The Meadows Blog

The Meadows has produced a new video, "The Meadows - The Right Choice" with Meadows' Senior Fellow Dr.Claudia Black. Visit The Meadows homepage: http://www.themeadows.com to view the video.

Claudia Black, MSW, PhD, has spent 11 years working in an advisory role with The Meadows. She is a renowned author and trainer, internationally recognized for her pioneering and contemporary work with family systems and addictive disorders.

In the mid 1970's Dr. Black gave voice to both young and adult children from addictive homes, offering a framework for their healing. This cutting edge work would be critical in creating the foundation for the codependency field and a greater understanding of the impact of family trauma. Since that time, Dr. Black has continued to be a passionate leader in the field of addiction.

Dr. Black has offered models of intervention and treatment related to family violence, multi-addictions, relapse, anger, depression and women's issues. Dr. Black designs and presents training workshops and seminars to professional audiences in the field of family service, mental health, addiction and correctional services. She has been a keynote speaker on Capitol Hill in Washington DC and on Parliament Hill in Ottawa, Canada. She has extensive multi-cultural experience working with agencies and audiences in countries such as Iceland, Brazil, Japan and others throughout the world.

Dr. Black is one of the original founders of the National Association for Children of Alcoholics and continues to serve on their Advisory Board, and also serves on the Advisory Board of the Moyer Foundation. In addition, she is the author of over 15 books, most notable is It will Never Happen To Me. Her most recent books are related to partners of sex addiction, Deceived: Facing Sexual Betrayal, Lies, and Secrets and Intimate Treason: Healing the Trauma for Partners Confronting Sex Addiction.  Dr. Black also creates educational videos for use with the addicted client and families affected by addiction. Many of her books and videos have been translated and published abroad.

For more information about Dr. Black, please visit www.claudiablack.com.

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The Meadows is sponsoring two breakfasts and lectures with Meadows' Senior Fellow, Jerry Boriskin, PhD, CAS, in Atlanta, Ga., at Maggiano's on Thursday, April 11 and in Durham, NC, at Maggiano's on Friday, April 12 from 8:00-10:00am.

Dr. Boriskin will present "Do You Have What It Takes? The Clinical and Personal Challenges of Treating Co-occurring PTSD and Addiction." This brief workshop will review the necessary foundations for understanding the scope and nature of PTSD as it co-occurs with addiction. In addition, attendees will be introduced to a multi-dimensional model that can assist in managing the volatile and complex challenges of treating veterans and civilians who struggle with their recovery.

Dr. Boriskin is a licensed psychologist, addiction specialist, author, lecturer, and clinician with expertise in trauma, PTSD, and addictive disorders. He was a pioneer in extending the continuum of care and developed two extended residential treatment programs for co-occurring disorders. A passionate advocate for integrated treatment, he possessed a vision the predated the ongoing movement toward specialized and integrated treatment for co-occurring disorders, particularly those involving trauma.

For information on The Meadows and activities in the Atlanta and Durham areas, contact Marlene Alligood at 770.776.9440 or malligood@themeadows.com

The Meadows is an industry leader in treating trauma and addiction through its inpatient and workshop programs. To learn more about The Meadows' work with trauma and addiction contact an intake coordinator at (866) 856-1279 or visit www.themeadows.com.

For over 35 years, The Meadows has been a leading trauma and addiction treatment center. In that time, they have helped more than 20,000 patients in one of their three inpatient centers and 25,000 attendees in national workshops. The Meadows world-class team of Senior Fellows, Psychiatrists, Therapists and Counselors treat the symptoms of addiction and the underlying issues that cause lifelong patterns of self-destructive behavior. The Meadows, with 24 hour nursing and on-site physicians and psychiatrists, is a Level 1 Sub-Acute Agency that is accredited by the Joint Commission.

