner would make me. Lost 40 pounds. Meds put it all back on...drat.) attempt diets repeatedly, see comfort, luxuries, and play activities as frivolous, skip vacations to work on unrewarding tasks, avoid normal activities because of fears (hmmm...I might still do this some...I tend to hide out when left to my own devices), have difficulty with play (I don't have a problem with this:), be underemployed, vomit food or use diuretics to avoid weight gain.

I think where it shows up in my life is in everyday neglect...not wanting to shower (but I do...so don't worry about the blog smelling bad:), not bothering to eat or eating badly when my partner isn't around, that type of thing. I may have it around some sexual stuff, but its hard to sort all that out. Sex is a real trigger for my ptsd. My partner is also a survivor, and since my ptsd messed up our sex life, we tend to avoid having sex on any regular basis. I don't know if its abstinence or just that freaking out isn't really fun or pleasurable for either of us. I'll talk more about that some other time.

All the quotations and information not otherwise attributed above comes from Patrick J. Carnes, The Betrayal Bond: Breaking Free of Exploitive Relationships (Deerfield Beach, Fla.: Health Communications Inc., 1997), 17-21.

Saturday, December 03, 2005

betrayal bonds: trauma splitting

trauma splitting: Carnes defines trauma splitting as the aspect of betrayal bonds that ignores "traumatic realities by splitting off the experiences and not integrating them into personality or daily life." It is creating another reality and going to it during traumatic events. When this coping style becomes a pattern of dealing with everyday life it becomes a problem instead of a solution.

It can take the form of amnesia. I had no memory of what happened at the time when some of the trauma and betrayal stuff happened for years afterward. When it came back I was overwhelmed with flashbacks and stuff, so splitting was an attempt to protect myself from that I guess. I would not be able to remember what day it was or how long ago the flashbacks were either, so I guess that was dissociation too. It can also take the form of splitting from one's body, maybe flying around the room, or detaching and looking down on the scene from above. Sometimes different personalities form during splitting. This gets called multiple personality disorder or dissociative identity disorder (DID).

Addictions often have a component of splitting. Addictive behavior, whether in the consumption of a drug, obsessive or compulsive sex, gambling, or even religious or artistic preoccupation, can be a form of splitting, of creating a fantasy reality that ignores the real state of things. Lots of addicts talk about a "Jekyll and Hyde" experience of having one set of values and behaviors they believe in and another personality, the out of control addict, that seems intent on destroying these.

Some signs of dissociation are spacing out as a response to painful memories, confusion and forgetfulness because of preoccupation, resorting to a fantasy world when things get tough, feeling separate from the body as the result of a flashback, amnesia, preoccupation, having compartments to your life others don't know about, living a double life, obsessing around addictive behavior, losing yourself in romantic fantasies, or using marijuana or psychedelic drugs. All of us space out sometimes, the problem is when it becomes a way of life.

All the quotations and information not otherwise attributed above comes from Patrick J. Carnes, The Betrayal Bond: Breaking Free of Exploitive Relationships (Deerfield Beach, Fla.: Health Communications Inc., 1997), 14-17.

betrayal bonds: trauma blocking

trauma blocking: This aspect of betrayal bonds is about numbing out in all its various forms. Alcohol and drugs are often used. I used compulsive masturbation and internet porn to kill memories and pain. Others eat compulsively, excessive sleep, watch mind-numbing TV to waste time, become workaholics, maybe bingeing occasionally on any of these behaviors. Often times this is trouble for recovering alcoholics: When they stop the drug, the pain rushes in and they go back or switch to other addictions. The behaviors reduce anxiety, but have their own set of problems.

Often trauma blocking alternates with trauma arousal. A person will engage in high-risk, high shame behavior such as compulsive sexual activity followed by numbing out with food alcohol or something to numb out the shame. Another example would be an addict alternating between ice and alcohol, the former for arousal and the latter to numb out afterwards. When I was using, I used to do speed with alcohol and depressants in order to be "normal!" Not quite.

All the quotations and information not otherwise attributed above comes from Patrick J. Carnes, The Betrayal Bond: Breaking Free of Exploitive Relationships (Deerfield Beach, Fla.: Health Communications Inc., 1997), 12-14.

betrayal bonds: trauma arousal

trauma arousal: This aspect of betrayal bonds is about getting hooked on high risk, high stress behavors, whether sex, business, violence, dangerous activities, or gambling: seeking pleasure in the face of high risk, danger, violence, or shame. I used to have this a lot more when I drank and drugged, but it was not as much a part of my behavior once I got off the booze and drugs. A person gets hooked to the rush, even if it becomes addictive and interferes with life.

All the quotations and information not otherwise attributed above comes from Patrick J. Carnes, The Betrayal Bond: Breaking Free of Exploitive Relationships (Deerfield Beach, Fla.: Health Communications Inc., 1997), 9-11.

betrayal bonds: trauma reactions

trauma reaction: This aspect of a betrayal bond takes the form of PTSD. It includes things like intrusive thoughts or memories, sleeplesness, sudden vivid memories, extreme caution, an easily triggered startle response, nightmares, distress at anniversaries or other triggers, angry outbursts, irritability, distrust, physical reactions like cold sweats, shortness of breath, or flashbacks. Any number of things can trigger a ptsd response, which may be pretty severe in the case of a flashback, or somewhat milder but still yukky things like nightmares. I still struggle with sexual relations because they trigger really strong memories of abuse and I have a sort of automatic reaction and just kind of shut down. BTW, this really sucks. the sustained, overwhelming sense of fear that triggers bring on actually changes the neurology of the brain. The body is constantly on a state of high alert, which is wearing.

All the quotations and information not otherwise attributed above comes from Patrick J. Carnes, The Betrayal Bond: Breaking Free of Exploitive Relationships (Deerfield Beach, Fla.: Health Communications Inc., 1997), 6-9.

Friday, December 02, 2005

more on betrayal bonds, aka trauma bonds

OK, back to ptsd and betrayal bonds. I wrote a little about them a few days ago. I have also put up a whole section on other symptoms of ptsd. Here is some more on betrayal bonds.

At the treatment center I went to for ptsd I was introduced to the concept of a trauma bond. They shared portions of a book, Patrick Carnes' The Betrayal Bond: Breaking Free of Exploitive Relationships, with me. I immediately bought the whole thing, and it remains about the only self-help type book that I have managed to work all the way through. It transformed my understanding of what was going on in my life, why I kept repeatedly getting involved in traumatic relationships even after getting clean and sober, why I was unable to "just get over it," and finally, what made these relationships so powerful in my life.

