Recently John Bradshaw, Clinical Consultant for The Meadows, and author of three New York Times bestselling books including Homecoming: Reclaiming and Championing Your Inner Child; Creating Love; and Healing the Shame That Binds You, was quoted in an article on NBC's Ivillage with his thoughts about alcohol addiction. See http://www.ivillage.com/once-addict-always-train-wreck/4-a-296860
Note: This article was originally published in the Winter 2007 edition of MeadowLark, the magazine for The Meadows alumni.
Techniques for Managing Post-Traumatic Stress Disorder
By Lara Rosenberg
This article is based on a workshop that Lara gave February 13 - 14, 2006, in Sri Lanka hosted by the INGO RedR. The workshop is focused on staff working with individuals, families, and communities that have experienced or continue to experience traumatic events. It was an introductory workshop of particular value for staff having community experience, but limited or no psychological training. It was assumed that participants had prior knowledge of stress.
Stress affects us in many ways: cognitively, affectively, physiologically, and behaviorally. "Stress" is a broad term. It's part of all of our lives; each individual has his own ideas of how to define it. There are many definitions given to stress, but the important underlying factor is that stress results from a change in one's environment and requires an adjustment. The environmental changes that require us to adapt and adjust are known as "stressors" they can include anything out of the ordinary. Many think of stress as only negative, but it can be positive and necessary to our healthy development. The ways in which we adapt to our environments leave some stimulated and others with feelings of fear, nervousness, and confusion, which lead us to either solve or avoid a problem. Change always brings extra pressure, as individuals have to adapt to new circumstances.
Humans and animals are born with the capacity to react to threatening situations in adaptive ways; the "fight or flight response" allows individuals to experience resilience in response to danger. Bessel van der Kolk (1994) describes the fight response as hyper-arousal or protest and the flight response as freezing or numbing sensations, which allow individuals to avoid consciously experiencing the event.
Trauma is caused by a stressful occurrence "that is outside the range of usual human experience, and that would be markedly distressing to almost anyone" (Peter Levine, 1997). Post-traumatic stress disorder (PTSD) causes one to experience a prolonged or delayed reaction to an intensely stressful event. According to The DSM-IV Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition, PTSD occurs when an individual experiences a threat (actual or perceived) of death or serious injury to self or others with a response of "intense fear, helplessness, or horror." PTSD can occur in adults and children from all socio-economic backgrounds. Most people who are exposed to a traumatic, stressful event experience some symptoms of PTSD in the days and weeks following exposure. According to the National Center for PTSD, data suggest that approximately 8 percent of men and 20 percent of women exposed to trauma develop PTSD; of that group, 30 percent develop a chronic form that persists throughout their lifetimes.
The World Health Organization (WHO) states that the prevalence of mild and moderate common mental disorders in the general population is 10% and can increase to 20% after a disaster. As stated by Dr. Daya Somasundaram from the Department of Psychiatry at the University of Jaffna, Sri Lanka (WHO, 2005), "WHO estimated that 50% may have problems and 5-10% have serious problems needing treatment. One [non-WHO] survey found 40% post-traumatic stress disorder (PTSD) in children," referring to people in Sri Lanka. Other data suggest that the mental health burden in Sri Lanka is even higher. Dr. Roy Lubit (2006), as well as Pia Mellody, a pioneer on the effects of childhood trauma, stresses that the full impact of trauma may not be experienced until a child reaches adulthood, engages in adult relationships and responsibilities, and develops more sophisticated cognitive capabilities.
The National Center for PTSD states that one of every three disaster survivors experiences some or all of the severe stress symptoms that may lead to lasting PTSD, anxiety disorders, or depression. Severe stress symptoms are extreme attempts to avoid memories and feelings. In order to numb their emotional pain, individuals will stay unusually busy, withdraw, and exhibit addictive behaviors. Violent behaviors often become prevalent.