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By: Jerry Boriskin, PhD - Senior Fellow for The Meadows

I usually track major media articles on PTSD but I was surprised this past week when two concerned members of my weekly Viet Nam Veterans PTSD group brought the Time Magazine article: http://nation.time.com/2013/01/11/dr-peter-j-n-linnerooth-1970-2013/ . I was flattered by their concern for me and others doing the sort of work I refer to as the "Special Forces" of mental health. The late Dr. Linnerooth was not only a member of this club but a front line leader directly deployed (for five years) and in harm's way. He may have not had the proper state license, but he had a Bronze Star. I suspect the number of mental health professionals with that credential is less than .0001%.

Dr. Linnerooth followed a path that hundreds of soldiers each year seem to track. He returned from deployment, lost his marriage, lost his job and then with a bit of Jack Daniels on January 2nd, lost his life. One article depicted his death as "losing the battle". I take offense to this depiction in the same way I look at obituaries characterizing death from cancer as "losing the war against cancer". I am a cancer survivor and I can tell you survival is a function of luck in concert with great medicine and support, not willful determination, tenacity or attitude. Sure, attitude and support matters, but when the odds are overwhelming sometimes acceptance is the only productive path. The warrior metaphor is part of the problem. It is war that creates a contradiction between helplessness and illusions of complete control and expectations of responsibility.

Those who have active PTSD are what I often refer to as "control and responsibility junkies". We do not need win-lose metaphors in describing such titanic struggles. Dr. Linnerooth did not "lose"; he succumbed to a process he worked so hard to treat. He became "infected" with the direct pain of others. More poignantly, he also apparently was recruited as a makeshift medic. According to several news stories he was tortured by images and recollections of children dying slowly. Those sights, smells and sounds do not simply go into ordinary memory. They change your world view and make you less tolerant of institutions and processes that work in a more ordinary fashion. Those who develop PTSD become more adept at handling life and death crisis, but far less skilled in handling ordinary challenges, like requests or demands from employers, wives, friends or even your own children. Dr. Linnerooth apparently lost his footing, his job, his mission and his family. Whether he was genetically vulnerable to alcoholism is something we may never know, but alcohol, along with a pill bottle, a gun and PTSD make an all too lethal combination. Dr. Linnerooth did more than was expected of him; he was part of a team attempting to help far too many soldiers in combat. He did not fail in his mission. The Army, VA, the mental health community and all of us failed him- not purposely, but due to our limited vision. Our institutions are working very hard to prevent deaths like those of Dr. Linnerooth. However, we are trying to do so with bureaucratic solutions, some of which are helpful but we may be missing the mark. Soldiers and professionals carrying "invisible wounds of war" need to be understood, heard and validated. Dr. Linnerooth was trying to get us to listen. Somehow we did not hear him.

Additional articles on Dr. Linnerooth:
http://nation.time.com/2013/01/17/losing-one-of-our-own/
http://nation.time.com/2013/01/16/the-va-on-dr-peter-linnerooth/
http://mankatofreepress.com/local/x964878699/Mental-health-expert-who-helped-suicidal-soldiers-took-own-life

For more about The Meadows' innovative treatment program for PTSD and other disorders, see http://www.themeadows.com or call The Meadows at 800-244-4949.

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Meadows' Senior Fellow, Dr. Jerry Boriskin, was recently interviewed for the "Chronic Pain Solutions' podcast. Dr. Stephen Grinstead talks with Dr. Boriskin about his insights around people living with chronic pain who also have an unresolved trauma history and/or an addictive disorder. In this interview Dr. Boriskin brought his 30 years of expertise to focus on this population. They also covered the importance of taking the stigma off the different diagnoses that the people they serve have developed- sometimes through no fault of their own.

To listen to this this one hour podcast, visit http://www.addiction-free.com/Guest-Podcast-Interviews.html.  To read the Chronic Pain Solutions Newsletter, visit http://www.addiction-free.com/Sept-2012-newsletter.html.

