Category Archives: Post traumatic stress Disorder

The Therapeutic Alliance: The Essential Ingredient for Psychotherapy

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umbrellas

 I am currently writing on the ‘therapeutic alliance’ – its relation to mindfulness, psychotherapy, understanding, and ‘being listened to…’   What follows is an interesting article that I came across that may interest some of you…

Excerpt:

Have you ever tried to change the way you do something? It could be anything — the way you hold your tennis racket, blow into a flute, meditate — you name it. If so, think about that experience. No matter how motivated you were to change, and no matter how much you knew that it would help your serve, musicality, or sense of inner peace, it can be difficult and scary to change even the smallest thing. In order to change, you have to give up your old way of doing something first and then try the new way. That means that for a while you’re in a free fall — you no longer have your old habit to rely on and you don’t yet have the new one.

The anxiety of trying to change something as complex and entrenched as how you relate to people close to you or manage stress takes the feeling to a whole new level. Yet, that’s just what you do when you enter psychotherapy. Just as you had to put yourself into the hand of your teachers and coaches, in therapy you need to gradually do just that with your therapist to help you through what can be a harrowing adventure. The foundation for therapy is called the therapeutic alliance (1, 2). When it’s there, you know that your therapist is there to help you, no matter how hard the going gets.

The therapeutic alliance might be the most important part of beginning a psychotherapy. In fact, many studies indicate that the therapeutic alliance is the best predictor of treatment outcome (3-5).

See entire article:

http://www.huffingtonpost.com/deborah-l-cabaniss-md/therapeutic-alliance_b_1554007.html

 

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A mad world A diagnosis of mental illness is more common than ever – did psychiatrists create the problem, or just recognise it?

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Unfortunate Events

When a psychiatrist meets people at a party and reveals what he or she does for a living, two responses are typical. People either say, ‘I’d better be careful what I say around you,’ and then clam up, or they say, ‘I could talk to you for hours,’ and then launch into a litany of complaints and diagnostic questions, usually about one or another family member, in-law, co-worker, or other acquaintance. It seems that people are quick to acknowledge the ubiquity of those who might benefit from a psychiatrist’s attention, while expressing a deep reluctance ever to seek it out themselves…

…While a continuous view of mental illness probably reflects underlying reality, it inevitably results in grey areas where ‘caseness’ (whether someone does or does not have a mental disorder) must be decided based on judgment calls made by experienced clinicians. In psychiatry, those calls usually depend on whether a patient’s complaints are associated with significant distress or impaired functioning. Unlike medical disorders where morbidity is often determined by physical limitations or the threat of impending death, the distress and disruption of social functioning associated with mental illness can be fairly subjective. Even those on the softer, less severe end of the mental illness spectrum can experience considerable suffering and impairment. For example, someone with mild depression might not be on the verge of suicide, but could really be struggling with work due to anxiety and poor concentration. Many people might experience sub-clinical conditions that fall short of the threshold for a mental disorder, but still might benefit from intervention.

See link for interesting article on psychiatry…and bits about the importance of psychotherapeutic intervention…

http://aeon.co/magazine/being-human/have-psychiatrists-lost-perspective-on-mental-illness/

When Ignorance Begets Confidence

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“There are few people whom I really love, and still fewer of whom I think well. The more I see of the world, the more am I dissatisfied with it; and every day confirms my belief of the inconsistency of all human characters, and of the little dependence that can be placed on the appearance of either merit or sense.”  Pride and Prejudice by Jane Austen

I begin with this quote to convey the feelings evoked in a recent exchange with a neighbor, one in which surprise (and some horror) was felt during the course of the conversation.  Logic and ‘reasonableness’ had little place in the interchange. I had just been reading a short article that looked at particular German words that gave expression to complex emotional states. An excerpt is as follows: 

“Fremdschämen describes embarrassment which is experienced in response to someone else’s actions, but it is markedly different from simply being embarrassed for someone else….Fremdscham (the noun) describes the almost-horror you feel when you notice that somebody is oblivious to how embarrassing they truly are.” Further…”Fremdscham-inducing events…usually cause one to ask this question: “how on earth can these people be unaware of how stupid they are being right now?”.