The place to start is with betrayal. What is it? Carnes starts his book by saying it is "a breach of trust. Fear. What you thought was true -- counted on to be true -- was not." ReallyNotImportant, in his blog on Zen and PTSD, describes it nicely when he says that "the world is suddenly a very strange place. Nothing makes sense. Nothing is clear-cut, everything has nuances. All the certainty is gone." The world becomes unsafe. It may fall away from beneath your feet at any moment. But its not all a lie. According to Carnes, "there was just enough truth to make everything seem right. . . . a little truth with just the right spin." The rest was exploitation and a harsh form of abandonment, which he connects to the core of addictions and shame. It is worse than neglect, being purposeful, in my case even intentionally cruel. And "if severe enough, it is traumatic," he concludes, creating "a mind numbing, highly addictive attachment to the people who have hurt you," leading to self-distrust and self-abandonment.

Because of my history of abuse and trauma, I managed to stack up a series of these betrayal bonds with god-awful results. Carnes notes that "adult survivors of abusive and dysfunctional families struggle with bonds that are rooted in their own betrayal experiences." He concludes that "Loyalty to that which does not work, or worse, to a person who is toxic, exploitive, or destructive to you, is a form of insanity." So I guess I was insane, at least for a while. That is how it felt, too.

He has a test on his website that you might take if you think you are in the grips of a betrayal bond. Some of the signs are "misplaced loyalty, inability to detach, and self-destructive denial." Then comes the punch line, the part that explained why everything could still go crazy even nine years after I had extricated myself from these relationships: " You will never mend the wound without dealing with the betrayal bond." Time won't heal it, compulsive or addictive behaviors won't numb it away, therapy won't cure it, spirituality won't work...none of it will unless you confront the trauma bond itself.

In what sort of contexts do they occur? Carnes gives a list of likely candidates:

  • domestic violence
  • dysfunctional marriages
  • exploitation within the workplace
  • religious abuse
  • litigation
  • kidnapping
  • hostage situations
  • cults
  • addiction (alcohol, drugs, gambling, sex, high-risk behavior
  • incest and child abuse

Half of those things happened to me in the span of a couple of years, and a couple more had happened earlier. Any of these are complex issues, and Carnes says "an unraveling must occur." There is no simple, quick fix.

He maps out abuse along two axes, from once or seldom to frequent or constant on the one hand, and from low trauma to high trauma on the other. That explains why someone who has a series of moderately traumatic events can have many of the same symptoms as someone who has a single highly traumatic event. While the symptoms are the similar, it seems to me that the unraveling is a little different for everyone.

He then lists eight ways trauma affects people over time, one of which is the betrayal bond. I'll go into those in the next few posts. Most often, a person who has been traumatized will be affected in more than one, perhaps even all of the ways listed.

As usual, if you got this far, let me know in a comment!

All the quotations and information not otherwise attributed above comes from Patrick J. Carnes, The Betrayal Bond: Breaking Free of Exploitive Relationships (Deerfield Beach, Fla.: Health Communications Inc., 1997).

Thursday, December 01, 2005

ptsd, flashbacks, and "pseudo-seizures"

Just a quick post today. I have lots to write about. Working hard on recovery and finding out some new things from this experience of blogging about my ptsd. I'll share in little bits over the next few days. Plus, I just spent my blogging time commenting on another thought-provoking article on Holly's Fight to Stop the Violence on Internet Porn and Sexual Addictions.

BTW, grounding exercises can help a little with flashbacks, so if what I describe below is familiar try them out. They don't make the flashbacks tolerable or make them go away, but they helped bring me back to the present a little sooner when I could do them.

I just want to talk about what are called "pseudo-seizures." They are a particularly nasty kind of ptsd flashback. When I first came upon the name in therapy, I was relieved that there was even a name for what I was undergoing, namely half-hour to hours long episodes in which I would become a tautly curled up shaking sobbing mass of pain, followed by major disorientation...I often would not know what day it was or if and how long ago the thing had happened. I had hundreds of these over the space of a few months, utterly terrifying and exhausting, doubly so when I didn't know what they were. I just thought I was going crazy. So unlke ReallyNotImportant, who dismisses the labels as not very helpful, I found having a name for what I was experiencing comforting to some degree. At least I was not alone. This was within the range of human experience, even sane experience.

If you are having these things, which doctors are now starting to call "non-epileptic siezures" because sufferers have understandably negative and invalidated responses to the "pseudo" part of the label, I truly feel for you and hope you will get help however you can to get through it. There is another side, as far away and impossible as that may seem. I didn't think so either but there is, so plz hang in and get help. There is nothing pseudo about the experience at all. It is horrible.

I tried to think what I might have called them if I didn't know what they were...When I was able to contain them to when no one was around, I invalidated them as just me being dramatic -- though never with an audience. I just tried to minimize, hide, and wish them away. Ultimately, they outed me and that is when I got help from my wonderful family of choice. I thought they would think I was crazy and just discard me like my abusers had when they were done with me.

I guess "crazy" or "insane" were my descriptors once the cat was out of the bag. And they would have been correct I suppose if I hadn't been so fortunate as to be able to get help and support. I looked and felt battered and emptied out of all humanity, only able to feel pain and not able to get rid of it for a moment. No relief.

I still get shadows of them today. Sometimes I shake badly. Sometimes like today I feel like I am hitting the top of an elevator all day, an unsteadiness in the pit of my stomach. It serves as a reminder of worse times, but it is nowhere near the intensity of before...I have been "pseudo-seizure" free for a couple of years now. They slowly worked their way out of me. So if you have 'em, please don't let them get that last little bit of you that you hang on by, even if you have to fight tooth and nail and act all unseemly and cry alot. I needed medication as part of my solution...Geodon was the key one for me, though I know others who hate it.

So if you are having these sorts of intense, seizure-like flashbacks, or have had them in the past, leave a comment and let me know I am not the only one in the blogosphere to have had them!

Tuesday, November 29, 2005

Trauma Bonds or betrayal bonds, Stockholm Syndrome

[n.b., I have a new post on betrayal bonds here that has more information]

reallynotimportant said:
I can understand your desire to want to try and understand everything and why people did what they did. It is natural. I have been there myself.
Ultimately, I think it is pointless and self-destructive.
For me, I decided in the end that some people did some bad stuff and deliberately tried to fuck up my (not personal though) life. Why they did it - well I really don't care. They did what they did. I have no desire left to 'understand' them.
There was something different about our experiences of trauma and ptsd here. You may be right about it being pointless and self-destructive to try and understand a perpetrator's motives. It is a long path to there for me. My last perpetrators were people I trusted and cared about a lot. What they did ultimately may have not been personal -- it is about their sick and twisted minds and the consequent actions--but they personalized it, putting a major head trip on me, which I bought into fully because I trusted and cared for them and was basically naive about how twisted people could be.