Jerry Boriskin, Ph.D, a Senior Fellow at The Meadows, has been at the forefront of the treatment of PTSD, addiction, and co-occurring disorders for more than 30 years. He is the author of several books, including PTSD and Addiction: A Practical Guide for Clinicians and Counselors and At Wit's End: What Families Need to Know When a Loved One is Diagnosed With Addiction and Mental Illness. For more information about Dr. Boriskin, please visit his website at http://www.jerryboriskin.com/.

For more about The Meadows' innovative treatment program for PTSD and other disorders, see http://www.themeadows.com  or call The Meadows at 800-244-4949.

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By:  Brad J Kammer, MA, MFT, SEP

After Hurricane Katrina devastated the Gulf Coast, I had the great fortune to travel down to the area as part of a trauma outreach team, training local crisis workers on how to use the basic principles of Somatic Experiencing (SE) to help them manage the trauma that was now overwhelming the remaining residents. I had been following the news reports post-­‐Katrina, and vividly remembered the horror stories of looting and violence, particularly those coming out of the New Orleans Superdome - like stories out of Lord of the Flies - with reports of gang attacks, rapes and murder. Having worked in refugee camps on the Thai-Burma border amidst civil war, I understood how trauma could so immediately overwhelm people and communities that they would turn against each other in violence. But what I also understood was that in our most overwhelming crises, people also come together for protection, safety and healing. It happened in those first few days after 9/11 in New York City and elsewhere, and as I traveled down to the Gulf Coast region, I imagined that despite all the news reports to the contrary, it must have happened there too.

What I found when I arrived was almost exactly opposite of those news reports I had been following. All over southern Louisiana, individuals, families and communities had come together to support one another. I heard countless stories of strangers helping strangers, taking families into their homes, and other acts of selfless giving. The most startling story I heard, however, had to do with the New Orleans Superdome. I was talking with a woman who had been on the clean-­‐up crew after the last few hundred refugees were evacuated from the Superdome, expecting her to share horrifying images of what she observed. Instead, she shared with me the image of folding chairs placed in circles, all throughout the Superdome, stating that folks had come together to share stories, food, laughter and comfort.

In my years of teaching about stress and trauma, I have found that nearly everyone is familiar with the "fight and flight" survival response. However, very few people are aware of the "tend and befriend" survival response. In Somatic Experiencing, we turn to animals in the wild to understand how despite constant predator-­‐prey dynamics, wild animals are able to manage life-­‐threatening experiences and not develop the symptoms of post-­‐traumatic and other chronic stress disorders. We have carefully studied how wild animals are able to recover from high stress states by completing their fight/flight responses and thereby discharging the high arousal associated with threatening experiences. We have also understood the nature of the freeze response, which comes on-­‐line when we cannot successfully fight or flee from a life threat, and how in humans, going into freeze predicts the onset of developing PTSD and other chronic stress disorders. In Somatic Experiencing, we have developed strategies and tools to help individuals move out of freeze and restore the feeling of being in control, balanced, and capable of meeting further life challenges.

But what about this tend and befriend response? What is this all about? And how does this relate to recovering from trauma? If we look back to the wild animals, we see that there are numerous examples of herds of animals that when threatened or attacked, form protective circles. I've watched videos of zebras, elephants, sheep, and other animal species who on initial response to threat, do not immediately fight or flee, but come together as bands - and if we look closely enough, we see this beyond just mammalian herd behavior, we see this with flocking of birds, shoaling of fish, and the swarming behavior of insects.

Now let's look back to the Katrina refugees, huddled in shock, terror and confusion, locked in the Superdome with thousands of other shocked, terrified and confused refugees. These individuals were in a life-­‐threatening situation, and their very survival was at stake. It is true that there were instances of violence, most likely instigated by erratic attempts at fight or flight, but we cannot overlook the majority of individuals who bonded together with others for safety and comfort. In many ways we can see this in the various social institutions we've created as well, from national armies to gangs to families - we join together with others to protect and secure safety.

