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Traumas as Social Interactions and Self Love

Malignant Self Love – Narcissism Revisited

Read “Traumas as Social Interactions” by Dr. Sam Vaknin, l (accessed August 12, 2015)

We react to serious mishaps, life altering setbacks, disasters, abuse, and death by going through the phases of grieving. Traumas are the complex outcomes of psychodynamic and biochemical processes. But the particulars of traumas depend heavily on the interaction between the victim and his social milieu.

It would seem that while the victim progresses from denial to helplessness, rage, depression and thence to acceptance of the traumatizing events – society demonstrates a diametrically opposed progression. This incompatibility, this mismatch of psychological phases is what leads to the formation and crystallization of trauma.

Self Love

Victim Phase I – DENIAL

The magnitude of such unfortunate events is often so overwhelming, their nature so alien, and their message so menacing – that denial sets in as a defense mechanism aimed at self-preservation. The victim denies that the event occurred, that he or she is being abused, that a loved one passed away.

Society Phase I – ACCEPTANCE, MOVING ON

The victim’s nearest (“Society”) – his colleagues, his employees, his clients, even his spouse, children, and friends – rarely experience the events with the same shattering intensity. They are likely to accept the bad news and move on. Even at their most considerate and emphatic, they are likely to lose patience with the victim’s state of mind. They tend to ignore the victim or chastise him, to mock, or to deride his feelings or behavior, to collude to repress the painful memories, or to trivialize them.

Summary Phase I

The mismatch between the victim’s reactive patterns and emotional needs and society’s matter-of-fact attitude hinders growth and healing.
The victim requires society’s help in avoiding a head-on confrontation with a reality he cannot digest. Instead, the society serves as a constant and mentally destabilizing reminder of the root of the victim’s unbearable agony (the Job syndrome).

Victim phase II – HELPLESSNESS

Denial gradually gives way to a sense of all-pervasive and humiliating failure, often accompanied by debilitating fatigue and
mental disintegration. These are among the classic symptoms of PTSD (Post Traumatic Stress Disorder).
These are the bitter results of the internalization and integration of the harsh realization that there is nothing one can do to alter the outcomes of a natural, or man-made, catastrophe. The horror in confronting one’s finiteness, meaninglessness, eligibility, and powerlessness – is overpowering.

Society Phase II – DEPRESSION

The more the members of society come to grips with the magnitude of the loss, or evil, or threat represented by the grief inducing events – the sadder they become. Depression is often little more than suppressed or self-directed anger. The anger, in this case, is belatedly caused by an identified or diffuse source of threat, or of evil, or loss. It is a higher level variant of the “fight or flight” reaction, tempered by the rational understanding that the “source” is often too abstract to tackle directly.

Summary Phase II

Thus, when the victim is most in need, terrified by his helplessness and adrift – society is immersed in depression and unable to provide a holding and supporting environment.
Growth and healing are again retarded by social interaction.
The victim’s innate sense of annulment is enhanced by the self-addressed anger (=depression) of those around him.

PHASE III

Both the victim and society react with RAGE to their predicaments. In an effort to Narcissistically reassert himself, the victim develops a grandiose sense of anger directed at paranoidly selected, unreal, diffuse, and abstract targets (=frustration sources).
By expressing aggression, the victim re-acquires mastery of the world and himself.

Members of society use rage to re-direct the cause of their depression (which is, as we said, self-directed anger) and to channel it safely. To ensure that this expressed aggression alleviates their depression – real targets must are selected and real punishments meted out. In this respect, “social rage” differs from the victim. The former is intended to sublimate aggression and channel it in a socially acceptable manner – the latter to reassert narcissistic self-love as an antidote to an all-devouring sense of helplessness.

In other words, society, by itself, being in a state of rage, positively enforces the narcissistic rage reactions of the grieving victim. This, in the long run, is counter-productive, inhibits personal growth, and prevents healing. It
also erodes the reality test of the victim and encourages self-delusions, paranoid ideation, and ideas of reference.

