It's Done.... Thank Goodness! An Introduction to the Next Three Posts :)

Whew! My term paper for the torture class is done and turned in. I am going to post it here but I will break it up into three different sections as follows due to length:

Post #1 - Censorship, Freedom of Speech and how they can contribute to Genocide
Post #2 - the Irish Potato Famine / Irish genocide
Post #3 - the Holodomor in the Ukraine

I'll post one a day so if you find the paper interesting... well, you won't have to wait long for the rest :) Let me know what your thoughts are!

(My several pages of sources are available to anyone who asks. :)

Ethical Concerns for Providers when Dealing with Refugee Populations

There is no doubt that mental health professionals and other service providers can help alleviate the effects of trauma, torture and other crimes that are perpetrated against people and communities due to circumstances, religion, war, etc... Throughout this class, I have learned quite a bit about the consequences to both individuals and groups based on trauma/ torture and have even broadened my views of how those terms should be defined. Between therapies that are individualized or set up for groups (such as a family, community or people with the same traumas and problems in common) and interactions that attempt to alleviate suffering through the use of medical training, pharmaceuticals, neurobiological or cognitive therapies, etc... Many groups and professional have been focused on – and continue to try- to help victims and the society as a whole heal, develop techniques for survival and daily care, as well as trying to improve the quality of health and life of those affected. However, there can be challenges as well as ethical problems that the mental health / medical provider can face in these situations.

One challenge can come in the form of using pharmaceuticals to help the patient deal with some of the symptoms that cause difficulty in their lives. While studies do suggest that medication makes a bigger impact on an individual's symptoms, the issue is not that black and white. How the patient and/or their family feels about medical care in general (or mental health medication specifically) has an effect on how the medication is used and therefore, how successful it can be. An individual's culture may also weigh into the decision to use medical treatments/ medicine of any kind. And how the services are provided might also affect the utilization of those services. Language, economics, and other barriers can cause misunderstandings and challenges as well. A perfect example of this problem can be found in the book, “The Spirit Catches You and You Fall Down” written by Anne Fadiman. An amazing and very sad biography.

Another thing that is very important for the provider to acknowledge and understand is that the trauma itself may be what the provider wishes to treat and focus on... but the provider is still treating a person. An individual with different perceptions, biases, experiences and other ways of seeing and moving through the world. And so while trying to treat the troublesome symptoms of the past trauma, it is imperative that the person being treated isn't seen in the narrow sense as a label or a diagnosis. The patient needs to be viewed and looked at in the 'prism' of their views and life... so recommendations and therapies need to be available to the patient in a way that fits their current set of circumstance and needs. I thought of an experience in my life when I had a few sick animals who lived with me and my family in a one room yurt. The vet said that one cat needed to be fed a special food, another cat needed a different special food and the other cats couldn't eat either food. When I mentioned that I lived in one room, I was told to deal with it. I did figure out a solution that worked, but it took a while and I didn't use the resources that had been offered nor have I been back to that clinic. I probably would have felt differently and used the resources offered if the provider had made them seem possible. Just a thought on that topic.... So making sure that the resources used are more helpful than stressful and really address the 'whole person' are needed. That takes more time and energy as well as an understanding of an an attempt to put your own biases, etc... aside. That is a bit difficult to do for most of us. :) Also making sure that the resources are available to use in a way that works for the client makes them more likely to be utilized and more likely to help the patient with lasting change in their lives... which is the goal!

Another important element – which I touched on in the last paragraph is to make sure that a thorough understand of the person and their culture are attained. By understanding what is important to the individual and what they use to not only make decisions but base most of what is important in their life on.... the suggestions and recommendations that are given by the mental health providers are more likely to not only be followed but misunderstandings are more likely to be caught quickly and early in the process. That helps develop the trust relationship between the provider and the patient as well as help the patient to work harder to help themselves because not only does it matter to them as individuals, the provider has shown that it matter to them too. (Aren't we all more likely to accomplish our goals when we have a friendly goal 'buddy'?) So by having decent understanding of the background and viewpoint of the patient, the service providers can make fewer but more meaningful referrals and help keep the patient on task. An example is not suggesting a patient with PTSD have an occasional drink to relax but maybe a cookie or a walk with a friend instead. If the culture sees nightmares and terrors as a curse from God that must be overcome.... then they are much less likely to take the Ambien to sleep nor will their family encourage them to do so. Telling an individual to eat pork or stop smoking for their health when smoking is part of their religious practices or the eating of pork is against their beliefs will either cause total noncompliance or partial uncompliance as the patient will only do it when they feel pressed to do so or have another compelling reason to do so. It is important that the clinician recognizes what his values are and recognize when he is potentially pushing values and cultural norms on the patient and not actual treatment. I know those examples are not mental health related, but I thought they did help me make the point I was attempting to make. :)

