The Meadows, America's premier center for the treatment of addiction and trauma, is pleased to present a series of videos featuring Dr. Jerry Boriskin discussing post-traumatic stress disorder and complex PTSD.
In the second installment of this 10-part series, Dr. Boriskin, senior fellow at The Meadows and leading expert in the treatment of PTSD and co-occurring disorders, addresses the most complicated form of the disorder: complex PTSD.
"Essentially, complex PTSD is post-traumatic stress disorder that affects multiple dimensions of functioning," he explains, adding that complex PTSD can affect one's interpersonal relationships, spiritual system, perceptions, and even biology.
Other videos in this series focus on treating PTSD and co-occurring disorders, evidence-based treatment methods, and long-term treatment of PTSD.
Dr. Boriskin is an author, lecturer, and clinician with expertise in trauma, PTSD, and addictive disorders. He began his career in 1979, when PTSD emerged as a diagnosis. In the mid-1980s, he began working with sexual abuse survivors and addicts. An early advocate of extended care, he developed two extended-care residential treatment programs for co-occurring disorders. He authored PTSD and Addiction: A Practical Guide for Clinicians and Counselors and co-authored At Wit's End: What Families Need to Know When A Loved One is Diagnosed with Addiction and Mental Illness.
To view the videos in The Meadows series, see 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.
I have been working in the field of sexual compulsivity for almost twenty years and during that time I have seen a seen a shift in the attitudes and education of medical and clinical professions. For a long time sexual compulsivity was seen as an unsubstantiated disorder. It was not legitimized by clinical trials, research studies or even more profound, recognized in the Diagnostic and Statistical Manual of Mental Disorders. However, in recent years the attitudes and treatment is shifting both professionally and culturally. These changes are positive, but still I pause. I believe we can do better. Diagnosing and assessing sexual disorders is challenging. Not for the client whose behaviors are overt, having been caught with evidence in hand. This disorder can be a pattern of complex interactive behaviors that often leave the professional perplexed.
Or even more profound leave them believing they have a complete assessment of the subjective world of the addict. At The Meadows extended care treatment specifically for sexual disorders, Dakota we have seen clients, (mixed gender population) who were not diagnosed with sexual disorders. Fortunately skilled clinicians saw signs or red flags and were astute enough to refer them to Dakota.
Consider this case. A female patient came into primary care with the following presenting issues: depression, alcohol abuse, self-reported "flirting" while drinking. A skillful clinician was able to see the indicators of a sexual disorder. By the time the client discharged from extended care the clients list of sexual behaviors included; compulsive masturbation, masturbation to the point of injury, erotic literature, sexual fantasy, seductive role sex, Internet pornography including sado masochism and rape sites.
Consider the case of a 31-year-old female. Her presenting issues upon admit included; depression, Post Traumatic Stress Disorder and love addiction. After five weeks in extended care she had disclosed sexual behaviors including; working as a prostitute and stripper, seductive role sex, phone sex, affairs, anonymous sex (sex clubs and swinging), working as a dominatrix, use of urination and defecation for sexual arousal and sexually exploited by boss.
The same is true for men. This is especially true in cases where men have had same sex encounters but identify as heterosexual. The confusion and shame is so overwhelming they do not disclose, keeping it a secret. They may be willing to talk about a pornography stash or acting out with prostitutes but a complete sexual disclosure is something they are unwilling to risk.
As we all know in addiction, it is the secrets that kill. It is the shame associated with the secrets that compel the compulsive lying. It is vital that we as clinicians create a safe and healing environment for the client to unburden themselves with the truth.
I often say this work is not for the faint at heart. Sexual addiction can lead our clients into very dark, socially unacceptable behaviors that can be both shocking and disturbing. It is our responsibility as clinician to hold that safe place for our clients to heal.
This may seem like a rudimentary statement but consider the previous case; it is much easier and or comfortable to explore issues of love addiction then the dark and seedy reality of a client who views defecation as sexually gratifying.
I like the idea that it is my responsibility as a therapist to hold temporarily for the client the burden of this shame. I respectfully and skillfully urge the client to describe his or her shame and the behavior it has generated. The client hands it off to me for storage until that time in our therapy when I can hand it back to him or her for inspection. At that point, the client has grown able to appreciate that he or she is not endemically evil, but is the victim of abuse.
I am able to hold the shame, the anxious hope, whatever belief system, or whatever emotion the client is feeling, and say to this suffering and trusting person, "You know what? I believe you can work through this, and that you can and will become even more than you now believe is possible. And I will hold all the shame or other emotion for you while we are doing this work together."