Victim Phase IV – DEPRESSION

As the consequences of narcissistic rage – both social and personal – grow more unacceptable, depression sets in. The victim internalizes his aggressive impulses. Self-directed anger is safer but is the cause of great sadness and even suicidal ideation. The victim’s depression is a way of conforming to social norms. It is also instrumental in ridding the victim of the unhealthy
residues of narcissistic regression. It is when the victim acknowledges the malignancy of his rage (and its anti-social nature) that he adopts a depressive stance.

Society Phase IV – HELPLESSNESS

People around the victim (“society”) also emerge from their phase of rage transformed. As they realize the futility of their anger,
they feel more and more helpless and devoid of options. They grasp their limitations and the irrelevance of their good intentions. They accept the inevitability of loss and evil and Kafkaesque agree to live under an ominous cloud of arbitrary judgment, meted out by impersonal powers.

Summary Phase IV

Again, the members of society are unable to help the victim to emerge from a self-destructive phase. His depression is enhanced by their apparent helplessness. Their introversion and inefficacy induce in the victim a feeling of nightmarish isolation and alienation. Healing and growth are once again retarded or even inhibited.

Victim Phase V – ACCEPTANCE AND MOVING ON

Depression – if pathologically protracted and in conjunction with other mental health problems – sometimes leads to suicide. But more often, it allows the victim to process mentally hurtful and potentially harmful material and paves the way to acceptance. Depression is a laboratory of the psyche. Withdrawal from social pressures enables the direct transformation of anger into other emotions, some of them otherwise socially unacceptable. The honest encounter between the victim and his (possible) death often becomes a cathartic and self-empowering inner dynamic. The victim emerges ready to move on.

Society Phase V – DENIAL

Society, on the other hand, having exhausted its reactive arsenal – resorts to denial. As memories fade and as the victim recovers and abandons his obsessive-compulsive dwelling on his pain – society feels morally justified to forget and forgive. This mood of historical revisionism, of moral leniency, of effusive forgiveness, of re-interpretation, and of a refusal to remember in detail – leads to a repression and denial of the painful events in society.

Summary Phase V

This final mismatch between the victim’s emotional needs and society’s reactions is less damaging to the victim. He is now more
resilient, stronger, more flexible, and more willing to forgive and forget. Society’s denial is really a denial of the victim. But, having
ridden himself of more primitive narcissistic defenses – the victim can do without society’s acceptance, approval, or look. Having endured the purgatory of grieving, he has now re-acquired his self, independent of society’s acknowledgment.

Asperger’s Syndrome

Asperger’s – A parent’s journey to being grateful

As the parent of a child with Asperger’s, I have gone through a series of emotional stages, and though I never thought I would be grateful, I am.

Aspergers SyndromeWhen I first realized my kid had Asperger’s, I was relieved.  I was relieved because there was suddenly an explanation.  I had thought that there was something “wrong” with him, but I couldn’t figure out what it was.

Finding out that he has Asperger’s let me know that he is “different” but not “bad.”  He isn’t just a kid who chooses not to behave.  He isn’t a kid with a mom who doesn’t make him behave.  He has Asperger’s.

Then, I was sad.  I was sad for all the times that I didn’t understand.  I was sad for the fact that others have taught him he is a “bad” kid.  I was sad for all the times I got frustrated and lost my temper.

I was also angry.  I was angry because even the health care “professionals” did not see.  They focused on his “bad” behavior.  They focused on what I wasn’t doing to make him better. They did not truly understand that he is “different” and they certainly did not see how great he is.

Today (several years later) I am in acceptance. I accept that my child (now 10) is different.  I accept that he will have difficulties.  I accept that his school will call about once a week to describe some heinous event.

I am also grateful.  I am grateful that I know.  I am grateful that I can appreciate the terrific kid that he is and mostly know how to help him through. I do still get frustrated and lose my temper but at least I know what I am doing wrong.  I no longer have to feel like I am doing everything wrong – or that I just don’t know what to do at all.