Another thing that it is imperative that mental health providers think about when dealing with challenged and refugee populations is to follow the information and tools that have work in the past as evidenced by studies and their own observations and life experience, but to also recognize that the current work that is being done can give good insights into potential therapies simply because if it appears to be currently working, with so few good studies out there.... if every is in agreement to try something new... that has the potential to help victims now as well as future populations. This kind of flexibility to look outside the box but also to be cautious and thoughtful about trying therapies that haven't had a lot of use and study is a challenging but needed trait in these providers. It is also this flexibility that allows the clinician to look at the individual in a well rounded way, and not just the way that they have been taught to see certain symptoms or mental distress.

Lastly, it is important that the clinician recognize and maintain clear boundaries between themselves and their patients so that both parties can work together for improvement and satisfaction. When the boundaries are loosened, both parties may find it very challenging to continue to work together and to work towards progress in the manner that was possible when the division between the two was clearly laid out. Providing services that also allow the individual to have privacy not only from strangers who do not have a legitimate need to know their information, but also family can also help the patient by making things clearer and less likely to be misunderstood through another person's biases and thoughts mixing into the mix. An example could be when the parties involved have a language barrier – a translator from outside the patients inner circle may make a different translation that a family member or a friend who may interpret what the patient is saying or needs based on what they think the patient needs... not quite the same thing. This kind of translation can also compromise a patient's need and right for confidentiality making services more challenging for them to get and undermining the trust needed between the patient and the provider. The provider must also to make sure to care for and recognize problems that may crop up with themselves from working with this population and take care to not allow themselves to become burned out or harmed in the process of helping others... which can cause them to be unable to continue to help or even to cause more trauma to the patient.

To be a provider to such a challenged population comes with both risks and rewards for the clinician and the patients. Understanding the important ethical concerns that should be addressed can help everyone involved do a better job, be safer, and to help people gain more resiliency and a better quality of life through the therapies. What more can we ask for? :)

The Consequences of Holocaust Trauma on Individuals and Future Generations

When I sat down to this week's readings, I felt like the last several weeks had given me a pretty basic background and preparation for this task. In addition to all the information talked about in this class I also had the benefit (I'm not sure that is the right word) of growing up hearing about the persecution and attempted extermination of the early adherents to my religion so I felt like that gave me an additional potential viewpoint. Yet even with all this preparation and my own past difficulties and trials- as well as a decent understand of how challenging the Holocaust was for those who were victims of the Final Solution (by far mostly Jews, but I believe homosexuals, Jehovah's witnesses and other groups were also targeted), I found myself shocked the depth and length of the trauma's effects even by those who had not experienced the worst horrors of the system... even those who experiences almost none of it, but lived with and loved those who had.

A few weeks ago, I made a comment in one of my discussion posts about a young child who I felt was potentially picking up PTSD from helping and living with her afflicted parent. I wrote it because I have been thinking it for a very long time, but I also have kept that thought to myself for the most part because I do not feel I have the qualifications to back up my belief... but I will admit my fear of the parent's reactions is pretty severe. I also wondered if that was generally possible- to get the symptoms and difficulties of a disorder simply by being around someone who has the problem... after all, you can't get AIDS or Alzheimer's with very few exceptions just by spending time with someone. Our readings definitely suggested to me that it is possible and while I may not be right, maybe there are some things that I can look into to maybe not only help, but also to have a greater understanding and sympathy for the suffering of this family.

In general it appears that the effects of surviving Holocaust trauma may be varied due to differences in people, trauma endured, and other life components, it is easily stated that this is a long lasting, multi generational problem that affects a survivor's social, cultural, medical and daily lives... as well as those individuals that live with, love, and entwine their lives with those that have survived. As mentioned in a paper written by Natan Kellermann, until the traumatic events are properly acknowledged and then the steps of the healing process properly followed, the trauma will continue to affect and distort the daily life of the victim and the secondary sufferers. Some symptoms that were mentioned from either direct sources or the family members of those primarily effected by the trauma are as follows: mourning and other emotions such as guilt, anger, anxiety, grief, etc. Also sleep problems including insomnia, nightmares, and other sleep problems and mental challenges dealing with depression, repression of difficult memories or feelings, overactive defense mechanisms causing problems with excessive fear, anxiety, lack of emotive or 'numb' response, etc... (Most of the symptoms of PTSD are present in this population.) Also, behavior that is defensive and not appropriate to the current situation is often found exhibited by victims. Some of these cognitive and behavioral challenges may affect the victim by holding them back from many social activities / events either emotionally or making special events that usually provoke joy to also cause sorrow and anger. These behaviors may vary per person and how the trauma has affected them, but it causes many parts of their daily life and activities to be challenged in a way that other unaffected individuals do not have to deal with. Other long term problems that sufferers may find are easier susceptibility to numerous other mental difficulties as well as stress related medical disorders.