Individuals can experience severe depression as part of PTSD, suffering a complete loss of hope, self-worth, motivation, and purpose. Some might experience disassociation, feeling outside of oneself as if living in a dream, or may become vacant for periods of time. Intrusive re-experiencing can occur through terrifying memories, nightmares, or flashbacks. For some, hyper-arousal manifests in panic attacks, rage, extreme irritability, or intense agitation. Other manifestations include severe anxiety, paralyzing worry, extreme helplessness, obsessive and compulsive behaviors, and feeling responsible for the event. Children often re-experience traumatic or stressful events through recurrent memories, nightmares, and play. Some children become very aroused, exhibiting nervousness, irritability, anger, disorganization, or agitation. Children also shun thoughts, feelings, or places that evoke memories of the event. Occasionally, they experience a loss of developmental patterns or skills, separation anxiety, bed-wetting, and learning difficulties. An 8-year old boy in Sri Lanka could not see for 10 weeks after enduring the terrifying experience of the tsunami, in which he lost his mother and home. This example of physical impairment demonstrates the freezing response described by Bessel van der Kolk (1996), as well as Peter Levine (1997) in his Somatic Experiencing® work.
Disaster stress may revive memories of prior trauma; pre-existing social, economic, spiritual, psychological, or medical problems can intensify. Individuals at higher risk for severe stress symptoms and lasting PTSD include those who have been exposed to other traumas, such as abuse, assault, or combat. Chronic poverty, homelessness, unemployment, or discrimination will often intensify the traumatic event, as can chronic illness and psychological disorders.
Most likely to develop PTSD are those who experience stress at a greater intensity, with unpredictability, uncontrollability, and real or perceived responsibility. Factors such as genetics, early-onset and longer-lasting childhood trauma, lack of functional social support, and concurrent stressful life events also contribute to the disorder. Those who report a greater perceived threat, suffering, terror, and fear are at risk for developing PTSD, and a social environment that produces shame, guilt, stigmatization, or self-hatred can affect sufferers as well.
Individuals experiencing PTSD face an increased likelihood of co-occurring disorders such as alcohol/drug abuse and dependence, major depressive episodes, conduct disorders, and social phobias. According to the National Center for PTSD, "In a large-scale study, it was found that 88% of men and 79% of women with PTSD met the criteria for another psychiatric disorder." Some experience difficulty in their psychosocial functioning, with profound problems in their daily lives. Concurrent prevalent physical problems include headaches, dizziness, chest pain, and other aches and pains. Often medical doctors treat only the symptoms, without considering PSTD development.
At the same time, stressful or traumatic experiences can facilitate personal growth. In treating sufferers, it is most important to restore safety in their lives, build coping strategies, and reduce pain. It is necessary to find out how they are coping with the situation and stress. Healthy coping mechanisms should be slowly introduced if behavior patterns reflect unhealthy habits such as smoking, drinking, or staying unusually busy. When dealing with disclosure, it is important that a secure and confidential environment is maintained. Humanitarian aid workers should teach survivors of trauma that they are not alone in order to help reduce a sense of isolation and rebuild trust. The aid worker should acknowledge and validate the person's feelings and experiences by offering comfort and support.
Aid workers should assume people are doing their best to cope and should empower them to feel as in-control as possible. Victims should not be asked to reveal emotional information, but if they volunteer it, helpers should listen. Access to mental and physical health services should be provided. In addition to reducing anxiety and depression, valued and meaningful goals help individuals regain hope and purpose. Improved access to education and employment opportunities encourages achievement. It is important to restore individual dignity and value, create opportunities for pleasure, and foster connections by maintaining or re-establishing communication with family and the community. Expressing oneself through journaling, reading, or becoming aware of experiences helps to release stress. Eliminating self-blame for what is occurring allows people to grow. Relaxation methods such as walking, breathing, meditation, yoga, prayer, and listening to music also promote healing, as do self-care behaviors such as brushing teeth, showering, and taking care of one's living environment. Small goals should gradually lead to a focus on the big picture.