Autism Spectrum DisorderI am grateful that at least right now, he is fortunate enough to have a teacher that gets Autism Spectrum Disorder.  A principal that gets it – and both of these wonderful ladies see how lovable he is, how smart he is, and even though they may get frustrated and angry, they still get it.   I am grateful that I have enough information to know that there are just some things that we cannot do, and that really we shouldn’t bother.

I was thinking about this because I heard about a convention that I could go to.  The convention organizers have a “kid camp.”   The children are put on a bus and taken to some activity – a museum, a park, a walking tour…and even though he is 10 and even though he is “high-functioning” – he could not do this.  He could not be calm and collected and manage.

He has difficulty with scheduling, he has difficulty with noise, he has difficulty with crowds, he has difficulty with spontaneous activities, he has difficulty with new food… I would not even consider sending him to “kid camp” or any other activity that I could not be at.

This is not because I won’t “allow” it.  It is because the well-meaning organizers will not be able to predict and compensate for his Aspergers Children“different-ness”.  He would not have a good time; I would not have a good time – it would not be best for him.  I cannot go to that convention, but that is OK.

Not every kid who has Asperger’s has the same “different-ness”, and not every parent feels the same way. But I am grateful that I have gone through the relief, the anger and the sadness, to be accepting of my life and his life.

I am thankful that I can compensate for his differences and see how terrific he is.

Children with Asperger’s Syndrome have different different-nesses!

Melissa Lind

Intermittent Explosive Disorder

Intermittent Explosive Disorder – More Than Just Anger

Intermittent Explosive Disorder (also called IED, that is appropriate as it can go off unexpectedly and cause significant damage)

Intermittent Hulk Explosive DisorderProbably everyone knows that teenage boy (or girl) who punched a hole through the wall.  Perhaps for some, this became a regular pattern of behavior during adolescence but most of those teenagers outgrew it.  In fact, at least one-quarter of teenage boys has done something dumb like punching a wall.

One boy I knew in high school even broke his hand by punching the roof of his car, and some boys were routinely doing stupid stuff.  Despite that, all of it was teenage angst and changes that can be attributed to the massive amounts of testosterone flowing through the male adolescent body – none of them had intermittent explosive disorder.

Intermittent Explosive Disorder is worse than punching a hole through a wall.

It typically is first identified in the early teens – but can be seen much earlier in some cases.    In order to be actually characterized as intermittent explosive disorder, an individual must have had three episodes of explosive behavior that is severely out of proportion to the stressor.

Intermittent Explosive Disorder HulkinsectThey must have broken or smashed something that is monetarily valuable (more than a few dollars), physically attacked or made explicit threats to attack someone with the intent of causing harm.  If these three episodes occur within the space of 12 months, the disorder is considered to be more severe.

Here is the catch.

How do you distinguish between IED, average – though extreme teenage behavior and other psychiatric conditions?  It turns out that IED is probably a diagnosis of “if nothing else fits” as other psychiatric disorders certainly overlap with similar symptoms – and you have to rule out the adolescent hormone issue.

Bipolar disorder may cause outbursts of extreme anger and agitation, Borderline personality disorder may cause outbreaks, ADHD patients can exhibit a severe lack of self-control, and drug abuse is always a potential cause.  Even though those diseases may cause IED-like events, a sustained behavior pattern is something to address.

Intermittent Explosive Disorder WarningA recent study reported by the National Institutes of Health shows that IED can actually affect up to 4 percent of adults and lead to an estimated 43 attacks over a lifespan.  The disorder may also increase that chance of depression, anxiety and substance abuse disorders.  People with IED have an obvious increased risk of legal trouble, financial difficulties, and divorce – that’s a no-brainer.

So the biggest problem for mental health professionals, like many other disorders, is to untangle all of the information leading in and out with a mix of behaviors and a mix of causes.  What came first – the chicken or the egg?  What came first – the drug abuse or the anger?  Which illness is more important – bipolar disorder or the IED?