A difficult and challenging problem to deal with... especially as we have had a few massacres performed on other groups since. I was listening to a commentary on a new music CD that was released by a group called 'Split Enz' (I think) a little bit ago and some of the songs on this album as well as past albums discuss the pain of the lead writer who is dealing with genocide of past relatives and his life of having to move and sometimes live a confusing existence as a refugee. One song was a poem by his mother who at the age of five lost many family members to genocide and he mixes his and her thoughts and feelings together in one song. As I was reading this week I thought about that interview and the struggles of people generations after the event as I hadn't really thought that much about it before.

A very difficult topic to be sure... what are your thoughts on this issue? Do you have any personal experience that you are willing to share? What do you think that we can do as a society to not only help victims of all crimes, but also try to help the families, caregivers and friends of those who have these challenges? Please share....

PTSD : The struggle between Homeostasis and Protection

Have I mentioned how much taking the class on “Genocide and Torture” this semester has really been such a blessing? I have known so little about PTSD and other symptoms and consequences of horrific human behavior and I feel like I have learned so much not only about other people, but also about how my body and my brain reacts to things which I have never understood before- at least not very well. I spent some time this week looking at how two specific systems in our body are used to help the body in times of threat and how it returns to its 'normal' state of being. And while doing these readings, it was really interesting to find out how PTSD actually changes the way that these systems function and causes some of the symptoms that cause sufferers of this disorder so many problems.

So the first group we looked at was a part of the nervous system called the sympathetic nervous system. It is actually one of the divisions in the autonomic nervous system. From my past medical days, I would remember what it used to do by reminding myself that the autonomic system controls almost all of our involuntary functions such as cardiac muscle, all smooth muscle in the body and also some of the glands. The sympathetic system is easily remembered (to me anyway) because it is the 'action committee' or it could also be seen as the person who feels sorrow for the hurts of a friend and leaps into action to try and help. “Fight or Flight” is the name of its mission statement per se and so when the body (or the mind) needs or believes it has encountered a threat to the body, the 'committee' leaps into action. Our heart rate gets faster (usually our breathing does too), our body shuts down its 'temporarily' unnecessary organs from normal blood flow to improve circulation to the heart, lungs, brain and muscles and the body also starts to release its reserves of stored energy so that the body has extra strength and zip when needed. There are two key neurotransmitters that are released into the body which help create this response; they are epinephrine and nor-epinephrine. The sympathetic nervous system plays a key role in how individuals can recognize a threat, feel fear and how each person will react and remember responses to future stimulus that I considered threatening.

Another response mechanism that the physical body has is called the Hypothalamic- Pituitary- Adrenal Axis. One of the most amazing things about our bodies is that all physical beings have a need to homeostasis- or keeping everything at a normal level. So when the body reacts to something, the body also has ways to attempt to bring the body back to its normal way of being. These hormones try to restore the body to a proper natural state after the person has experienced stress, fear, etc... So when a person has been under the influence of a 'stressor', the hypothalamus releases a hormone that goes to work on the pituitary gland to release another hormone. That hormone works of the adrenal glands to stimulate another hormone that helps to calm the body and 'turn off' the signals of the high 'stress' hormones and neuro transmitters.

In the average individual, these systems work together really well to help a person deal with a significant threat (or perceived threat) in good ways and then brings the body back to a normal level of function. In someone with PTSD, however, these systems do not always work the way that they were intended. So, the sympathetic system can be turned on over sounds or events that are not currently happening, memories etc... and the body will response as if the threat is clear and present. Other studies had shown that some people with PTSD have challenges with incorporating or being sensitive enough to the hormones that turn the stress response off. So people with these challenges are more likely to be overly stressed often and have more challenges in getting the body calmed down and focused again for their regular tasks and needs. That seems like an extra challenge to be sure!

So, take a few minutes and think.... How does your body react to stress and how well does it call down? If you have PTSD, how do you think your body reacts differently than someone else that does not? What techniques do you use to try and help your body reach a level of calm faster?