I invite you to read this short article on the cognitive bias created in the Dunning Kruger effect – an effect that causes one to be unaware of their performance – and their incompetence.

http://www.psychologytoday.com/blog/evolved-primate/201006/when-ignorance-begets-confidence-the-classic-dunning-kruger-effect?fb_action_ids=10202209567024712&fb_action_types=og.likes&fb_source=other_multiline&action_object_map=%7B%2210202209567024712%22%3A483617186047%7D&action_type_map=%7B%2210202209567024712%22%3A%22og.likes%22%7D&action_ref_map=%5B%5D

CG Jung and the ‘Leap of Faith’ Into Individuation

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The Red Book has been described as Jung’s creative response to the threat of madness, yet it has also been seen as a deliberate exercise in self-analysis. I believe it’s likely both. When creating The Red Book, Jung knew he was on the verge of madness, and he also knew his analytical skills and expertise as a psychiatrist were his best chance at alleviating suffering, if not creating the conditions for transformation.

In many regards, The Red Book reads like a healing journey — a phrase often used to describe the reclaiming of self after a history of abuse — which is a transformative period that happens for many people committed to overcoming early life trauma. On the way to an authentic self there is first the need to step away from the person one became to survive abuse. Those confronted with this journey often experience a period of ‘going crazy’ on their way to establishing an authentic sense of self.

As The Red Book shows, individuation is a blessed curse. It opens the way to becoming one’s authentic self, and yet also the risk of alienation from the ‘tribe’. Childhood trauma survivors often know this conundrum intimately. Transformation requires a significant reorienting away from the beliefs, feelings, fantasies, and body states that made possible living in traumatizing conditions. Invariably, there is a part of the self that has gone unacknowledged or rejected, and aches to be reclaimed.

In The Red Book Jung found a process for continually rediscovering authenticity. As he often remarked, individuation is an ongoing journey and not an endpoint reached. Jung also intimated the need for what I called in an earlier post leaps of faith: turning away from the larger world’s expectations and towards one’s inner world of wisdom with acceptance and curiosity.

This quote from The Red Book inspires the impulse to creatively go forth into all that you are:

“Woe betide those who live by way of examples! Life is not with them. If you live according to an example, you thus live the life of that example, but who should live your own life if not yourself? So live yourselves.

“The signposts have fallen, unblazed trails lie before us. Do not be greedy to gobble up the fruits of foreign fields. Do you not know that you yourselves are the fertile acre which bears everything that avails you?”

Jung knew such a ‘leap of faith’ is not easy. He also wrote:

“To live oneself means: to be one’s own task. Never say that it is a pleasure to live oneself. It will be no joy but a long suffering since you must become your own creator.”

But he gives helpful advice for the journey, particularly how to live if the world feels contrary to whom you are becoming. Then you must learn to be your own guide:

“To certain things of the world I must say: you should not be thus, but you should be different. Yet first I look carefully at their nature, otherwise I cannot change it. I proceed in the same way with certain thoughts. You change those things of the world that, not being useful in themselves, endanger your welfare. Proceed likewise with your thoughts. Nothing is complete, and much is in dispute. The way of life is transformation, not exclusion. Well-being is a better judge than the law.”

Reprinted in full with permission by the original author Laura K. Kerr, Ph.D, who moderates the blog, Trauma’s Labyrinth: Finding Ways Out Of Trauma. Laura K. Kerr is a mental health scholar, blogger and trauma-focused psychotherapist. [Her] focus is on healing, with special attention to trauma, modernity, and mental health systems of care.

Trauma Recovery Done Right: 8 Keys to Safe Trauma Recovery

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Trauma Psych

TraumaRecoveryReview8 Keys to Safe Trauma Recovery: Take-Charge Strategies to Empower Your Healing.
Babette Rothschild. 2010. W.W. Norton, New York.  174 pages.