This sort of betrayal creates something called a trauma bond or betrayal bond. A trauma bond is where an intense, traumatic experience or betrayal of trust takes place, forming an equally intense relationship/bond with the perpetrator. It is related to Stockholm Syndrome, after the hostages of Stockholm bankrobbers who waited for them to get out of jail a decade later and defended them -- and one even got engaged to one of them. Its not a real simple thing to just detach from such a bond. I had no frame for understanding it. It cost me my whole community, and I ended up starting over in a new place, which in the long run was a blessing, but in the short run was overwhelming, just having gone through a series of really intense betrayals and having nowhere or no one to go with them and just vent, much less try to make sense of them.

Ultimately you are right, trying to understand stuff like this is like Nietzsche says, "if you stare long enough into the Abyss, the Abyss stares also into you." It literally made me insane. I had to learn that I was not how other people constructed me...I was and am in charge of my own identity, who I am, and why I do things. This is basic for most people I guess, but it has been a real task for me. I had to come to an understanding that what had been done was abusive, because in the manner of good psychopaths, they made everything look normal on the outside, that it was me with the problem. And so it was: their lives weren't being torn up, mine was.

I guess what makes things hard for me is that I really cared about and trusted these people, and it was so personalized, being meant to basically destroy me. I'll write more about this later maybe. I'll try and get some some sleep now.

Monday, November 28, 2005

my name, and more on 12 steps, aa people, and trauma

Another commetn that turned into a post today. Reallynotimportant raised the issue of ptsd and identity in a comment, saying my screen name over-identifies with ptsd, making the ptsd who I am rather than serving as a loose-fitting bundle of descriptions that more or less describe what is going on in my life. I chose the name ptsd guy without much thought. In fact, if I had waited five minutes or a half hour, I would have been traumarama, which I think is kind of funny, instead, but I didn't feel like going and creating a whole new account and so forth. If this blog were my whole identity, I'd be worried about my name...and a whole lot more, but its not. I have put together a pretty regular life, pretty much against all odds. A few people know about the ptsd because I shake badly from it sometimes and they wonder why, but I don't make it a big deal.

Hanging around with what you call normal people instead of people who define their whole lives around their addictions was a big and scary step for me, and the best one I ever took. I don't hang with people who define their lives by what is wrong with them any more and it has made a huge difference. For one thing I stopped being repeatedly re-traumatized, which was sort of a revelation.

One of the tools I picked up in the trauma treatment center I went to was to separate the trauma from me and distinguish between the two. This remains something I have to practice, some days maybe more than others, so I agree with your critique of my chosen name, but the blog is about that part of me and trauma and ptsd have shaped who I am to some extent, so as long as the blog is not all of who I am, its fine I think.

Maybe you are right about it being a 12-step hangover (nice concept) but to me its not all-defining. This blog is where I hope I can work out the parts of me that have been shaped by ptsd. I don't want to say a whole lot more. I don't put all of myself here. I like the anonymity. It allows me a freedom to speak and be spoken to experimentally, without the repercussions of if you knew more about me. Not trying to be mysterious here, but to explain what I put of myself into this blog.

Also, I pretty much hacked on 12 step programs in some of my posts (here, here, and here), but they really did save my life. I am quite ambivalent about them. I was incapable through willpower to quit drinking or using -- I tried that route for five of the most miserable years of my life -- and entering AA, working the steps with fellow addicts and alcoholics is what allowed me to get clean and sober, so I am not really an iconclast about it. It works for what it does, where other stuff fails. I just think that 12 step programs are ill equipped to deal with more than their single purpose. If someone came to me and said they couldn't stop drinking I'd take them to aa -- and probably leave them there:) But it does actually get millions of people sober who were intractably and incurably addicted to alcohol and other drugs. I think it is hard for someone whose willpower works for them to understand what it is like to not have it work. Addicts' willpower utterly fails them and they need something more to get clean. 12 step programs do provide that.

The problem is that when you dry them out, you have a room full of crazy addicts who are ten times as dangerous because they are no longer drugged and think they are the cat's pajamas when they are really incredibly twisted human beings who are fortunate to even be alive. That was not a good situation for me, because I seemed to be able to find the sickest most abusive, manipulative, and insidiously cruel people and choose them for friends.

I think that might be where our ptsd or trauma experiences might be a little different, something I just noticed you mention in another comment (Having a hard time keeping up!). What you have described seems to be a really major once-and-done thing (correct me if I'm wrong here). Mine is a long history of continued traumas, anyone of which might not have been debilitating in itself (but pretty much any of them could have killed me) which combined to make a pretty yukky soup out of my mind and experience. I have a lot less certainty about who I am maybe. I don't know, I am a little uncomfortable making this sort of comparison -- I posted on avoiding the oppression olympics so I don't want to imply that one is better or worse, just different in some ways in our experiences and responses. But at the same time, there is enough going on in common to make for a conversation in which I need to think about things from sometimes new, sometimes different perspectives, something I'm all for.

Anyway, I am being somewhat contradictory but that is how things are, and I guess I'll stick with my ill-chosen name for now. I'll keep what you said in mind though, and if I get around to it or think of a compelling one, maybe I'll change it. Maybe its reallynotimportant:)

Sunday, November 27, 2005

feeding the right dogs

I am doing a bit better today and yesterday than I was the couple of days before that. Reallynotimportant and Holly stopped by the blog and had helpful things to say. Thanks! Originally, this post was a response to the comments, but I spent a little time on it so I thought I would make it its own entry.

Reallynotimportant suggested a bunch of things for the intrusive thoughts and the nightmares. I do try to do something to distract myself when the intrusive thinking comes up. When I feed the right dogs, I can often get through by seperating me from the abuse and the abuser, realizing that I am not the trauma or what my abuser tried to make me. Sometimes that works. Other times its something good like exercise, playing my guitar, or doing some work, but often I feed the wrong dogs and its internet porn to kill the thoughts and feelings. I don't use drugs or alcohol for the past 20 some-odd years, so fortunately that's not an option. Lately I've been writing in this blog and that has greatly reduced the need for the pain-killing behaviors. The medications help a lot with the intrusive thinking and the compulsive aspects of my reponse to it too.

With the nightmares, I was trying to write them down for a while and taking them into therapy, but often I don't wake up enough to get to that. I hadn't thought about the feelings being more important than the content. Hmmm....

Mostly the nightmares suck because I thrash around and mumble stuff and wake my poor partner up and she won't be able to get back to sleep. This has been going on for 4 or 5 years now, ever since the worst of the ptsd kicked in, so we've mostly worked out a sytem where she'll jostle me and tell me what I'm doing and that will snap me out of it. Often I don't even wake up. She gets kind of resentful about this sometimes, but she knows I am working on it and is really patient. Neither of us wants to sleep alone. I'm pretty grateful for that.

You are right about getting whatever kind of sleep you can. I take a lot of naps. Fortunately with my work, I can schedule things mostly how I want to, with lots of flexibility.