When threatened, our first biological response is to orient to the danger. Our senses are heightened and we will scan the environment for the source of threat. Maybe this has happened to you late at night while you're sleeping. You hear a noise downstairs and immediately startle, sitting up, and using your senses (ears, eyes, possibly even smell) to locate the source of the noise. I live in the country and see this happen frequently with deer. I'm walking on a trail and observe a deer some 30 yards ahead, standing still, but with probing eyes and shifting ears, attempting to evaluate if I am a source of threat. If I continue to walk closer, they will immediately run away (flight).

However, part of this orientation - often overlooked due to the rapid firing of these instinctive survival responses - is an orientation to the herd. Before the deer run away, they are also orienting to the other deer. And before you get out of bed to check the noise downstairs, you might wake up your sleeping partner to check in with them. If others are there for us, we will come together in numbers to better assure protection and safety. And if not, we will move rapidly into fight, flight or freeze responses. These are not well thought-­‐out plans, these are instinctual, biological and genetic programs that are activated in the face of danger and threat. As humans, we are programmed to connect and collaborate for survival: this is the tend and befriend survival response.

Over the past 20 years, thanks to the emergence of incredible brain imaging technology, we can now map the brain and body like never before. These studies show us that the regulators of our minds and bodies are embedded in relationships. This goes beyond the realm of mere survival into the realms of understanding illness, health, and resilience. Research suggests that in terms of health and healing, social support is more powerful than anything besides genetics. And when there is an absence of appropriate social interactions, when individuals retreat into social and/or emotional isolation, substitutions are made in the form of such things as food, alcohol, drugs, sex, TV, computer and video games. Meanwhile, chronic stress builds in the nervous system which leads to a host of symptoms and chronic disorders. There is plenty of information showing us that isolation and lack of social engagement can make us sick. And yet, we live in a world where we retreat more and more, creating alternate realities and identities on digital screens, whispering messages of loves through text taps, and flirting with emoticons. Contrary to what we may believe, these forms of engagement are not bringing us closer together nor are they triggering the hard-­‐wired mechanisms in our brain and bodies that are required for supporting health and well-­‐being.

Some years ago, oxytocin, the "love" chemical, was discovered in the brain. Scientists observed that this chemical was released in both mothers and their babies during labor and birth, and during bonding between parents and their children. This chemical is released to support the loving feelings necessary for healthy bonding and attachment. As we have learned through studying bonding, the mother's presence and loving attention helps to regulate the newborn's not yet fully-­‐developed nervous system. Studies have shown that when there is an absence or oxytocin release, bonding suffers and proper infant development is threatened. For the baby, then, along with food, water and oxygen, the ability to feel connected assures their very survival.

But interestingly, oxytocin also shows up in the human body during times of close social connection including romantic encounters, trusted friendships, and even the comforting pat on the back or rewarding high-­‐five. Being a big basketball fan, I enjoyed reading a research study on the National Basketball Association (NBA) a few years back which compared the performance of a team with the number of times during a game players on that team use supportive touch with one another - anything from a handshake to a chest bump to a bear hug. This study demonstrated that there is a strong correlation between successful teams and the frequency of contact, with the Boston Celtics and LA Lakers, the two teams that met in the 2008 NBA Finals, being the two "touchiest" teams.

As scientists continued to research this neurochemical, they realized that not only does oxytocin coordinate social behavior with bonding, healthy development, and improved performance, but it also supports physical health. It acts to lower the neurochemicals associated with stress and anxiety, is analgesic (blocks pain), and anti-­‐inflammatory (aids in healing). Maybe this accounts for why children run to their parents when they fall off their bicycles and scrape their knees - maybe their mother's embrace actually triggers pain-­‐reducing, healing mechanisms in the skin. Maybe this is why being with friends and family during tragedy can help us stay balanced and sane. Maybe this is why all the Katrina refugees joined together in circles at the Superdome.