One of the biggest clues may be in examining (or better, paying attention to) behavior that occurs before puberty.  In other words: What came first – the behavior or puberty?  Clearly if the behavior started before puberty, there was and is an issue.  If the behavior begins during adolescence – you have to wait (and hope) to see if the behavior goes away once the hormones are settled.

IED is not a simple diagnosis.

It requires a careful examination of an entire psychiatric and behavioral history – and the “ruling out” of a lot of other disorders that may be to blame.  Unfortunately, in the end – unless an underlying cause can be found, there is no medicationAnger management and cognitive behavioral therapy are likely the only answer – minimization of harm, not very satisfactory if it was your car window that got smashed in a fit of rage.

Melissa Lind

Childhood Sexual Abuse and Mental Health

Mental Health and Childhood Sexual Abuse – Don’t Carry the Secret

Recently I saw something on Facebook that was very sad.  It was a video of a 50 plus year old man named Scott – also called “Spider,” who told the story of his life through written cards, in a fashion similar to Ben Breedlove’s “This is my story” about his heart condition. In the video, this tough looking man, confessed the trauma of his own sexual abuse and the damage it had done to him over the years – drug abuse, divorce, culminating in an arrest for beating his child’s sexual predator with a bat.

The story was naturally sad but is all too common.  In fact, statistics shows that 1 in 6 boys will be sexually molested by the age of 18 and worse for girls with 1 in 3.  The other sad fact is that many, many children who are sexually abused don’t tell anyone.  Either they are threatened or ashamed – or both.  They carry the secret for much of their lives.

Trauma, abuse, neglect – biology didn’t account for its infliction on children.  As children, our brains develop best in a loving,
supportive environment with plenty of nutritional food and quality exercise so that our bodies become the best they can be.  Childhood Trauma - Mental HhealthAround the world we see the damage that poor nutrition, neglect and physical abuse can do to children.  What is not so obvious is the damage wreaked by sexual abuse – it is a hidden traumaSexual abuse is hidden by the child, hidden from the adults, hidden from other children, and sometimes even hidden by the child’s memory.

Secrets are always dark.  Carrying secrets can ruin a relationship or ruin a career.  Carrying secrets imposes a burden of stress on your body – your heart doesn’t work as well, your adrenal system gets burned out, your sleep is affected.  Carrying a secret like that can change a child’s brain.

Studies have shown that abuse or childhood trauma actually causes physical changes to the developing brain.  It can make the child unable to grow to what they would have been.

So what does this have to do with mental health?

The effects of childhood trauma are hard to predict.  Mental health is hard to identify – particularly the cause.  In some cases, we can easily point to the parents and say “Mom and Grandma have clinical depression; it is no surprise that the daughter has depression.”  Schizophrenia has been shown to be driven by over 100 genes and a child with one schizophrenic person has a 13 percent chance of developing the disorder.  Some people are “born” alcoholics in that they are missing an enzyme that allows them to process alcohol properly and will nearly always become addicted if they drink.

In other cases – we can’t identify the cause.  You have some cases of mental disorders that develop in people with perfect childhoods.  You have people with horrible experiences who are remarkably healthy – rare, but true.  In many cases though, someone with a history of child abuse will develop some mental disorder – but the type is very hard to predict.

In “Spider’s” case, he became a drug addict, had an anger problem and felt that he had to prove he could “conquer” women (his own words), leading to the destruction of his family.  Likely he suffered from depression, anxiety disorder, and possibly Mental Health - Child AbusePost-Traumatic Stress Disorder.  Telling the “secret”, not carrying the weight may, just may have kept him from his self-destructive behavior.  Unfortunately, it may not have stopped his daughter from being a victim, but it might have allowed him better tools than a bat to deal with her problem.

In severe cases, extreme trauma can actually cause the personality to “split,” in “Dissociative Identity Disorder” (DID), which was previously called “Multiple Personality Disorder” (MPD).