Saturday, November 26, 2005

crawling out of my own skin

PTSD sucks some days. The last few days fell into that category. At least its not constant like it used to be. Two days ago was crawling out of my own skin day. I just walked around with this ripping burning nauseous feeling centering on my solar plexus like I wanted to puke my guts literally out...just get whatever it was out of my body. It makes me kind of understand bulimia, which I never fortunately had. My partner gave me a massage which helped a little, but it didn't go away until I went to sleep. I suspect it had something to do with stuff brought up in therapy that day.

Then the next day I was revisited by another of the joys of ptsd, intrusive thinking. Any moment of down time, thoughts of my abuser would come flooding in and I would try to make sense of the senseless, over and over. This lasted until I went to sleep, maybe longer, as I tossed and turned a lot and had nightmares. All in all it kind of sucks. My partner thinks it might be because of the onset of the holidays, which is a tough time for me. Anyway, at least now it is not constant. Before the intrusive thinking and the ripping feeling, along with a lump in my throat were my ennervating constant reality.

Wednesday, November 23, 2005

ptsd, race, class, homelessness, and money

I am very fortunate. When my ptsd got bad and I had about 120 flashbacks that looked like seizures over the course of seven weeks and was completely incapacitated, I had very good friends and family (not my family of origin, though) that supported me and got me through. Left alone I would have surely killed myself or ended up homeless, babbling on the street. Iwas staying in a big city at the time and would see homeless people, often with that thousand mile stare, and feel how little it was that separated me from them. Many times I felt like just walking off and joining them, just giving up. I realize that there are all sorts of reasons people become homeless. For a while in my addiction I was too, so I am not just romanticizing or being dramatic. I believe that many of the homeless are people who suffer from acute, untreated ptsd. Lots are vets, a population at high risk for ptsd. Many show the symptoms. The lack of trust in homelessness resources, hypervigilance that people with homes perceive as scary paranoia, the "crazy" looking behaviors, the empty broken look in their eyes: all of these could be from ptsd, a way of coping with overwhelming trauma.

Like I said, I am very fortunate. I was able to go to a treatment center for ptsd for seven weeks. We did not have the money to be able to afford all of it, so we borrowed from friends and my partner's family and ran up the 0% credit cards. Help came from unexpected quarters. A loan here, a gift from an unexpectedly supportive source, a plane ticket to the treatment center, a friend to accompany me there when I might not have been able to make it on my own, even the treatment center gave me a week-and-a-half "scholarship" at the end so I could get the most out of it: All these came through.

My parents, in complete denial about the emotional, mental, and sexual abuse that took place in our family would have nothing to do with it and refused to help. When I told them I was suicidal and needed help, they asked if I had gotten a second opinion ... Like a bad Rodney Dangerfield joke or something. Iwas so familiar with their ways that I already had gotten one, and a third and fourth one too. All recommended treatment if it was possible to go. The 'rents asked if I had talked to anyone that disagreed and refused to help, basically saying that no one else in the family had ever said there was abuse (this was not actually true, but denial is a wonderfully effective tool) and that I was making it up and under the control of evil shrinks! It is still tempting to cave in to their way of thinking -- especially if I have contact with them -- which is that I am just incompetent and lazy and kind of brainwashed. For that reason, I don't keep in touch any more. I just cannot deal, so I don't.

So anyway, the treatment center is in the southwest. Pretty much everyone there was well-to-do. A few were covered by insurance (I was not). Everyone was white. Not a single person of color among the clients. There was one Chicana and one part Native American woman on the part-time staff, but otherwise, all of them were white too. The drivers, janitors, and housekeeping staff were all Mexican, though. Nobody seemed to notice. That is just the way things were (and probably still are). Clients in groups would waste time on BS to avoid dealing with trauma issues, which really made me angry, because of all the sacrifices we had made for me to be able to go. When I got angry about this, they got mad at me that I was minimizing the connections they were making. Maybe that is right, I don't know.

I have a friend, a woman from the Caribbean who has ptsd from political violence, and she came to visit, curious if there was anything there for her. She noted that everyone was caught up in their own little worlds...all the trauma, including mine, was very individualistic. There was no awareness of racial or class differences even though they were really obvious if anyone took the time to look. And it didn't seem as if socially inflicted traumas from war, political violence, or poverty were anywhere on the horizon of their consciousness. I wonder if that has changed at all with all the Iraq vets coming home and developing ptsd.

Anyway, Like I said, I am very fortunate. Fortunate to be a white male. Fortunate that I was in a place where I was able to scrape together the resources to get help. Fortunate that my traumas were generally within the scope of what they deal with (although I think I was the only one there at the time who had ever been poor or homeless). Fortunate to have such a great and supportive network of friends, my family of choice, something that a few years earlier I did not have at all.

With all that good fortune though, came the realization that many -- maybe most -- of the people suffering from ptsd just do not have the resources to get the help they need. That really says a lot about our society, that the people who are most vulnerable and in need, the people most traumatized by structural conditions like racism and poverty, are just left out of the picture for the most part. There are token efforts and some volunteer efforts to reach them, but the Bush administration (regime?), his cronies in Congress, and the Army are putting current veterans' benefits under siege. You can forget about serving 9/11 or Katrina survivors -- Bush's response is to pray for them. And a discussion of structural poverty that results from greed and racism and leaves thousands traumatized or homeless or drug-addled or poor or all of the above is nowhere on the horizon. Maybe its time to start having these discussions. What do we do? Especially those of us who are fortunate enough to be able to afford and have the support to recover somewhat. Don't we owe it to those that don't have the resources to try and change things? But how? PLz talk back.

Tuesday, November 22, 2005

Choosing a therapist for people with ptsd

[n.b.: links fixed, 12/8/08]

When the symptoms of my ptsd exploded on me a few years ago, I had no idea what it was, what was going on or how to deal with it. I thought I had gone crazy and was headed for a trip to the loony bin again. Fortunately, with a lot of help from friends, especially my partner, I was able to get help. I wish I had a guide like the one I found today from the Sidran Institute back then. If you need emergency help, if you think you will harm yourself or others, get help from 911 or a hotline immediately. If you are well enough to look for a therapist check out the guide now. What follows is my experience in finding both really bad therapists and finally figuring out how to find some good ones (I also needed to go to a treatment center, which helped a lot, giving me an understanding of ptsd and some tools to deal with it in a safe supportive environment).

I had no idea of what to look for in a therapist when my life fell apart on me. Part of my ptsd involves earlier abuse by therapists, and I was turned off by the whole thing but really needed help. I chose a real loser at first, another abusive therapeutic relationship. There are so many bad shrinks out there. This one blamed everything on me and said I had caused all my own problems because of my shortcomings. I think he was trying to goad me into getting angry at him, some kind of manipulative move to get a reaction from me for the sake of "therapy." I went with my partner to one visit and she was like "this guy is nuts, let's get out of here," so we walked. She has good sense. I seem to have a broken "picker," something that is pretty common to people with complex ptsd.