Living with persisting trauma memories is tough. Involuntarily triggered by events, or people, or places, or thoughts, or feelings . . . well, anything can be a trigger, actually . . . these intrusive, searing memories will turn one’s life inside out. Recovery from traumatic experience is tough as well, and achieving a sense of safety is essential to successful recovery. Rothschild’s brief, personable, and accessible book directly targets safe, successful recovery in a way that compels and convinces the reader. If trauma memories impact your life or that of someone you know or treat in a healthcare setting, you need this book. Because of the importance of this material, and because I want this to be a bit more than a mere review, I will be discussing this book in a two-part post…

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Stress and Memory From a Neuroscience Perspective

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Stress and Memory From a Neuroscience Perspective

 

 

 

 

 

 

“From a neuroscience perspective, amnesia in the absence of brain damage can be partially explained in biochemical terms. Stress causes a chemical reaction that affects regions of the brain responsible for memory. With repeated overwhelming stress, neurotransmitters and stress hormones are released in the brain in such excess quantity that they can adversely affect portions of the brain responsible for emotional memories as well as other kinds of memory.” p. 33, The Wandering Mind: Understanding Dissociation from Daydreaming to Disorders by John A Biever, M.D. and Maryann Karinch.

i'm not out to convince you or draw upon your mind*Image Credits (all work used with permission through CC license)–
“i’m not out to convince you or draw upon your mind” by Andrea Joseph
“Standing at the Gates of Hell” by Shane Gorski

Benjamin Fry and depression

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‘I had a golden life, so why was I falling apart?’: TV psychotherapist Benjamin Fry was devastated by depression. Then he discovered a radical new treatment

By Benjamin Fry

PUBLISHED: 23:01 GMT, 27 July 2013 | UPDATED: 23:01 GMT, 27 July 2013

 
'Only the thought of my children stopped me from killing myself' ‘Only the thought of my children stopped me from killing myself’

Your life looks fine – even enviable – on the surface. But underneath you are more stressed and anxious than anyone realises. You’ve been called ‘oversensitive’ or accused of ‘overreacting’ because the setbacks and stresses that other people seem to take in their stride can knock you for six. You’ve also been told that you are attractive, bright, full of potential, yet somehow you have failed to find real success in relationships or work.

You are not weak or lazy or self-pitying. You are overwhelmed; stuck in a state of anxiety that has been massively misunderstood and wrongly diagnosed. The good news is that there is a radical and transformative new way of understanding it, and of getting yourself unstuck, for good.

I know what this feels like. I was ‘stuck’ myself for years until, in 2008, I suffered a complete breakdown. I looked like an unlikely candidate for a breakdown. I was a trained psychotherapist and a privileged person in many ways.

I grew up in a wealthy family, went to Eton and Oxford, my first job was as a teenage model for Mario Testino and then I became a successful nightclub entrepreneur. By 30 I had made my first million, married a wonderful woman and was living in a big house with a much-loved child, the first of five. It looked like a golden life, but inside I was falling apart.

I trained as a psychotherapist, treating patients in my own practice and working on TV programmes such as Freaky Eaters and Spendaholics. But I always felt as if I didn’t properly ‘belong’ with my colleagues. Many of my patients generously told me that I had helped them, but the truth was that I understood them because I was exactly like them, full of anxiety, unhappiness and isolation.

What was wrong with me? I had lost my mother, who died from aplastic anaemia when I was 11 months old. For the next two years I lived with family friends while my father rebuilt his life and career. He would visit me regularly, and after he remarried he took me to live with him and his new wife.

Our early years are fundamentally important in our emotional development, so I was always aware that my mother’s death had scarred me, and that early experience had contributed to my anxiety. But I loved my father and went on to have a successful life, so though I was never glib enough to say I had ‘got over’ that loss, I believed I had survived it.

By 2008, my golden life was unravelling. My wife was pregnant with our fifth child, and I was in deep trouble. I had made a series of property speculations in Greece that crashed badly and ruined us financially.

We had to leave our home, rent a smaller place out of London and beg my father to bail us out of our huge debts. Poor me, eh? I know that this isn’t the worst problem someone can have. I had the privilege of a safety net, and if I’d made money before, maybe I could make it again. But I didn’t see it that way. It felt utterly overwhelming and devastating and sent me into a spiral of worry which led to serious clinical anxiety and depression, and finally into a suicidal despair because nobody could help me recover. Only the thought of my children stopped me from killing myself.

I tried everything: my doctor, the NHS, the church, the Priory – I even tried a faith healer. Nothing worked. I was well-informed and well-connected, but I discovered a massive failure in our therapy system, which repeatedly misdiagnosed me, or just medicated me, which often made me worse. 

Finally, after a series of therapeutic failures and disasters, I found myself at Mellody House in Arizona, where I discovered what was really wrong with me and what had been wrong with me all my life. I was suffering from post-traumatic stress. The death of my mother at such a young age had sent me into deep trauma, and rather than recovering from it, it had ‘frozen’ inside me.

