The Meadows Blog

Monday, 19 March 2012 20:00

What Caused Sgt. Bales to Snap?

A group I facilitate for Vietnam Veterans struggled with this question even before the name of the accused sergeant was released. Violence, injury, death and war stir intense emotions in all, particularly among veterans who have been up close and personal. The issue of atrocity and slaughter of civilians is, naturally, an incredibly intense and sensitive subject.

My group members wrestled with this for 90 minutes; most had extreme empathy for the cumulative damage war has upon warriors. They could not even begin to grasp the immense pressure put upon younger soldiers, some of whom serve three, four, and up to nine tours. They/we are humbled by shocking reports of soldiers committing sudden violence, some of which is toward family, but more often towards self. They embraced the contributing factors that need be considered: alcoholism, traumatic brain injury, post traumatic stress disorder (PTSD), financial problems, issues of unemployment, possible relationship problems, a passed over promotion, an unwanted next tour, recent injury, and experiencing the wounding or killing of fellow warriors.

Reports indicated that Sgt. Bales was suffering from many of these factors; he was also reported to be highly decorated, a model soldier, and has saved lives of civilians and Americans in some of the hottest conflicts in Iraq. How could a highly trained soldier, a member of an elite unit, trained sniper and leader of men possibly commit such an atrocity? Our group struggled with this question and did not come to a clear explanation. They had empathy and contempt; some launched into politics of the current wars, some blamed the military for too many rotations, some defended the military, others discussed the role of combat, loss of recent friends, PTSD, alcohol, and tbi (traumatic brain injury). The discussions were intense and a few favored certain factors, but no consensus or full explanation was derived.

One thing we did derive: in certain situations our usual narratives fall apart. If the conditions are right, we are all capable of sudden violence or extreme behavior. The media will no doubt speculate on which factor(s) were critical in this current horror. Forensic experts will attempt to definitively opine, but we may never fully know why this particular soldier "snapped" in such a dramatic and horrific fashion. Thousands of soldiers carry the burdens of war. Most struggle in silence and harm no one, and if they do injure anyone, they hurt or punish themselves.

We may never know the full explanation of what went wrong. My personal speculation is that alcohol played a large factor. It is the most common variable in violence: domestic, self or toward others. It also works in tandem with PTSD and traumatic brain injury. What will probably emerge is a complex picture of a determined and accomplished soldier worn down by many variables, military and domestic. Early reports suggest Sgt. Bales and others were drinking heavily that evening, against military rules. Those early reports also suggested drinking to levels of blackout. Sgt. Bales allegedly had a drunk driving hit and run episode while stateside. Whereas not the sole factor, alcohol might have been the "tipping point". Alcohol is a common way of "self-medicating" or "de-stressing", but it can have an almost "evil" impact in unleashing primitive emotions. In fact, it is a common but often understated factor in the surging suicide numbers in young soldiers. Alcohol has a long history of violence in so many settings, especially the home. Unfortunately, we continue to deny alcohol's power or even its presence. Mr. Bale's attorney alleged his client had not been drinking.

We will know more as facts emerge, but we may never fully grasp what went wrong or why. We do know that war is ugly; it changes people and distorts mind, body and soul. The results of war can make you feel "untouchable" and unique. My hope is that veterans or military personnel reading this blog will recognize that their worst fears are not reflected in the rare disasters. Most people, even civilians, have a fear of "snapping". Exposure to the horrors of war intensify that fear beyond that which most observers can express or comprehend. The vast majority of those who develop PTSD do not snap. Instead, they suffer quietly and deconstruct their lives. PTSD, especially with co-occurring addiction, is complicated and destructive, but highly treatable. Recovery requires Sleep, Safety and Sobriety, the three "S's" that are the first steps in separating you from the demons of war.

Jerry Boriskin, Ph.D, 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 about The Meadows' innovative treatment program for PTSD and other disorders, see www.themeadows.com or call The Meadows at 800-244-4949.