Things were too crazy and unmanageable for me to give up the search, so with my partner's help, I kept looking. We asked around about what to look for and interviewed several people before settling on one who turned out to be good. We came up with a set of questions to ask, but I forget what they were. Today, while reading the post on treatment centers, I followed a link at the bottom of the page that turned out to be an excellent guide to choosing a therapist for people who have ptsd and trauma-related issues. It would have been great to have it back then.

The guide gives a few important criteria for choosing. First, the therapist should be your partner in healing, not the director of it. She has to respect you and your experience and draw on it to help you. This doesn't mean you need to be pals inside or outside therapy. That can turn into more trauma and cause major trust issues later when trying to start with another therapist. But you need to collaborate in your recovery, so look for a good rapport. This was pretty hard for me, as trauma and abuse taught me not to trust my intuitions. That is why I was lucky to have friends to bounce things off of while I was choosing a therapist -- once I was willing to, anyway. Like I said, I stumbled on my own at first. That is slowly getting better though, and I am reclaiming trust in my intuitions, which are actually pretty sharp, like those of most survivors.

Second was to find someone qualified. Anyone can call themselves a therapist, so ask about training. Look for people with at least a masters degree in an appropriate field. Psychologists have to be licensed and have at least a Master's. I have looked for ones with Ph. D.s. This is not a guarantee, as the one we walked out on was a Ph.D. Losers come in all flavors. I had consistent problems with a group of people called "certified addictions counselors" (CACs). All you need for this is a Bachelor's degree and some additional experience and training. The people found tended to go for new-agey solutions or be didactic about twelve step programs, and were in hindsight consistently bad. I also had lots of problems with boundaries with these peole. They did a lot of overzealous intrusions into my life. Part of the problem is that many of them are egotistical "type A" alcoholics. Unfortunately for the dually diagnosed ptsd suffering addict, most rehabs refer clients to CACs. I am sure there are good ones but my experience has been uniformly awful, not matter how well-intentioned they were. A thorny problem is that bad therapists tend to be more affordable than good ones, which is really an important factor for people who don't have insurance and are in early recovery from addictions. If you are on a budget and don't have insurance, be extra careful!

There are many types of therapy, and various camps will tell you that one or the other is the only or most effective treatment for ptsd. I have found that rapport and qualifications and a willingness to collaborate are much more important than the particular approach, whether it is cognitive behavioral, Jungian psycoanalytic, Psycho-dynamic or whatever.

HOWEVER, that said, avoid at all costs quick wonder cures or anyone that tries to sell you a one-size-fits-all treatment regime. Recovery from complex ptsd takes time, flexibility, and sensitivity. I don't know, maybe simple ptsd, where there is no chronic or multiple abuse, responds to some of the more legitimate brief therapies, but not mine. Run as far away as quickly as possible from any cultish or new-agey spiritual methods like "neuro-linguistic programming" (NLP) or any of its myriad offshoots like "time-line therapy," "advanced neuro-dynamics," "humanistic neuro-linguistic psychology," the fake Hawaiian spiritual practice "Huna," or whatever other label they are using this week. These promises of quick cures are tempting to people who are literally dying for a solution, but they play on vulnerability, slowly, even imperceptibly, seeking to separate the client from his wallet through ever-more expensive treatments and "trainings." They are manipulative, and if the "cure" fails, they blame the client rather than trying something else, further compounding the trauma. They often play on people's spiritual longings or cloak themselves in quack versions of legitimate sciences like linguistics or quantum physics.

Unfortunately, these treatments, with their promises of quick solutions, often present themselves as the most affordable and financially accommodating, making them doubly attractive to the doubly vulnerable, those without insurance or a lot of financial resources. Look for someone you can trust. If you are not sure of your own instincts, get someone whose judgment you respect who has no connection to the proposed therapist to help you pick and choose. Its vitally important that you be able to develop rapport and a partnership with your therapist. It will take some time.

Having said all that, here is a brief excerpt from the guide to choosing a therapist if you have ptsd. If you like it they have a version that you can print out and take with you (pdf) too.

Questions:

  • What are your credentials?
  • What are your specialties?
  • What professional organizations to you belong to?
  • How long have you been conducting therapy?
  • What experience have you had in treating traumatic stress conditions?
  • How do you approach treatment of traumatic stress conditions?
  • What do you charge?
  • Do you accept insurance? If so, what kinds?
  • Do you have a sliding fee scale? If so, how is payment determined?
  • Do you bill people, or is payment expected at the time of the session?
  • How do you protect client confidentiality? Who (besides you) will have access to my files?
  • How long is each session? Are there exceptions to this?
  • Has anyone ever lodged a formal complaint against you?
  • Have you ever been censured by a professional organization?
  • If I were in crisis, would I be able to reach you? How do you handle crises?
  • What is your policy about missed sessions?
  • What is your policy about physical contact with clients?
  • What is your policy about contact outside of the session?
  • Do you arrange vacation coverage?
  • What happens if one of us decides to terminate without the other's
  • agreement?
  • Do you think you can help me?
  • Is there anything I should know about your services that I didn't think to ask about?

My impressions: check all that apply

  • I felt safe and reasonably comfortable
  • I felt understood and taken seriously
  • I was treated respectfully
  • We agreed about the nature of the problem
  • This feels like it could be a good "match"
  • My questions were answered adequately
  • My treatment goals were addressed
  • This individual is clinically qualified
  • I can afford it
  • I can get there with reasonable ease
Overall impression:

  • Good
  • Fair
  • Poor

Comprehensive list of US Treatment Centers for PTSD and Trauma

updated, 5/10/2015
This is one of the most read pages on the site, so I guess there must be a need for more information of this sort. The Sidran Institute gave me the original list, which I have now removed because it was outdated.  Sidran keeps a comprehensive list of U.S. treatment centers but this list is now three years old as well.  Your best bet is to email help@sidran.org.  Sidran has an excellent help desk. If you need help locating a treatment facility, contact them. If you have concerns about contacting a place over the net, they have a page explaining how the help desk works.   (As of 7/14/2016, the website appears to have been hacked, so email is best bet.  You can call too, but they prefer email.)  If you want to help out, their help desk is currently without funding and run all by volunteers, so make a donation or volunteer once you are better. They will use it to make sure someone is there when you need them and to update their resources to make it easier for volunteers to find the information you need. They are doing great work.

You can check the comments section of this page for individual experiences.  If you contribute, please do not use any of the staff names and such.  I won't post if your comment if you do.  Check the dates, as many comments are quite old.

Before contacting any of the centers (besides Sidran) it would be a good idea to look at the post on how to choose a therapist for PTSD.