(Photo-source: http://blogs.ocweekly.com/navelgazing/2014/08/scott_spider_spideralamode_facebook_molest.php)

Sexual abuse has another problem – that children are often disbelieved which worsens the trauma.  Unlike physical abuse, unlike neglect, unlike starvation – there are no “obvious” signs.  There are signs, but you have to know what they are.  Children who have been sexually abused do exhibit signs:

•    changes in behavior or personality type – a normally outgoing child becomes withdrawn, a normally gregarious child becomes angry and sullen
•    bed wetting and nightmares (oddly the bed-wetting may be punished)
•    refusal to go to school, church, sports or club activities or to a certain friend’s house
•    sudden clinginess or a sudden desire to be left alone

Too often, adults don’t ask.  Too often, children don’t tell.  Sadly, sometimes adults won’t listen.  If you know of a child that has
sudden behavioral changes – ask.  If you are an adult, believe.  If you are a victim, tell.  Even at a late date, telling can change your life and resolve some of your “issues.” I think in the end, “Spider’s” main message was “tell your kids to tell.”

What does this have to do with mental health?

Sexual abuse can contribute to:

PTSD, Depression, Bipolar Disorder, Anxiety Disorder, Intermittent Explosive Disorder, Obsessive Compulsive Disorder, Bulimia, Anorexia, Drug Addiction, Alcoholism, Attachment Disorder… and many more.

History of Child Abuse – Free PDF

Melissa Lind

Mental Health and Grief

Grief and Mental Health – When the Two Merge

Grief is something that we all experience at one time, or another.  The stages of grief – sometimes explained as 3, 5 or 7 different stages – are pretty well known and include shock, denial, anger, sadness, acceptance in some order.  Most people will struggle but eventually come to some resolution with no prediction as to how long that will take.

Resolution of deep sorrow can be made much more difficult when a pre-existing mental illness is imposed.  A severe loss can trigger a relapse of virtually any mental illness, even when the illness was well treated, and the patient was stable.  Patients may relapse into severe depression, bipolar episodes, panic attacks or a return of obsessive compulsive behavior.  If the patient was not well stabilized, the whole apple-cart can be upset.

Depressed and Suicidal GirlEven the most mentally healthy person can become unstable if unable to resolve the feelings caused by painGrief has been known to result in clinical depression, lasting for a long period which can lead to extreme difficulties and even death in the case of suicide.  The problem comes in a case where one becomes “stuck” at a certain point – usually during the agitation period.

There is a saying;   “depression is anger turned inward.”  The existence of anger over an extended period can cause depression.

Anger allows us to have a heightened response to a threatening situation.  Anger fuels energy, giving us a false sense of power, but over time, the brain and the body run out of that same energy.  This can result in fatigue, emotional lability, and symptoms of depression.  In some cases, depression caused by grief may be resolved with grief counseling.

In other cases, however, depression may have become severe enough that medication may be warranted.  Clinical depression is characterized by:

•    Fatigue and decreased energy
•    Cloudy thinking
•    Feelings of guilt, worthlessness or helplessness
•    Insomnia or excessive sleeping
•    Irritability
•    Loss of interest in pleasurable activities
•    Body pain or digestive problems
•    Persistent sad or empty feelings
•    Thoughts of suicide

How different is this from grief – not much.  The only difference would be in how long it lasts.  Depression carries a high risk of suicide and if symptoms last longer than what would be considered “normal” – for any reason – you should seek treatmentMental Health ChaosDepression that is severe enough to interfere with normal activities for longer than four to six weeks should be treated – even if life circumstances explained it.  Counseling may work – or you may need medication for a short period.

If you have some known mental disorder, stay in contact with your mental health professional.  Most – and I did not say “all”, but most mental health patients find it difficult to self-assess, some find it difficult to be openly honest.  The only way to ensure that an episode of grief is resolved without severe consequences of going “off track” is to allow someone else to help assess your mental state.

Whether you are or are not a mental health patient, know that grief can cause mental illness and can worsen an existing illness – even if only for a short time.  It is not something to be dismissed or ignored as the risks are high.

Melissa Lind

Depression is Anger Turned Inward