PTSD, Torture Specific Syndrome and the Varied Effects of Torture

In some of my readings, this week I was asked to look into the symptoms of psychological torture and how they differ from 'physical' torture. The psychological effects of torture are many, varied and while not as easily 'seen' by the naked eye as physical torture... as just as damaging to the victim's mental, physical and cultural health. However, unlike physical torture, psychological torture is harder to define, prove cause and effect, as well as determine whether it has occurred at all. (Maybe that is why more 'civilized nations' such as the United States will use it more than physical torture.... it gives the leaders plausible deniability. It also appears to give the perpetrators the 'idea' of being humanitarian but also getting the results that they are looking for.) So, whether torture was provided by physical means, psychological... or some of both, all have many of the same effects on the person affected. Isolation, for example, tends to produce changed brain function, disorientation, etc.... and has been described to have some of the same effects as a severe physical beating.

Other symptoms can be insomnia, PTSD and other mental health challenges, emotions such as guilt, pain, grief, anger, as well as problems that can bring back the images and feelings inappropriately. Many victims can feel pain in different areas of their bodies (constant or intermittent), migraines / headaches, troubles eating, social and relationship difficulties as well as severe problems with self identity. Delusions and other psychosis can be caused as well.

Unfortunately, it is also suggested by statistics and interviews that the people around the persona affected end up with many of the same symptoms, challenges and negative world views as the actual victim. So torture is not just the destruction and damage to one human life, but several... a bit like second hand smoke.... invisible but quietly making some internal changes that become difficulties and illnesses over time.

Torture Specific syndrome is usually described by four categories of symptoms:

1. impaired memory and concentration
2. sleep disturbances / nightmares
3. anxiousness, depression, physical symptoms that come without any findable cause, such as stomach complaints, breathing and heart problems,
4. other mental health problems such as depression or anxiety

These symptoms appear very similar to me as almost the same symptoms of post traumatic stress disorder and I suspect that these disorders are treated very similarly if not in the same ways. I'm actually a bit skeptical (and the textbook suggests many others are as well) that they are actually different disorders. It seems like they are just slightly different ways to describe the same problem. I wonder if people would feel more comfortable with one name over another.... like some parents did with the terms Asperger's over autism even though they are parts of the same thing. Not sure. Definitely some challenging reading this week. :)

What do you think? If you have been diagnosed with either disorder... which name 'feels' more comfortable to you? Any thoughts?

My Thoughts on our Military Entering Syria....

One of the classes that I am currently taking is called Human Rights Violation: Torture, Trauma and its Effects on Society. I took this class because I thought it might be really interesting to really learn about how challenging and how people are affected by this treatment or affected by and/or deal with witnessing it, etc... In my first reading this week, I found that two sentences really stuck out and I found myself reading the paragraph that they were 'embedded' in and ask your thoughts on them.

The first sentence is: “The US Declaration of Independence state that “all men are created with certain inalienable rights” and makes the case that a people can reject the authority of a government that violates those rights....”

The second phrase is: “Thus, a major focus of human rights law is not only to describe rights that are legally protected but also to prohibit actions by governments that violate such rights...”

So I was hoping for your thoughts on them. When I read these two sentences, the thoughts that came to mind were actually on Syria. I was against the Iraq War and going into Afghanistan, but I have shocked a few of my friends when my pacifist non-violent self admits that I feel we should go into Syria and help. I know that my opinion on both equations is the opposite of what statistics showed of public opinion in 2011 and today. Yet when I was reading these two lines, I realized that these are my thoughts on the issue stated more clearly than I knew how to express. In Iraq and Afghanistan, the need for military intervention was not clear and diplomacy and sanctions and other methods probably would

have brought these countries more in line with human rights and would have improved the lives of those living there. As those governments were only breaking these rights mainly legally (according to their laws), I don't feel like we were likely to change them... and it doesn't really appear that we have made any changes except for who is running the country. In many ways I believe we have left these countries worse off and more likely to have severe human rights abuses without recourse. The people of Syria have been trying to get more rights for over two years now and have been fighting their government with everything as they have 'rejected the authority of a government that violates' their rights. We have 'in theory' been trying diplomacy for two years as well without success. The Syrian government has now used a weapon that single-handed killed over a thousand people- many of whom couldn't have really been fighters or a threat to the government – I'm thinking of the children. So if we as a nation believe in the later quote above, should we not attempt more wholeheartedly to stop these prohibited actions...?

I guess I wonder what is our place in human rights and our responsibility.... my responsibility, my community's responsibility, my federal government's... and the world's. Some of these questions seem so easy to answer unless I think about them long enough. So what do you think your responsibility is towards Syria... or even in your own communities?