If anyone has a comparable list for other countries, email it to me and I'll post it. If you are considering one of these places, make sure you check for references to it in the comments below the main post too, as many readers have offered their very valuable personal experiences at a number of these places. If you have had good or bad experiences, feel free to share. I reserve the right to not publish if it seems there is disrespect or slander going on. Please avoid naming particular people, but saying the" director," "my therapist" and so forth is fine. Otherwise, keep it real and I'll approve the post no problem. There are some names in here right now because I did not put this policy into place until 4/29/2010, but I'll leave them unless I get complaints from the person named as the comments are still valuable and I cannot edit them, just publish them or not.


Sunday, November 20, 2005

Holly's blog entries on ptsd and other stuff

I've been putting off posting a few days while mulling some things over. In hunting around for other blogs about ptsd I found Holly's Fight for Justice and Holly's Fight to Stop the Violence. Both have tons of great entries. She has a clear and concise description of what ptsd is and her own experiences of it. There is a excerpt and another link to a site about emotional rape, which puts a label on the last and worst trauma that fuels my ptsd. An entry on trusting memories of sexual abuse is affirming and reassuring to those like me who tend to minimize it and not believe our own memories. She has given me a lot of food for thought and some fuel for future posts, I hope. You Go, Holly!!

Wednesday, November 16, 2005

ptsd and wasting time...

ok, so no rant today.

One of the difficult things about my ptsd is that I end up wasting vast amounts of time. I have a job where I can sort of get away with it, but there's lot's of stuff I'd like to be doing instead of what I do do. I have been spending whole days surfing internet porn sites. Actually writing this blog has improved that a little bit. Now I spend 7/8 of my time reading blogs and writing mine and 1/8 surfing porn and whacking off. It is kind of self destructive, which is something I have fought with for years, even after setting down what seems like they should be the most self destructive behaviors, the drugs and alcohol.

In treatment for the ptsd and in therapy, I was told that all this avoidance is avoidance of pain having to do with the various traumas. I always intend to spend the day productively but just seem to get sucked into diversions. Is it pain killing? Or lack of discipline and laziness?

It actually was a little better for a while when I was on heavier dosages of the Geodon, but when I reduced that, the bad depression and ptsd symptoms (like wanting to crawl out of my skin and feeling constantly nauseous and so forth) came back and so the time wasting and internet porn surfing came back to mask/numb/avoid feeling that. I re-upped the dose, but while I feel better, the old time wasting habits returned and are hard to kick again.

It is sort of a double bind. When I am medicated enough to not compulsively act out I am too fuzzy for much else, and when I reduce the meds, I think a lot clearer but the compulsive behavior returns. Go figure.

If you read this let me know, ok?

Tuesday, November 15, 2005

ptsd, aa and christianity

Well, yesterday's post got me looking around for other bloggers writing on ptsd, and I found some doozies. Apparently, there is a whole movement afoot to basically take over aa and replace tolerance for all sorts of spirituality and even atheism with a narrowly evangelical, homophobic, misogynist christianity. For example, Ted W., who basically gives his last name and thus breaks his anonoymity at the level of publishing, argues that
I guess its an undeniable truth that some people get sober in Gay AA and then later face up to the truth of the sin of homosexualtiy. Nevertheless, I still believe AA would be better off if it didnt publish pro-homosexual literature.

One of the key messages of a program of recovery is tolerance, something that seems to be missing here. In another entry, Ted preaches that hate is the root of addiction...not his any more of course, but others toward him. I wrote back that:

Pretty amazing that you can preach that hate is the root of addictions at one spot in your blog and then go off on this homophobic nonsense here...Anybody can get together and call themselves an aa group as long as their primary purpose is to get sober. There are lots of homophobic, racist, misogynist straight white guy meetings (you can just call them real meetings, because you don't see the privilege you are taking and denying others by forcing your morals and standards on them). And don't give me that "love the sinner, hate the sin" nonsense and expect me or anyone with a whit of sense in their heads to take seriously your hypocritical rejection of hate. There need to be gay meetings and other special interest meetings precisely because of people like you and your intolerance.

My experience is that there are haters of all kinds in aa, cloaking their hate in 12-speak or god-talk but somehow the most vocal are always straight white men who don't understand why the Blacks (they'll often use other terms in the parking lot) and homosexuals need to have there own meetings because aa is for everybody, and if they don't like the white straight male hateful version of it they just don't want to get sober. I've watched this sort of thing clear the room of the people named and make meetings whiter and straighter. De facto, that is a special interest meeting in itself, a white straight male one. I don't like those meetings even though I happen to be a white straight male. They do damage and drive people away who otherwise might have a shot at recovery then and there were it not for intolerance. In fact, if it were not for this type of intolerance, special interest meetings for people other than racist homophobic white straight males wouldn't be necessary. So if they want to get rid of special meetings, Ted, why don't you just show some tolerance for people who are different from you?

Then there are the wing-nuts who are trying to make aa into a evangelical, religious, christian organization. They are pretty straight up about it, arguing that it comes directly from christianity and therefore that is how it should be now. Sort of like the argument for original or framers' intent on the constitution, to which the late Thurgood Marshall noted that if the case of original intent was sound, he would be a slave to the white judges rather than a fellow jurist. "We know only a little" the Big Book says in one of the last paragraphs, so why do these people want to limit that to the little bit that they knew when they wrote it? Probably because any thing, practice, or person that is different from them scares them. One of the chief responses to fear is to lash out, and that is what I think is going on.

So what does all this have to do with ptsd? Well Ted argues that his alcoholism was the result of unaddressed ptsd. Did he ever stop and think that his addiction to hate and intolerance might be too? The people I read today are good examples of what I was calling yesterday "Type A" addicts. Well it is time for us "Type B"s to speak up.

Monday, November 14, 2005

ptsd, AA, and different types of addicts

OK, so today I want to talk about something I figured out from years of AA (Alcoholics Anonymous) meetings. First, let me say that I am speaking as a member, though not an active one, and I can do this because my blog is anonymous. I make no claims, as will become obvious, to be speaking for all of aa. In fact many would probably disagree with what I have to say.

I think there are two (who knows, maybe more, but two will do for now) types of alcoholic or addict. The first kind is the kind the program is designed for. Sort of a "type A" aggressive, in your face, screw-up-everyone's-life-around-you alcoholic. Then there is te second, the "type B" alcoholic that basically self-medicated and tried to disappear into oblivion in order to avoid dealing with pain, often in the form of traumatic memories leading to ptsd. This isn't to say that "A"s don't experience pain, trauma, or ptsd. It is more about how they respond to it.

The twelve steps are designed to break down this "type A" kind of alcoholic's denial about the effects of her alcoholism on those around her. This is often a rude awakening, as the alcoholic comes to terms with all the damage he has done, and he will often fight it tooth and nail, hence the necessity of breaking down the defenses.