What can make for successful interventions is becoming the solid ego state against which the wounded ego can collide, yet survive. I mirror for them the respect, understanding, and safety they have never known. The wounded part begins to heal. The therapist becomes the good parent. The client internalizes that identity. The healing takes place within the therapeutic relationship.
The goal of early treatment is to help clients trust that I respect them in their full humanity, even the darkest parts. I want them to understand that I can deal with their demons and find the healthy soul trapped within. This is the beginning of the healing.
THE KILLING OF BIN LADEN AND THE SEARCH FOR MEANING
"The scenes played out on TV and computer screens all across the nation - people spilling into the streets in jubilation over the news that Osama bin Laden had been captured and killed. Some recited the Pledge of Allegiance. Some sang the national anthem. Some clapped. Some cheered."
"For the majority of us, the impact of Sunday night's events will be positive, bringing relief and a form of closure, experts say. But for some of those who were personally touched by the 9/11 attacks, the news may result in a rekindling of symptoms and traumatic memories." (Linda Carroll: "Bin Laden's death may reignite PTSD for some," www.msnbc.msn.com/id/42867361/ns/health-mental_health/from/toolbar, May 3, 2011.)
Reactions to Bin Laden's death have varied from jubilation to reflection to a sense of justice; for some, it is a reliving of pain and PTSD. Some have commented negatively on the spontaneous outbursts of joy on Sunday evening. Most have experienced at least some, perhaps not visible, relief. The veterans I work with have almost universally expressed a sense of joy and relief. One Vietnam veteran expressed pride in the Navy Seals and joy for the younger veterans, but then articulated some envy: "We never really had a sense of closure, or that what we did had a positive ending." Another stated, "The end of the war for us was the evacuation of the Embassy in Saigon and the sight of helicopters being pushed overboard." One younger veteran simply said, "I feel like what we were doing over there had a purpose. We know now that what we did had some good." Another veteran cited all the bad news, questioning the mission, considering articles about warriors who kill themselves, and focusing on the criminal behavior by some soldiers in country or after returning home. The death of Bin Laden was clear, dramatic, sudden - a gift of good news in a society immersed in too much bad news and contention. Party lines evaporated, and a sense of justice, though transitory, was palpable across the nation.
I was reminded of a concept from the early days of treating PTSD: "sealing over." Sealing over puts violence into a meaningful perspective and provides a healthy container for emotional pain. It is the "welcome home" so coveted by returning soldiers. It refers to the gratitude and recognition we give to those who deliver justice or win a war. All the horror has a "seal" that helps the survivor move forward with a little less pain. Taking this concept further, we all search for meaning, especially in the face of loss, ambiguity, unfairness, death, and criminal wrongdoing. Yet, too often we have to accept ambiguity in terms of justice: prolonged trials, eluded capture, a lack of consequences for the perpetrators. Soldiers who have participated in the war on terror have not received a formal "sealing ritual"; however, even though it took almost 10 years, the televised outburst of elation this past Sunday evening made a contribution to the ritual.
Even more profound are the lessons from psychoanalyst and Holocaust survivor Victor Frankl. He taught us that we all seek a sense of future, meaning, justice, and purpose. What keeps us going is a yearning for ultimate clarity and meaning; we often need this in order to assume, envision, or trust in a future event. For some, this ultimate meaning might be determined by higher forces or a higher power. Frankl strongly asserted that we want and need to find meaning in suffering. When this happens, as it suddenly did on Sunday evening, most people rejoiced. Even if delayed, even if it lasts for just a fleeting moment, justice delivered swiftly and unambiguously provides a degree of the clarity and relief so desperately needed by those who suffer.
Jerry Boriskin, PHD
Jerry Boriskin is an author, lecturer, and clinician with expertise in trauma, PTSD, and addictive disorders. He began his career in 1979 when PTSD emerged as a diagnosis. In the mid-1980s, he began working with sexual abuse survivors and addicts.
Dr. Boriskin is 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 is a licensed psychologist and addiction specialist who recently resumed working with traumatized soldiers at the V.A. of Northern California.
He is the author of "PTSD and Addiction: A Practical Guide for Clinicians and Counselors" and co-authored "At Wit's End: What Families Need to Know When a Loved One is Diagnosed with Addiction and Mental Illness."