Many ancient cultural and religious rituals serve this very function. For example, in the Jewish tradition, close family and friends come together to mourn a loved one's death for seven days following their passing. This practice of "sitting shiva" allows for grieving family members to be supported by their community as they manage the intense emotions associated with the loss of a loved one, possibly inoculating them against the effects of depression and illness reactions. More recently, social, self-­‐help and therapeutic groups have served a similar function in our modern society. An informative research study from Stanford University was done with 50 women diagnosed with metastatic breast cancer. They followed two groups of women - one consisted of women who joined cancer support groups and the other were women who did not join any support groups. The results demonstrated that the women who joined a support group lived twice as long as the women who did not join a support group. Not only that, those women who joined a support group also reported a higher quality of living, including 50% less pain than those not in a support group.

When working with individuals dealing with trauma, many are so engaged in managing the energy of their basic survival - which can be observed in such behaviors as conflict, avoidance and isolation, and such emotional states as rage, anxiety and depression - that their ability to be present and available for meaningful relationships suffers. This means that the most primary survival response - tend and befriend - goes off-­‐line, leaving individuals vulnerable to further effects of trauma and chronic stress disorders.

When working with Somatic Experiencing, we are focused on the unresolved dysregulation of the brain and nervous system, those neuro-­‐circuits which became dysregulated through our incomplete responses to danger and threat. In other words, a life experience overwhelmed our capacity to cope, leaving our brain and bodies disorganized and unbalanced. For example, what if upon waking in the middle of the night to that noise downstairs, you register that a hurricane had hit your home. You survive the environmental assault on your home, but your body might have not returned to the balance you experienced before this event. Now every time you hear a loud noise, you startle, or maybe you've even lost your ability to fall asleep and sleep restfully throughout the night. Unbeknownst to you, your body might be frozen in that past experience, still stuck in an incomplete fight/flight state, thereby creating a dysregulated nervous system.

Understanding the avenues of resolving the fight, flight and freeze states is essential in effective trauma treatment, but I remind my students to be on the lookout for the disrupted tend and befriend states as well. My work centers around supporting people in social engagement. I recognize that without social connection - when tend and befriend are off-­‐line we miss out on the healing process this behavior promotes. Part of this healing is to return to the feeling of one's sense of self before a traumatic experience disrupted one's life. To many cultures, the loss of connection with others equates to the loss of one's self.

A memory comes to mind of sitting around a refugee camp in Asia with my Burmese friends, eating good food, laughing at our poor language skills, and singing along to the guitar playing Burmese freedom songs. I was moved by the moment and by

their inspiring resiliency. I was curious as to what techniques or rituals they had in their culture to help them deal with the unrelenting trauma of social oppression. So I asked my friends what helped them deal with the brutal trauma they were experiencing. They looked at me puzzled, and finally Ko Yee Zaw, a dear friend, said "this". Right in front of my eyes, between us there that evening, safety was being established and healing promoted. Despite the very best efforts from international organizations and providers to equip the Burmese people with the technical, medical and educational support they needed to survive, my friends recognized the inherent support they already had with them - social connection.

What I've learned since is that safety translates to biology, meaning that if we trigger states of well-­‐being through personal connection, we can promote both psychological and physical health. Amidst unspeakable acts of human and environmental destruction, what I discovered in the refugee camps of Southeast Asia and the parishes of southern Louisiana was that relationships might just be the best medicine.

Brad J Kammer, MA, MFT, SEP is a Psychotherapist, Somatic Experiencing Practitioner and Assistant Trainer, and has been involved in bringing SE to various communities and cultures. Brad lives and works in Ukiah, California, but also has a private practice in San Francisco. Brad is an adjunct psychology instructor at Mendocino College and National University. To contact Brad or learn more about his work and teaching: www.body-­mindtherapy.com.

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