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Parents of young addicts suffer the aftershocks of trauma long after the addict has entered REHAB and begun recovery. The Family Member PTSD Scale © Note1 which assesses family members of drug addicts for SHOCK, ISOLATION, VICTIMIZATION, SHAME, OVER-RESPONSIBILITY, LACK OF HOPE, and GRIEF, as well as for other symptoms of Post-Traumatic Stress Disorder (PTSD) or Complex Post-Traumatic Stress Disorder (C-PTSD), is the first tool to use when starting to work with families of addicts. The scale was designed to determine the degree of trauma and the residual effects that trauma has had on parents and siblings. There are stages of unresolved trauma which must be known before beginning family reconciliation.

Examples of some of the typical SHOCK questions on the scale that parents of addicts endorse include: "I am numb from dealing with the crisis of addiction" or "I am shut down emotionally and do not respond like I used to" or "I have flashbacks of incidents that happened in our family when we were dealing with active addiction" or "When the phone rings late at night, I sometimes still experience startle, fear and vivid memories."

Most families have some form of PTSD. A parent who found their child collapsed in the bed or bath nearly dead from an overdose, who experienced a surge of adrenalin to handle the emergency, and never processed the crisis, is frequently haunted by vivid recollection, and nightmares. The nightmares can last for years. For many parents, the long battle with trying to save their teenager's life has resulted in C-PTSD. C-PTSD was first described in 1992 by Judith Herman in her book Trauma & Recovery. It is a psychological injury that results from protracted exposure to prolonged interpersonal trauma with "loss of feeling in control", "disempowerment", or "feeling trapped," which parents suffer knowing they are responsible for underage children in grave danger. The key difference between PTSD and C-PTSD is the concept of "protracted exposure."

All previous family models for working with addiction have approached the family system from the point of view as if addiction began with adults and was passed down generationally. Today we are seeing a very high percentage of first-generation addicts, and the devastation to relatively normal parents when their children turn to drugs is incomprehensible. We have begun to work with families using a different model from the traditional model of family systems theorists of 20 years ago. Once the addict is admitted to REHAB, an immediate assessment for Post Traumatic Stress (PTS) of parents and siblings of these young addicts is begun. Some form of relief from the PTS symptoms is the most immediate need of family members. For some parents, the admonition to just "start working on your own issues" feels like a slap in the face. When the very first advice parents get from treatment center staff are things like "look at your enabling" or "look at your codependency" or "go find an ALANON group and work on your own stuff", some are offended and further traumatized by the lack of empathy for their current state of SHOCK.

"The most painful thing that we see parents dealing with," says April Lain, M.Ed, L.L.S.A.C, who has facilitated over 360 family workshop sessions integrating young adults back into their family of origin, "is the confusion of being told to disengage and leave the addict on their own - the concept of ALANON of "detach with love" is healthy but can be confusing. Parents are sometimes even made to feel guilty for continuing to seek help for their adult children who are caught in the grip of addiction, when intervention is required." She goes on to say, "I tell these parents not to feel guilty for seeking help. If you saw a stranger standing out on the ledge of a 14-story building about to jump off, wouldn't you at least call 911 and try to save their life? If you would do that for a stranger, why not for your own son or daughter who is standing on the proverbial window ledge and their life is in great danger from drug and alcohol use?" For parents who are in the trenches strategizing interventions, they are still on the battle ground. The adrenalin is still pumping. Lives are at stake.
The PTSD/C-PTSD approach to dealing with families is cutting-edge and compassionate. Without fail, along the way, the family members have suffered severe abuse from the addict. Abuse comes in several forms: Overt, Covert, Stealth, Structured, and Impulsive.