‘This “frozen” trauma is stored up in childhood and then triggered in adult life by a new stress’

Trauma is not a word most of us use about the bad things that happen to us. We think it refers only to extremes, such as soldiers in a combat zone. But so far as our minds and, crucially, our bodies are concerned, trauma means anything that causes us stress so overwhelming that our physical response to it is to ‘freeze’ – think of a rabbit caught in headlights and unable to move.

This ‘frozen’ material is usually stored up in childhood and then triggered in adult life by a new stress, such as a bereavement, a break-up, a car accident or a redundancy – the kind of stresses that we’ll all experience at least once in our lives. Most of us recover fully from our traumas, but some of us don’t. Why some of us don’t, what happens to us as a result and how we can heal is at the heart of the new science of trauma. Mellody House had created a radical new understanding of the causes of psychological distress that many therapists believe is the greatest leap forward in this field in our lifetime.

 
Benjamin
 

Benjamin at the age of 18, modelling for Mario Testino, left, his stepmother Jane, half-sister Annabelle, and father Charles, right

This new model of thinking was mainly pioneered by a man called Peter Levine, who spent years studying the habits of wild animals under stress. Imagine a young gazelle, grazing peacefully with his herd, when a lion appears.

We’ve all heard of the fight-or-flight response: when the threat is too big to fight, the gazelle runs for his life. As the lion bears down, Peter Levine noticed that often the gazelle would suddenly drop to the ground, as if shot, moments before the lion caught him. About to be caught and killed, he ‘freezes’. But sometimes the lion keeps running – there are other, fatter gazelles to chase – and the gazelle would wake from his frozen state and escape. But before he did, he would behave in an odd way, shaking and twitching all over.

Over time, Levine realised what was happening: the flight response floods the gazelle’s body with hormones and stress energy to enable him to run for his life. If the threat is removed, that energy is no longer needed and the body discharges it – the gazelle would do this by shaking and twitching his body. All animals instinctively process their trauma. But humans are too self-conscious, too ‘clever’ to act like the frozen gazelle, who shook and twitched and shuddered his way out of the trauma once he came to.

Our sophisticated brain tells us that this is ‘crazy’ behaviour, disturbing for us and for those around us, especially when there is no visible threat in sight. Instead we push it down, take a pill, think or talk our way around it, and tell ourselves we’re fine. We may have rationalised it, but that energy – crying out for release – is stuck.

‘It takes support, patience and love to recover from trauma, but it can be done’

Perhaps our first big stress happened, as it did to me, when we were very young and we simply weren’t able to process it thoroughly. Or it felt so overwhelming, we didn’t manage to discharge that stress energy fully.

Having begun with animals, Peter Levine went on to test this theory with patients and found again and again that problems such as extreme emotional sensitivity, anxiety, depression, and many behaviours, such as obsessive compulsive disorder, attention deficit hyperactivity disorder, borderline personality and eating disorders and other addictions, could all be traced back to a frozen trauma.

If we think of our bodies as a measuring jug, that original threatening event filled us almost to the brim with stress energy. Any new stresses – even small ones – quickly cause our stress to spill over, which is why we can so quickly become anxious and overwhelmed. This kind of anxiety and stress are not just emotions, but physical responses trapped in our nervous systems. Peter Levine discovered that if he could help his patients discharge that energy, he could reset their stress gauge and help them heal.

That was the treatment I received in Mellody House, where they had been pioneering this new model of trauma treatment in a residential setting for more than seven years. It changed my life, and inspired me to set up a clinic in the UK to replicate that treatment over here. I’ve seen many examples of frozen trauma, and how it damages people’s lives.

OTHER EXAMPLES

Sarah, in her late 30s, came to our outpatient clinic in London because her second marriage was on the verge of collapse, and so was she. Only recently married, she was driving her husband away with her rages and ‘withdrawing’ behaviour. This had been a pattern for all of Sarah’s relationships. She’d fall quickly and deeply in love, convinced that this person was her soulmate, and lavish them with attention. But once the relationship was established, she constantly tested this love with cruel behaviour. When he grew angry or distant in return, she’d despair, feeling abandoned and terrified.