The majority of trauma survivors will prove resilient; their feelings of fear and anxiety, along with urges to avoid or relive the experience, will decrease over time. Everyone handles life experiences differently, and it is necessary to allow each individual to heal at his or her own pace. The experience will always be a part of this person's life; however, the possibility of growing from the experience becomes more attainable when anxiety is reduced.
The Meadows is proud to present its 2010 Annual Symposium from Wednesday, October 13 through Friday, October 15 at Hoffman Estate, Illinois. The Symposium will include presentations by Pia Mellody, Maureen Canning, MA, LMFT, John Bradshaw, MA, Bessel A. van der Kolk, MD, and Jerry A. Boriskin, PhD, CAS.
This dynamic event will feature the insights of the speakers as they share their philosophies, treatment techniques, and skills regarding such issues as trauma, addictions, relationships, healthy sexuality, codependence, spirituality, and family systems.
Interested persons can sign up for the entire event or may choose to attend the Wednesday evening lecture only. More information about the Symposium, including program session descriptions, a detailed schedule, and information about Continuing Education credits, is available at the Symposium page on The Meadows web site.
Note: This article originally appeared in the Spring 2004 edition of MeadowLark, the magazine for alumni of The Meadows.
Living Lives of Quiet Desperation
By Ben Barrentine Jr., MA, CAS
I was scared. I was lonely. I was a little boy. My father was a college professor. My mother was college educated. I have two younger brothers and a younger sister. We had plenty of food and clothes. We got birthday presents. Santa Claus came to see us. We were a very distant family, like ships passing in the night. We rarely hugged. We rarely expressed emotion. We rarely talked about what was going with us as individuals or as a family. I was scared. I was lonely.
I remember that, when I reached puberty, a neighbor boy showed me masturbation. I masturbated a lot. Now I wasn't so scared, and I wasn't so lonely. I found a magazine. It was just an ordinary magazine with a picture of a woman in a bikini. It became my first pornography. I wasn't so scared, and I wasn't so lonely. When I was a sophomore in high school, I started drinking and, from the beginning, I drank alcoholically. I wasn't so scared. I wasn't so lonely.
I masturbated a lot, and I found Playboy, Penthouse, and other porn magazines and books. I drank a lot. I started dating. I got into relationships. I wanted the women to make me happy. I looked at the women the way I looked at the women in the porn - as objects. I would fantasize and lust about the women I was dating in the same way I did the women in the porn magazines and books. After awhile. I could run the porn images in my head. and I no longer had to have the porn magazines and books. I drank a lot. I was scared. I was lonely.
I went to treatment for my alcoholism. When the staff discovered that I did cocaine and marijuana, they said I was a drug addict. I stopped drinking alcohol, but for the next two years, I continued to use cocaine and marijuana. I liked doing cocaine and marijuana with sex. It wasn't until many years later that I realized that it was my sex addiction that kept me in my drug addiction for another two years. I was scared. I was lonely.
With no awareness of my sexual addiction, I got into recovery for my drug addiction. I was still using sex-porn, lusting, looking at women as objects, masturbating lustfully. I was scared. I was lonely.
When I went to treatment for my sexual addiction, I began to get into recovery. I began to learn something about intimacy with myself and other people, not just women - men and women. I began to like myself and to discover who I was - my values, my interests. I began to connect with people on a more intimate level. I wasn't so scared. I wasn't so lonely.
As the facilitator of the "Men's Sexual Compulsivity Recovery Workshop," I have firsthand knowledge of recovery. I first developed this workshop some 10 years ago, before Patrick Carnes joined The Meadows. The workshop builds on the groundbreaking work of Patrick Carnes and Pia Mellody in the areas of sexual addiction and codependence, respectively.
Sexually compulsive people are caught up in sexual addiction: thoughts and behaviors, pornography, lusting, leering, fantasizing, anonymous sex, one-night stands, prostitution, affairs, simultaneous relationships, adult bookstores, etc. They are scared. They are lonely. They are in pain. They feel guilt. They feel shame. They are living lives of quiet desperation - empty on the inside, while on the outside, they may have all the trappings of success.