The "type B" alcoholic gets treated with this same barrage, but has a different system. Often this type of alcoholic, of which I was one, is more than willing to take on all the baggage of being some kind of perpetrator even though he -- I in this case -- mostly did damage to himself. On a personal level, I thought I was rotten to the core, because I had internalized my abusers' messages to me. As a result, I basically isolated myself from other human beings. I had this backwards idea of boundaries that rather than being there to keep other people out of my space, their purpose was to keep me in, to prevent me from doing more harm by nature of my very existence.

Of course, the "type B" -- and here I'll just switch to the first person to keep it real -- soaks this stuff up. List our personal defects? You bet. How we had harmed others? Oh sure, I was worried about how I might have upset my perpetrators and thought I had to make amends to them for what I had done wrong!

And then there is the AA approach to anger...just accept things, forgive and forget, turn it over, do anything but get angry: This is "a dubious luxury we cannot afford." Of course to a rage-a-holic, this is pretty good advice. But to someone who has been beaten and battered it is harmful. Unacceptable things happened! Accepting them is wrong. Maybe accepting that they happened is productive, but accepting that it is ok is just messed up. Forgiveness for atrocious behaviour needs to be optional. I'll do it, or not, in my own time, and I don't need to forgive assholes in order to heal. That is just a bunch of crypto-christian BS. But for a decade, I was turning it over, praying for my perpetrators, and dying inside because I didn't get any better. That is because they were wrong, fucked up, and I don't wish them well. I wish them a hell on earth of their own making, I wish that they get back what they gave me. And since I have come to terms with that, I have been able to get better.

But the the program seems to encourage the opposite. Particularly since most of the big book thumpers and the people who tend to take things over and have the strongest opinions are "type A"s who are more than willing to say that everyone should be doing things and being exactly like they are. They cram their version of spirituality down people's throats, even if it means using their god as a justification for doing sick and twisted things. Anyway, that was my experience. None of this was done in a hostile way, it was always, even at its most aggressive, done with a patina of holiness and a sort of new agey type zen affect.

I am so well trained in AA that I feel a little guilty even saying this stuff, and I do think that the twelve steps can be a useful approach, but not unless there is some recognition that there are more than one type of addict and that one size recovery does not fit all. Rehabs an dplaces that deal with ptsd are starting to realize this (pdf).

And finally a quote for said big book thumpers:
Our book is meant to be suggestive only. We realize we know only a little.
Maybe some of them, if they opened it and read it instead of just thumping it, would be a little more open to the full gamut of people who suffer and are in recovery from addictions, not just the ones who match their profile, which they then claim to be universal.

So anyway, a bit of a rant today. If you read it, plz let me know by leaving a comment, whether you agree or disagree!

Sunday, November 13, 2005

ptsd and 12 step programs

I think for the next few days I'll write about ptsd and 12 step programs like Alcoholics Anonymous (AA), Narcotics Anonymous (NA), AlAnon, Adult Children of Alcoholics (ACOA or ACA), Survivors of Incest Anonymous, Sex Addicts Anonymous, Emotions Anonymous, and one I didn't know about, Trauma Anonymous. There are many more, but these are the ones I have had experience with (except the last one). They all use the twelve steps developed by AA as a system of recovery. All of these groups are ostensibly focused solely on the addiction or condition they each target. This keeps controversy to a minimum and recovery from the particular addiction or condition primary.

AA is the most no-nonsense of the groups and the one I have the most experience with. During my first six years of recovery in the second half of the 1980s I went to seven to ten meetings a week, mostly AA with some NA, AlAnon, and ACOA thrown in. AA seemed to be the place where people most often actually got better. In the other groups, I felt that things often got bogged down in the illness and skimped on the recovery part. That may have been denial on my part, but that is the logic I used at the time and I kept clean and sober, which is something I was utterly unable to do alone.

After that first six years, and some traumatic experiences with people in 12 step recovery, I moved away and slowed down on meetings for a while. When I moved again, I went back to almost daily meetings for another few years, but then finally stopped going when I moved once again. I haven't been to any meetings for a couple of years now, and my life has improved as a result. I have been clean and sober over 21 years now, something I am grateful for, as I never would have made it this far while still using, and I never would have gotten sober without 12 step programs. I am pretty lucky to have survived my active addiction as it was. I don't think I would have made it this far using. I won't rule out going back to a 12 step program, but right now its not on the horizon for a number of reasons I'll eventually go into.

When I was in trauma rehab a few years ago for my ptsd, 12 step programs were part of the recovery agenda. What I discovered there though was that people from twelve step programs were part of my trauma and meetings were a trigger. Ultimately, I stopped going to meetings while at the treatment center, something I think is kind of unusal, but they and I decided it was better to skip the meetings and the attendant flashbacks than to go. I wasn't about to run out the door and get drunk. My drug and alcohol addiction is not really an issue any more. Its the underlying problems that mess up my life, most of which are trauma and ptsd related. If I pick up, maybe I'll make it back to the rooms, maybe not, but I have no desire to use anymore. It just is no longer a part of my life and that's that.

I mentioned in my first post that ptsd combined with alcoholism or drug addiction made recovery from any of them much more challenging (pdf). Because individual 12 step groups are focused on single issues, they tend to push aside all other issues. The ones that don't do this, like ACOA in my own experience, are the ones that get bogged down in negativity and never get around to the recovery aspects. So it is sort of a bind. There are some 12 step groups that seem to be aware of this, like Dual Recovery Anonymous and Trauma Anonymous, but I don't have any direct experience with them and the other programs' meetings that I went to at the time I went were adamant in their single purpose.

This made me feel like some kind of fuck-up, like I wasn't getting it, or I was lazy, or just not doing the steps right. If it doesn't work, the people that are invested in it working -- remember, their very lives depend on it working -- tend to blame the person it is not working for. They have to. I can't be the program that doesn't work, they have to much invested in it for it not to work, so it must be ME that is at fault and if I just got over it/got off the pity pot/accepted it/forgave/stuffed my anger/worked the steps harder then I'd be fine like them.

So I left. This was hard. AA trains you to think that if you stop going you will pick up eventually, and maybe that is so. A lot of people that go regularly end up picking up too though. Nonetheless, my fear of living without going to meetings was an obstacle to leaving, especially since I had already tried to get sober by working the steps on my own and it failed miserably. I have sort of thought all this through and in some ways de-programmed myself with some help from my friends.

I think single purpose 12 step groups are made for a certain type of addict, and this single focus works for them but not for all addicts. I'll go into that next post. If you have read this far, let me know what you think by leaving a comment!

Saturday, November 12, 2005

my ongoing recovery from ptsd

OK, two days ago, I told a little of what my ptsd was/is like and yesterday I talked about meds and ptsd. Both were a little intense, so today, I'll talk a little about what has gone right over the past couple of years. In many ways, I have been very fortunate.