Sarah’s mother had a difficult labour with her first child and she didn’t want any more children – Sarah was an unplanned pregnancy. Sarah absorbed her mother’s feelings of rejection, which continued during her childhood. Although fed and cared for, she never felt loved or wanted. This long-term lack of safety overwhelmed her system and so traumatised her, and that trauma had frozen.

Benjamin as a babyIn adult life, she set people up to reject her, and every new disappointment brought her closer to a breakdown.

My clinic uses several methods for unblocking trauma, but to begin we talk about earlier experiences and feelings. Instead of dwelling on the events, I ask the patient to observe how their body feels. Sarah became aware of her clenched body language, and of how her stomach would feel tight as she discussed her mother. The big breakthrough with this therapy is understanding that the stress is a biological one, so although I don’t touch my patients, the therapies we use –sensorimotor psychotherapy and somatic experiencing – focus on physical sensation.

Patients will usually observe a physical response as energy is released. Some will feel warm – they may break into a sweat – or cold. Twitching and shaking are common. We treat the nervous system, not the past, which can’t be changed but can lose its power to control our lives.

We treated Sarah just like a fallen gazelle, and like a gazelle, her biology was intelligent enough to do its work once we opened up the pathway. Once released from her trauma, Sarah’s rages and terror of abandonment disappeared, and she has a very different approach to relationships.

Another patient, Kate, treated at our residential clinic in Oxford, told me how every time she thought she was ‘in trouble’ with authority figures – such as being late for work – her heart would race and her chest feel tight. Her fear of people with power over her stemmed from her early life with strict parents and an even stricter school.

Constantly in flight mode throughout her childhood, she had built up too much stress energy to discharge it properly, and the frozen stress haunted her interactions as an adult. In a case like this, it’s helpful to stop worrying about the ‘trouble’ and observe your reactions. Instead of saying ‘my boss is making me crazy’, think, ‘I notice when my boss gives me a look; I instantly experience worry and stress.’

Now see if you can identify the physical sensation that goes with this feeling. As you do, you start to connect with the deep mammal instinct that knows how to let go of that stress response, and if you are lucky, or after you have practised this for a while, you may notice a response in your body, such as trembling or other form of energetic release. You may feel an emotion connected with this – sadness, anger – or you may even cry. This is what happens as the trauma thaws and passes.

HOW YOU CAN HELP YOURSELF

For temporary relief

  • Smells such as aromatherapy oils are the quickest way into our nervous systems.
  • Press your feet into the ground and feel the size and strength of the earth: it tells our body that we are ‘grounded’.
  • Breathe through your nose and exhale slowly through the mouth. This mimics the body’s response to rest and safety.

For longer term help

  • Read Waking The Tiger by Peter Levine. It explains this new understanding of trauma; he also has a CD to guide you through the process.
  • Notice your physical sensations rather than your thoughts as much as possible.
  • Traditional exercises, such as yoga and meditation, can help reduce the impact of the mind and get us into our body.

For professional help

  • Find a practitioner in somatic experiencing (seauk.org.uk), or sensorimotor psychotherapy (sensorimotorpsychotherapy.org), or contact Khiron House (see below).

 

While self-help is possible for many of us (see above right), for deeper or very stuck traumas, it is too difficult to try to manage this process alone. Cara came to see me with a history of bulimia and self-harming. She had been sexually abused as a child and her early adult life had been dominated by a heroic attempt to overcome her history and not be defined by it. S

he worked at a bank, bought a house and earned a lot of money. But always anxious, she abused food and alcohol, before her increasingly black depressions undermined her career and the self-harming started. In early sessions she curled up in a chair in the foetal position, and our first job was to make her feel safe.

We worked with a happier memory from her childhood – a best friend whose family welcomed Cara to stay in their loving home – and this became her safe place to go to when she felt overwhelmed. Releasing trauma too quickly can be retraumatising so has to be managed carefully. It doesn’t matter what happened, only that the stress is frozen. So one person from a war and another from a dysfunctional family may have the same symptoms. Our nervous system can’t distinguish between a car accident or a person – it just understands threat, and the same stress energy floods our system.

This is the big difference between this treatment and conventional talking therapies, especially those that try to ‘retrain our thoughts’. Our thoughts are not the main problem (although they can then contribute to it) – they are a symptom of a deeper cause. We need to tap into the deep ‘mammal brain’, which is part of all of us, below the rational level, to the sensing, nonverbal place where the damage is stored. After eight weeks in residential treatment, Cara still had work to do but looked, moved and felt like a completely different person.