The "Men's Sexual Compulsivity Recovery Workshop" is an educational and experiential workshop. With a limit of six participants, the workshop is designed to promote changes in the lives of those suffering from sexually obsessive thinking and compulsive behaviors.
The workshop explores the cycles of addiction, recovery and relapse.
Individuals have an opportunity to explore their arousal templates - to discover and examine the events and experiences that caused them to act out sexually. They learn how to lead different lives, how to empower themselves in healthy ways. They learn to experience intimacy with the other men in the workshop. They develop a written recovery plan. They are not so scared. They are not so lonely.
Note: This article was originally published in the Spring 2004 issue of MeadowLark, the magazine for alumni of The Meadows.
Until You Can Love Yourself
By Lawrence S. Freunclich
At our first AA meeting, many of us were so sick and hungover that the most we could hope for was to sit still for an hour without crying or throwing up. That last culminating drunk had wiped us out. We needed help, but we were as frightened of asking for it as we were of another drink. We huddled in against ourselves and tried to disappear. The friendly gestures and words of welcome sounded false to us, and we thought we were among naïve dogooders, or perhaps religious fanatics who had lost contact with reality. We felt we were special; and we were humiliated to be associated with a group of losers, who, unlike us, were just a bunch of common drunks. We felt we would never be able to make them understand what made our own stories so special. We didn't know where to rest our eyes or what to do with our hands. Each time someone shared, we took it personally, as if each remark were aimed directly at us. We wanted to interrupt to show how much we knew, of how different we were. We wanted everyone to understand how we had been wronged. Most of us, however, were too frail to speak.
During our first 30 days of meetings, if someone said how grateful she was for the peace and hope that sobriety had given her, we thought that only a person with a shallow understanding of life could be so easily sedated by the homilies of AA. If someone expressed his rage, we grew frightened, feeling as if his energy were somehow a direct personal threat to us. If someone told us how they got drunk at the business meeting, we belittled his exploits because we had done so much worse. If someone shared that she hated people who shared petty annoyances, we thought she was talking about us. If someone expressed her gratitude for having gone from bankruptcy to wealth, not only did we think her a braggart, but we felt the hot humiliation of our own awful financial desperation and how we had failed our loved ones. Some of us attended meetings and never raised our hand. Others of us, when we finally talked, couldn't shut up, as if we had to tell the world our whole story in one breath. No matter what we said, we felt that we had made fools of ourselves or, worse, that no one in the group could possibly understand us.
Yet we always felt like phonies. In this early stage of our AA solitary confinement, we were in the soul-mangling grip of what AA calls "self-centered fear." When we learned more about self-centered fear, we would hear ourselves described as "arrogant doormats" or "that piece of garbage around which the entire universe revolved." We felt that all eyes were on us, that we were in a play with a large cast - but the spotlight was on us only, and that the characters we were portraying were worthless and had to deny it. We were obsessed with people we despised, and those people were ourselves. As the weeks went by and somehow "we kept coming back" "one day at a time," because we had "smart feet" and went to meetings "even if our ass fell off," we recognized that not only did we have self-centered fear, but that every other addict in the room did as well.
Something startling - and for many of us, unprecedented - had been taking place. For the first time in many years, or perhaps for the first time in our entire lives, we had been learning to listen - learning to listen to something other than the voices in our own heads. We didn't know it, but our world was beginning to get a little larger. No cross talk! What a challenge. With listening came identification. With identification came emotional bonding; we came to see that the other addicts in the room had gone through the same kind of hell we had. They had gotten just as sick, lost just as much money, offended their loved ones, crashed cars, told embarrassingly bad lies and cursed God.