Overt abuse is clear-cut and easily recognizable and easy to describe. Cursing, name-calling, fighting, and verbal threats are overt and obvious. If your beloved son or daughter is standing in your kitchen threatening you with a knife, it is obviously abuse and is easily describable to others. If your teenager is throwing things or kicking holes in doors, you have evident visible damage. If you have bruises, broken lamps and you've started to put locks on your bedroom door out of fear, you are dealing with overt, tangible abuse.

On the other hand, covert abuse by an addict revolves around the addict's need to assert and maintain control over his/her parents or brothers and sisters. Covert abuse may not be visible to others such as to the non-custodial parent in divorced families, or with grandparents or schools and even police or coaches who continue to see the addict as charming. These "outsiders" will say, "Oh, you are making a big deal out of nothing." Or, "They will grow out of it, quit nagging them." Covert abuse is emotional and manipulative. It takes advantage of trust and costs parents their self esteem and confidence. Covert abuse is made all the more painful because others do not see the emotional damage - they only see a seemingly "crazy person" who is dealing with the aftermath of addiction.

Stealth abuse such as gaslighting is a form of abuse where the truth gets denied so often and so convincingly that the parent starts to believe they are going crazy. It is the deliberate use of false information to make others doubt his or her own reality, doubt their own memory, and not trust their own perceptions. (The term gaslighting comes from a 1944 film called "Gaslight" starring Ingrid Bergman. Her charming new husband deliberately attempts to drive her crazy, i.e., gaslighting.) Many parents report a feeling "like I was losing my mind".

Sometimes addicts manifest what is known as a patterned (or structured) abuse. That is someone who abuses everyone around them, not just parents but other children, friends, authority figures. The abuse is predictable- everyone gets a fair share. Other addicts are more unpredictable and impulsive with their abuse - they are nice at times and then they strike "out of the blue" in a flurry of chaos. One never knows when the rage fit will hit.

Bessel van der Kolk, in his "Assessing and Treatment of Complex PTSD" identified depression, lack of self worth, problems with intimacy, inability to experience pleasure, satisfaction, or to have fun, as symptoms of C-PTSD. There are no reliable statistics of the number of marriages that do not survive dealing with a child addict, but it appears it could be as high as 20 percent. It is complicated because other factors might have impacted the marriages. The emotional toll is very high on the family.

Drugs and alcohol have taken a foothold on our younger generations on an epidemic scale. Validating the stress that the families have endured is the first step for starting to work with the family. Helping the family to recognize the PTSD characteristics of their reactions, helping them to heal and finally, helping the addict to feel and show empathy for how the trauma has impacted those who love them- that is the work of a REHAB Family Counselor.

Bonnie A. DenDooven
dendooven7@gatehouseacademy.com

Bonnie A. DenDooven, MC, LAC, a family workshop therapist at Gatehouse Academy, is a former business owner-turned-therapist. The author of the MAWASI© for therapy and healing of financial disorders and work behaviors. She is a former primary and family counselor and assistant clinical director for Dr. Patrick Carnes at The Meadows. Bonnie was schooled in Gestalt therapy and is a member of Silvan Tomkins Institute of Affect Script Psychology, an advocate of Martin Seligman Positive Psychology, and a champion for the initiative for VIA Classification of Strengths and Virtues (jokingly referred to as the "un-DSM").

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Monday, 12 December 2011 19:00

Jerry Boriskin: Treating complex PTSD

The Meadows, America's premier center for the treatment of addiction and trauma, is pleased to present a 10-part video series featuring Dr. Jerry Boriskin discussing post-traumatic stress disorder and complex PTSD.

In the ninth installment of his 10-part series, Dr. Boriskin, psychologist and senior fellow at The Meadows, talks about treating the most complicated form of post-traumatic stress disorder, complex PTSD.

"Complex PTSD is not just an anxiety disorder; it's almost an otherworldly sort of experience," he says. "Everything changes, and you go into the equivalent of the 'Twilight Zone'."