My story ended happily too. I went through multiple stages of both physical and emotional releases: shaking, twitching, deep grief, sadness, loss and anger. My children were delighted to have their father back, but it had taken a toll on both my marriage and my children. Trauma always affects those around us as well as ourselves. My illness and absence, which they have experienced as an abandonment, along with their fear that I was so ill I might die and never return, upset my family deeply. Having seen how well I was doing with this therapy, though, some of them have also had the treatment to recover from the trauma of this passage of our lives.

They are all doing much better. It takes support, patience and love to recover from trauma, but it can be done. Feeling overwhelmed does not have to rule your life or be a permanent part of it. Somewhere, something happened to you that caused you a huge stress, and you have been unable to release that trauma. But our bodies are wise, they know exactly what to do – they have been doing it for millions of years. All we need to do is get out of our own way and let that happen. I did it, and so can you. The rewards are life changing.

Benjamin Fry is the founder of Khiron House, a residential clinic in Oxford and an outpatient service in Harley Street, London, tel: 020 7754 0477, khironhouse.com

Read more: http://www.dailymail.co.uk/home/you/article-2376132/TV-psychotherapist-Benjamin-Fry-devastated-depression-Then-discovered-radical-new-treatment.html#ixzz2gSxby8gS
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A Schizophrenic Way Of Saying Things

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A Schizophrenic Way Of Saying Things

 

 

 

 

 

I’d like to go home

but I have to go to the bathroom

and they won’t let me see the stars

cognitive-symptoms-of-schizophrenia-03

I’ll give you a doughnut

because I haven’t got anymore

toilet paper

I want to go to Disneyhome

but Mickey’s dead

God looks at me from the sky

I can see the eyes of

Atlantis

diaptych(right) :: mess-up N/N mess-age

Shut up! she said

I told her somebody stole

my bananas

the walls are missing

where did my feet go

I can smell your armpits, Mister

The hallway’s flooded with blood

because somebody farted

now the toilet smells like

home

Thousand Plateaus Drawing

When I comb my hair pieces

of wood fall out

My brother eats maggots with

his bare feet

My feet went home

Can I go too

I hear dogs calling my name

They don’t know the TV’s on

Oprah’s interviewing Justin Bieber’s

image

diaptych(left) :: mess-up 1/1 mess-age

My mom’s in the audience

with her pet home on a leash

Jim Morrison is singing in my

ear

But I can’t hear the water

running     What?

Was that the doorbell

Someone let the table out

I want to go home

but the silverware left without me

Is it my fault the bed’s on fire

oh, it is

catatonia-schizophrenia-symptoms-01

I don’t sleep in a cloud full

of roses

Want to go outside and play

in the weeds

the roaches won’t care

They’re too busy picking curtains

at the supermarket

Go away but I lost 10 pounds

of home

Help me.

*Image Credits (all work used with permission through CC lisence)–
“cognitive-symptoms-of-schizophrenia-03″ by Life Mental Health
“catatonic-schizophrenia-symptoms-01″ by Life Mental Health
“Thousand Plateaus Drawing” by Magda Wojtyra
“diaptych(left) :: mess-up 1/1 mess-age” by Joel, Evelyn, Francois
“diaptych(right) :: mess-up N/N mess-age” by Joel, Evelyn, Francois

18 minutes of trauma

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Mind Hacks

I’ve just found one of the best discussions on the importance and limits of the concept of post-traumatic stress disorder on a programme from the Why Factor on BBC World Service.

It’s a brief programme, only 18 minutes long, but packs in a remarkably incisive look at PTSD that tackles its causes, its cultural limits and its increasing use as an all-purpose folk description for painful reactions to difficult events.

Both compassionate and critical, it’s one of the best discussions of post-trauma and its diagnosis I have heard for a while.

As is typical for the internet-impaired BBC radio pages, the podcast is on an entirely different page, so you might want to download the mp3 directly.
 

Link to programme page and streamed audio.
mp3 of programme audio.

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The Aftermath of Trauma: Four Common Characteristics

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Definitely click on the link at the end of the post to read about the Four Common Characteristics.