These commonalities began to fascinate us, and our attention was diverted from ourselves to others. We were becoming less self centered. As the reality and similarity of our colleagues sunk into our hearts and minds, we began to see that our stories were not unique and that other people could understand what we had been through. Even when a share made us angry or contemptuous, we sat still and let the person have his say. It was all right for them to show their imperfections; after all, they were only human. And if they were only human, it was easier to admit that we were only human. This was a spiritual breakthrough for us. Surrendering to the truth of our own humanity was a key spiritual gift. For us alcoholics, our imperfection had always been experienced as shame; it had made us allergic to our own humanity and forced us into emotional adaptations aimed at denying our imperfection.
Until that breakthrough moment in AA, we had never believed that anyone could love us if they knew the truth of who we were. "Hide that truth at any cost," our alcoholic brains screamed out to us. Drown it in booze and lies. Some of us mocked the homilies of AA that were tacked up on the walls of the meeting room, sayings like, "Stinkin" Thinkin,";" "Put a Plug in the Jug," "Let Go and Let God," and "We row; God steers." But even we mockers found our eyes continually drawn back to one motto, which never seemed to go stale. It was the sign that said, "We Will Love You Until You Can Love Yourself."
When we celebrated our 90 days, we felt blessed by what AA had so far done for us. We felt as if we had rejoined the community of man, and now we thought we understood what the old-timers were talking about when they said that AA "was a we program." We had a fledgling faith - or if it wasn't yet faith, we dared hope that the love of our fellow AAs could give us the self-esteem that our addiction had destroyed. If we kept coming to meetings, we would experience the loving that we were not yet capable of believing we deserved.
And, for many of us, the support of our AA colleagues kept us sober for years. We saw our lives improve. We saw that, if we stayed sober and practiced the principles of AA in all of our affairs, our relationships matured and we found the strength to survive the rough patches of life: things like losing our jobs, divorce and the refusal of the children we had abused to forgive us. We found the patience to deal with people at the job who annoyed us.
During our years in AA, many of our friends had gone back to drinking. Some died; some we never heard of again. Some came back into the room and reported that the hell in store for the recidivist was there for the taking. They added, "The misery is optional." Many of us believed what we had heard about the misery being optional. Despite the fact that we continued to go to meetings, we could feel, after 5, 10, 15 years, the alcoholic demons beginning to rise up within us again. We felt that the AA program had done us good, and we were grateful for it. But there were parts of us that remained in pain and refused to be medicated by the traditions, steps and people of AA. For us, the inevitable occurred. We joined the ranks of the slippers. And, sure enough, we discovered the misery we had been told awaited us.
As we began the arduous and humiliating process of "coming back" (and some of us would do it several times), some of us were overtaken by a sense of alcoholic doom. We became convinced that, even with AA's constant offer of forgiveness, understanding and guidance, that a part of us was too damaged to heal. Even if we couldn't be precise about it, the promise that "We will love you until you learn to love yourself" was for us a nice thought, but a beneficent fantasy.
What we did not know was that the abuse our caregivers had inflicted on us in childhood had so damaged our awareness of our inherent worth that any promise of love stirred up post traumatic associations. The promise that our colleagues in AA would love us until we learned to love ourselves was offered in tenderness and compassion, but we were hard-wired to reject it. It sounded to us just like our parents. People like us would slip and slide until they wound up where AA had predicted: in jail, dead or in a mental institution.
The only kind of love that was going to work for people like us needed to come from caregivers who were trained to discover the etiology of our abusive childhoods - and who, when our trauma histories were clear to us, could teach us the practice of boundaries so we could protect ourselves from the posttraumatic stress that triggered our alcoholism and relational dysfunction.
Our caregivers had to be healthy themselves. We would not be cured if they came at us from a position of superiority. That would plunge us back into childhood. To the extent that their own trauma histories escaped the containment of healthy boundaries, our caregivers would infect us with their own dysfunctions.
When people like us came to The Meadows, most of us desperate and without a clue that we had at last come home, we had no idea how lucky we were. We were finally at a place where we could love ourselves, and because we could, we also could love others. For those of us who still loved and valued AA, because we, at long last, had a spiritual awakening, we felt the personal responsibility to carry this message to the suffering alcoholic.