First of all I have gotten away from the really sick people in my life that I seemed - and am still capable of -- attracting. For me this involved finally clearing out of 12 step programs and hanging around with what they call "earth people" -- normal people without all the problems and twisted personalities that go along with addictions. I probably owe my life to this. I had a knack for being able to immediately pick out the sickest person in the rooms -- it was whoever I was most attracted to. I still have the knack, but now when I bring home strays, the other people in my life will point out how sick and twisted/ dishonest/ manipulative/ uncaring/ unreliable the person is, all stuff I have a hard time seeing, no doubt as a result of normalizing all the trauma in my life. But now instead of being re-traumatized by these people, in spite of their best efforts, I can laugh at myself and move away and on with my identity intact.

Second, I relied on this support network of sane people to help me get help. They really came through...from people on my job, to friends with advice or timely loans or frequent flier miles, -- especially to my partner. There is where I have been kind of lucky, because it was a chance thing and some decisions I made that put me in the situation where I first made friends with these earth people, but it has made all the differnece. Find sane friends!

Bouncing ideas off these people helped me put together a non-abusive therapeutic support system, a first for me. There are a lot of bad shrinks and indifferent psychiatrists out there, and left to my own devices, I managed to find the sickest of them, which was hurtful to my recovery. One of the major issues I have to work on in therapy is trusting the therapist. I can dissociate and talk about anything that happened, but I don't trust my therapist enough to show how those things actually make me feel. This has slowed things down tremendously, but I am really cautious, having been really screwed over by therapists who ranged from incompetent to evil charlatans.

One thing I have observed is that addictions counselers, who often only have a BA, tend to be awful. A lot of them are really sick recovering addicts or co-dependents who are doing it out of some "save the world, aren't I wonderful now" perspective. Addictions counselors also seem to draw a higher ratio of scam artists using new-agy crap to suck in vulnerable people than therapists with more education who have met more stringent requirements of a higher degree. Not to be an education snob...two of the worst therapists I have had were PhDs or MDs...but the very worst, and most evil and ignorant, have all been addictions counselors peddling alternative, new agey crap as therapy. So I am not saying that all addictions counselers are bad, just that they are not qualified to deal with ptsd, they get in over their heads, and instead of admitting it they laid stuff on me, which I being dutifully trained in the 12 steps, took on and internalized. So if you have ptsd, or you are seeing an addictions counselor and they are blaming you for your lack of recovery or progress, clear out. Find somebody qualified. That especially qualifies if they are pedalling new age remedies. RUN!

So that is what to avoid. What we looked for, first and foremost, was someone who listened and actively tried to find out what my needs were. I think that is more important than whether the person is a cognitive behavioralist or a jungian analyst or whatever. The next thing was to pay attention to the training. All the best of the therapists I have had (and two of the worst, so it is not a sure shot) have been Ph.Ds. Third thing is to find out what there method of treatment is for ptsd. Is it a formula that they impose? These can be retraumatizing, especially if they don't work and the therapist then blames you. Look for somebody that will work with you to make the changes that you want, at your own pace, not somebody that promises to fix you with a twenty step protocol. I say this even though I am doing a 20 step protocol with my present shrink, but we stop and adjust and there is a "let's try this and see" approach rather than a promise of a cure at the end.

Unfortunately, meds have been a crucial part in making me stable enough to function. I think they mask my emotions and subdue them somewhat, but I am not overwhelmed and constantly being retriggered anymore. This has made me stable enough to stay off Social Security and keep a job, which I wasn't able to do before. The stabilty, though it has come at a cost, has made my life a lot more bearable and made progress possible. Hopefull as I grow more stable I'll be able to continue to ease back on the meds and be able to deal with the underlying damage without them. That remains to be seen though, and I am not in a hurry. My psychiatrist works with me on this rather than just telling me what to do. She pays attention to how I tell her I am feeling. I often don't like what she has to say (usually something to the effect of "slow down") but I have learned to respect what she has to say because she listens and responds to what I am saying, not to some pre-supposed path laid out by the pharmaceutical companies.

Exercise and meditation are both good things but difficult. For a long time, I couldn't go running or work out because it would trigger me really badly, I'd go into a rage and break down crying. It sucked. I used to meditate, but after the last round of trauma, I couldn't clear my mind. Anytime I had a moment of stillness, memories would come flooding back and overwhelm me. I also learned yoga, but I had to work on that a lot. Some of the cult abuse I had happen to me involved misappropriations of meditation, yoga, tai-chi and other non-western mental/spiritual practices, so I had to do a lot of work to reclaim them. I'll talk about that more sometime. Anyway, I couldn't do yoga in a group at the Y because it would trigger flashbacks, so I got a really good teacher who did Kripalu yoga, which is one of the mellower less stressful kinds, perfect for me. That was really good, but I stopped practicing it. I have a hard time making the time for that or meditation even though I know they are good things. Maybe I'll be able to yet. I was running again recently, and really liking it, -- no flashbacks or intrusive thinking -- but hurt my knee, so I have to be careful about that for now. But I know that all this stuff that I'm not really doing is good for recovery. So is a good diet, another thing I have trouble with (sugar addiction[pdf]).

Another big help has been acupuncture and some massage. Here I was quite leary of drifting back into the realm of the new age, but I found a good no-nonsense acupuncturist with the help of an acupuncturist friend from another city. I'll talk about that more too maybe, but the type I do is called "Five elements." It is supposed to be more attuned with emotional issues as a part of overall wellness than some other forms of acupuncture. Again, I haven't had time for it recently but will probably go back soon. I am especially skittish about the massage, because again, part of the cult abuse involved very new agey "body work" the goal of which was to work all the money out of my family's bank account, even at the cost of destroying it. So I go slow there too.

A lot of people might wonder, does spirituality come into all this? Isn't that part of recovery? For a lot of people it is, but some of the worst abuse I have had in my life has been spiritual abuse, most commonly of the form of screwing me over and claiming it was "meant to happen" or "happened for a reason" or it was "god's plan" and that I need to stuff my anger and forgive them (if they even admitted to doing anything wrong!). This is a real mindfuck, and an over-simplification of what happened, too, and I really struggle with spirituality as a result. It used to be a big part of my life (not organized religion, but spirituality) but some people really betrayed me and used it as a cover and it no longer works for me. I have come to terms with that somewhat, but I'll have more to say about it later maybe, as I know other people struggle with this, and you won't find any guidance for spiritual abuse in 12 step rooms. You are more likely to encounter the abuse there.

My life is a lot more liveable today than it was a year ago, or two or three or five. I can stand being in my own skin. I am able to be present a lot better. I am a lot less driven by demons than I was. I can work. I have a wonderful network of supportive friends. I still have a ways to go and lots of recovering and growing to do, but in some respects, I have never been doing better in my life.

Anyway, it has turned into another long post. If you actually read this, plz leave a comment and let me know!