Dr. Boriskin then talks about the need to demystify the disorder. Its power must be taken so the patient can be comfortable in the moment, instead of needing to flee or "disappear in plain sight."

"It's important to normalize, teach certain skills like breathing and centering, and work on the interpersonal and spiritual parts," Dr. Boriskin explains. "It sounds complicated, but it's really quite simple. It's doable by everyone with the right set of supports."

 

In other videos in the series, Dr. Boriskin discusses long-term treatment for complex PTSD, the relationship between addiction and complex PTSD, and evidence-based treatment methods for PTSD.

Jerry Boriskin, Ph.D, 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.

Other videos in The Meadows' series include interviews with leading experts in the mental health field, including John Bradshaw and Maureen Canning. View the videos at www.youtube.com/themeadowswickenburg.

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

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As part of its ongoing video series, The Meadows presents an 11-part interview with John Bradshaw, world-famous educator, counselor, motivational speaker, author, and leading figure in the fields of addiction and recovery.

In the ninth video of the series, Mr. Bradshaw praises his colleagues at The Meadows - the senior fellows and clinical advisors who have helped make it one of the nation's leading treatment centers for addiction and trauma.

"A treatment center is no better than the people doing the treatment," he says.

Mr. Bradshaw then addresses the important contributions to the treatment of trauma, PTSD, and sex addiction made by people including Pia Mellody, Peter Levine, Bessel van der Kolk, and Maureen Canning.

"We really have some stars, some excellent people," Mr. Bradshaw attests. "It's really a beautiful thing to be part of The Meadows."

He has enjoyed a long and mutually beneficial association with The Meadows, giving insights to staff and patients, speaking at alumni retreats, lecturing to mental health professionals at workshops and seminars, and helping to shape its cutting-edge treatment programs. In recognition of Mr. Bradshaw's contributions to addiction recovery, an on-campus lecture hall has been dedicated in his honor.

Identified as one of the most influential writers on emotional health in the 20th century, Mr. Bradshaw has changed the lives of millions of people around the world through his writings and sold-out workshops and seminars. His New York Times best-selling books include Homecoming: Reclaiming and Championing Your Inner Child, Creating Love, and Healing the Shame That Binds You.

To learn more about The Meadows' senior fellows and clinical staff, see (insert link here).  To view other videos in The Meadows’ series featuring interviews with Dr. Jerry Boriskin and Maureen Canning, visit www.youtube.com/themeadowswickenburg.

For more about The Meadows' innovative treatment program for addiction and trauma, see www.themeadows.org or call The Meadows at 800-244-4949.

Published in Blog

The Meadows, one of America's leading centers for the treatment of addiction and trauma, is pleased to present a 10-part video series featuring Dr. Jerry Boriskin discussing post-traumatic stress disorder and complex PTSD.

In the eighth installment of his 10-part series, Dr. Boriskin, psychologist and senior fellow at The Meadows, talks about contemporary treatment methods for PTSD and addiction.

"There is no magic bullet," he explains. "But over the years, we've gotten some proven techniques that work very well if introduced at the right time, in the hands of the right clinician, in the right clinical setting."

Dr. Boriskin speaks about some of those techniques - including EMDR, cognitive behavioral therapy, and somatic sensory processing - but warns that they by themselves are no panacea. One can't just apply them and expect everything to be automatically resolved, especially when dealing with the multidimensional aspects of complex PTSD, which require a more integrated treatment approach.

"If you just fix what's broken and don't deal with the spiritual injury and the interpersonal aspects, things are going to unravel."

Jerry Boriskin, Treating PTSD

In other videos, Dr. Boriskin discusses such topics as long-term treatment for complex PTSD and evidence-based treatment methods for PTSD.

Dr. Jerry Boriskin, Ph.D, 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.

Other videos in The Meadows' series include interviews with leading experts in the mental health field, including John Bradshaw and Maureen Canning. View all the videos in the series at www.youtube.com/themeadowswickenburg.

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

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