public awareness of PTSD

TraumaBlogEvery breath—a new beginning. And with every breath, we come home.

In this, my first post in this new blog, I want to tell you a little about how I got here, by way of introduction.

Over a period of some 15 years, I have found myself increasingly focused on trauma psychology and the psychotherapy of trauma. My professional life did not begin with that focus, but rather with a near total failure to recognize that the psychology of trauma—much less that of dissociation—mattered much. I will take responsibility for it, but I did have a lot of help in creating this failure of understanding.

Trauma process was anything but a focus of training in graduate school. We learned many useful things, but because there was so much to learn and so little time, we mostly opened doors and looked in; then rushed on. Even several years of internship, during graduate school and afterwards, barely informed me of what lay ahead.

Immediately after graduation, I began directing the admissions department of the major private psychiatric hospital in Portland, Oregon. In reality an internship of a different sort, it was indescribably valuable. I engaged with people in real trouble with their mental health. I can recall dealing with one person who had dissociative identity disorder (DID), and two or three who had posttraumatic stress disorder (PTSD). It was kind of exotic stuff, pretty much as I’d been led to believe in graduate school.

After two years of that I was ready for an increased clinical focus, and was hired to manage a branch office of a county mental health agency in eastern Washington State. As the senior clinician, I tended to get most of the really tough cases, and before long I realized that I simply didn’t know enough. A few of the people in my case load clearly qualified for PTSD diagnoses, while the majority appeared to have one flavor or another of depression, as well as various sorts of anxiety. Many of them were essentially chronic cases. Why couldn’t I do more with them? Why was I the only one bothered by my ineffectiveness?

Then I got my agency to pay for training in eye movement desensitization and processing (EMDR), a new approach to dealing with trauma, which we appeared to have a lot of in rural Washington. I learned a lot about PTSD in that training, came back to my case load to reassess every individual, and discovered that 85% of them had PTSD! I was stunned.

At that point I had a problem: I didn’t think I could share this revelation with my supervisor, because it was just too unexpected, too anomalous. As I began treating people with this new, trauma-focused approach, I saw immediate transformative results. They got better, and I got wiser.

Not only had I been clueless as to what was right under my nose, I had never been instructed in graduate school or by any of my clinical supervisors to routinely look much deeper than the symptoms and “the complaint” that my clients initially offered to me. That laissez-faire approach had clearly been failing my clients.

At this point, I finally confided in my supervisor. To my surprise, he accepted my finding of an 85 percent rate of PTSD in my case load. Why hadn’t he directed me to look for this, if he found my report to be unsurprising? It just wasn’t his focus. It wasn’t anyone’s focus. Still, it quickly became mine. It had to, as I had a fatal flaw: I actually wanted, above all else, to be effective with my clients.

I suggested to him that our entire agency needed to shift its service delivery model to this new orientation, get a lot more individuals trained in how to treat trauma disorders, and start insisting that virtually everyone get assessed for trauma-related disorders. He said that while it might be a good idea to do so, we had to give priority to a major paperwork-compliance problem we were working out with the state, which would take at least another eight months to resolve. We had new software to bring online, for one thing. Maybe we could address this over the next budget period, he proposed.

While that prospect might have worked for him, however, it certainly did not for me. I knew I was finished at the agency. Within 10 days or so, I gave my 30-day notice. I had to go where I could be far more responsive to the needs of my clients, and that meant private practice.

That was about 15 years ago. Since then, I’ve been learning, writing, and doing clinical work—all of which has increasingly been focused on trauma-related disorders. At the same time, my profession has also been continually learning, researching, writing, and working with such disorders. We now understand—those of us with this special focus—that merely having a relative who develops cancer can result in your acquiring PTSD. We understand that children can get a particularly challenging form of it (“complex PTSD”) merely from inadequate parenting. We understand that for the most part, dissociative identity disorder (DID) is advanced, severe PTSD with an early-childhood  onset.

What started out as a large fish has turned into a veritable whale. Is this a good thing? Well, it does have its critics, surely. However, little of what they say amounts to more than a protest about having to alter their basic paradigm for much of mental illness. When it turns out that much of substance abuse is connected to trauma in childhood; that one girl in 3–4 and one boy in 5–6 is sexually abused growing up; that while the mass media is fixated on soldiers with PTSD the reality is that, by more than 2 to 1, individuals with PTSD are neither male nor have any military background—how can this new paradigm be anything BUT a good thing? Solving the wrong problem is never helpful.

I now understand that what some of us know in my profession needs to be passed on more quickly to our peers. They need to understand that just as certain things in medicine (cancer, and obstetrics, for example) are clearly best dealt with by specialists, so it is with trauma disorders. They need to learn how to do better assessments, and then make appropriate referrals.

I also have found that misunderstandings about trauma are endemic in the general population, and that merely treating individual after individual in one’s office will not do much to address that problem. People aren’t getting treatment because they don’t know it’s possible, or they don’t know that their symptoms could well indicate a need for it. At a personal level, this is simply tragic, given the consequences of having to live year after year with PTSD or DID— consequences that touch not just the individual but their spouses, children, work associates, and friends.

So . . . what I want here is this: a chance to dialog with you about psychological trauma disorders, to pass on correct, current and useful information; to tell stories about people who been profoundly affected by trauma, and have found ways not just to manage their symptoms, but to recover from their disorder. I have some things to show you that you really should know about, if your life is touched by any of these disorders. What I want is simply a chance to say them.

One other thing. I’m here because the publisher of Mom Psych and I think essentially the same way about the critical importance of evidence-based psychology. Unless we resort to folkloric explanations and remedies, it’s all we have to push back the darkness. Fortunately, it’s a very powerful tool.

You deserve to know about all this. For the most part it’s good news, and it just keeps getting better. For many of you it will be life-changing information.