The Meadows, one of America's leading centers for the treatment of addiction and trauma, presents an ongoing series of videos featuring leading experts in the field of mental health, including Dr. Jerry Boriskin, Maureen Canning, and John Bradshaw, among others.
In the first installment of this series, Dr. Jerry Boriskin, senior fellow at The Meadows, introduces himself and discusses his 30-year career as a licensed psychologist and educator working in the fields of post-traumatic stress disorder (PTSD) and co-occurring addictive disorders. (Co-occurring disorders exist in an individual who has one or more addictive disorders and one or more psychiatric disorders.)
"My passion is teaching about how PTSD and addictions work together," he explains.
Dr. Boriskin is an author, lecturer, and clinician with expertise in treating trauma, PTSD, and addictive disorders. He was an early advocate for the use of extended care and has developed two extended residential treatment programs for co-occurring disorders. He has authored 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. He currently is working on a book focusing on Complex PTSD, the most complicated type of post-traumatic stress disorder. The working title is Dancing With Demons: Why People With Complicated Post-traumatic Stress Disorder Live in the Past, Dread the Future, and Live in the Moment.
"I think that title captures the essence of a lot of what I'm trying to teach," he says.
To view Dr. Boriskin's video - and other videos in the series - see 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.
"It's enough," said the 64-year old.... "Something has changed. The world feels strange now. Even the way the clouds move isn't right." (Excerpted from an article on the 7.1-magnitude aftershock in northeastern Japan, USA Today, April 8, 2011.)
Dissociation: Personal Transition in a Chaotic World
Traumatic events set off a chain reaction of biological, emotional, psychological, interpersonal, and spiritual changes that can disrupt your entire sense of self and how you view things going forward. When your world is shaken and you no longer feel safe, you can lose your sense of identity. The resulting shifts in perspective and perception can cause a disintegration of your baseline ego.
Survivors of traumatic events say things like:
"I was so frightened, I stopped feeling. It was like I reached a point where I didn't care anymore if I lived or died."
"Once I got through this and accepted my own death, my fear went away. I was able to get through."
"It is odd; I would look at myself, look at my hand, and it was like it was no longer attached. Everything shifted from three dimensions to two; it is like colors disappeared, yet everything was intense. I can't really describe it; I just went numb. I became disconnected from my body."
Such shifts in perspective and dimensionality are a core component of dissociation, which tends to follow in the wake of absolute fear or panic. Permitting one to detach from emotion, it can be very adaptive. For instance, it can help soldiers to act as a team and follow orders. In Vietnam, many soldiers would recite a simple chant while doing horrible tasks: "Just another day, no big thing...." This helped to desensitize them, reinforce dissociation, and establish the numbness required for survival.
Dissociation also permits emergency room personnel to disengage from the horrors they see and do their jobs. ER workers who are “in touch with their emotions” may not be able to act as efficiently in a crisis as a focused, emotionally dissociated team. Optimally, rescuers need to perform first and process their emotions later.
Soldiers, healers, and survivors encounter problems if they cannot reattach to their bodies or emotions after the intensity diminishes. If they remain in a state of constant arousal, it negatively affects their sense of balance, communication, self-awareness, and connection to loved ones. Once your core is shaken, it is difficult to resume a "normal" perspective. Everything feels different. On one hand, things that upset others might not set you off. New crises are familiar, almost expected; they may even be welcomed or become "the new normal." Survivors often adapt well to overload. They feel comfortable, perhaps even comforted, within new arenas of challenge or intensity. This, in part, is why so many soldiers devastated by war would enlist again if offered the option. They get used to functioning well at the edge; it almost becomes addictive.
Paradoxically, little things can cause overreaction. A partner's complaint about a failure to clean the kitchen, for example, might result in a temper tantrum, a fit of righteous indignation, or a violent clash. The big things become little, and the little things become big. The new normal is numbness, punctuated by fits of rage or terror. In this "fifth dimension," everything is scrambled. You are numb and detached; nothing hurts. It's "just another day, same old thing...." Yet everything is different - even the clouds.
Dr. Jerry Boriskin is a Senior Fellow at The Meadows. He is an author, lecturer, and clinician with expertise in trauma, PTSD, and addictive disorders. Dr. Boriskin is a licensed psychologist and addiction specialist who recently resumed working with traumatized soldiers at the V.A. of Northern California. He is the author of "PTSD and Addiction: A Practical Guide for Clinicians and Counselors" and co-authored "At Wit's End: What Families Need to Know When A Loved One is Diagnosed with Addiction and Mental Illness."