The Meadows Blog

Dr. Shelley Uram on Explicit and Implicit Memories

One of America's most respected centers for treating trauma and addiction, The Meadows presents a 16-part video series, viewable on YouTube, in which Dr. Shelley Uram addresses topics ranging from family dysfunction to the benefits of Somatic Experiencing.

In the installment titled "Explicit and Implicit Memories," Dr. Uram - a psychologist and senior fellow at The Meadows - discusses the complex relationship between psychological trauma and memory. She communicates key points through the use of visual aids, audience participation, and anecdotes from her childhood.

In other videos in this series, Dr. Uram shares her expertise on trauma triggers, addiction, and the effects of emotional trauma on brain development.
Shelley Uram, M.D., is a Harvard-trained, triple board-certified psychiatrist who speaks nationally and internationally on the brain's survival wiring - and how it can interfere with modern life. As a senior fellow at The Meadows, Dr. Uram conducts patient lectures and trains staff members. She also serves as a clinical associate professor of psychiatry at The University of Arizona College of Medicine, and she treats patients in her Phoenix office.

The Meadows' video series includes interviews with other prominent figures in the mental health field, including John Bradshaw and Maureen Canning; see  To learn more about The Meadows' innovative treatment program for PTSD and other disorders, visit or call 800-244-4949.

The Meadows is a sponsor of the Wickenburg High School Safe and Sober Senior Grad Night Party that is being held on Friday, May 25 at the high school cafeteria. The Safe and Sober Senior Grad Night Party was started to create an alcohol and drug free, safe environment for the students to celebrate after the high school graduation ceremony.

According to the National Highway Traffic Safety Administration, in 2005 during prom and grad season (April, May, June), 676 students under the age of 21 were killed in alcohol-related traffic accidents. One third of the alcohol-related fatalities involving teens each year occur during those months.

"We are very pleased to support the Safe and Sober Senior Grad Night Party," said Jim Dredge, the CEO of The Meadows. "We applaud the efforts of both the Wickenburg High School and the parents in focusing on the safety of the students while providing a memorable event."

Jackie Jacobson, Principal of Wickenburg High School, said that the Safe and Sober Senior Grand Night Party is a tradition at their school that the parents take very seriously as they plan and execute the entire event. "The objective is to keep the students safe and make sure they're not in the desert or at someone's house making very poor choices," commented Jacobson. "The event has been wildly successful with a 90% attendance rate."

Sergeant Owen Black of the Wickenburg Police Department said that while the police provide outside security at the party, they take a very small role as it is managed by the senior class parents. "It's an amazing thing that they do. It provides a safe environment for the kids to celebrate where there are no drugs or alcohol," expressed Sergeant Black. He commented that during the time the safe and sober format began, which he thinks was in 1984, he is not aware of any major incident from a drug-related issue at graduation.

The party goes all night from 10:00pm to 4:00am with prizes and activities, including a money machine where students spend a few minutes trying to catch money floating in the air. The parents monitor the comings and goings of every student, taking their keys and having them sign in and out. The gifts are distributed at the end of the event as an incentive for the students to remain at the party.

The organizer of the Safe and Sober Senior Grad Night Party, Annette Roberts, said that all students leave with a gift. This year there are approximately 170 students. In the past, the parent committee would buy televisions, computers, anything that the students could use for college. "This year may be a little different with more students participating, along with the economic conditions," said Roberts. "With more graduates, it's harder to buy gifts."

The parent committee will accept donations through May 25. Last year, according to Roberts, $18,000 was raised. At present, the committee has raised $8,000 through various fundraising events. For more information on how to donate to the Safe and Sober Senior Grad Night Party, please contact Annette Roberts at 928.671.0312 or Lori Hancock at 928.684.9434.

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

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 centers or 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 psychiatric hospital that is accredited by the Joint Commission.

How many significant figures of history actually suffered with PTSD? We may never know. The diagnosis, now part of our collective 21st century lexicon, did not exist before 1980. Many historians point to the Civil War with the description of Soldier's Heart as the earliest attempt to describe emotional consequences of war. Jonathan Shay wrote about warriors from Greece who incurred the invisible injuries we now diagnose as PTSD. The earliest medical descriptions of PTSD started in the 1830s during the early era of railroads. Numerous collisions and explosions resulted in a condition called "Railway Spine", something akin to mild traumatic brain injury at first, but later described as a psychiatric condition consistent with PTSD.

Did Clara Barton suffer with PTSD? On the basis of Melinda Henninberg's article, (, I would say it was quite likely. More importantly, what can we learn from Clara Barton's rather extraordinary life? I think there are many lessons applicable to modern observers:

  • Her childhood was filled with fear. She grew up in a chaotic and likely violent family. The article describes pervasive and dramatic mental illness, a sister locked away and a brother who committed suicide; another brother robbed banks. As noted in her diary: "In these later years I have observed that writers of sketches, in a friendly desire to compliment me, have been wont to dwell upon my courage, representing me as personally devoid of fear, not even knowing the feeling. However correct that may have become, it is evident I was not constructed that way, as in the earlier years of my life I remember nothing but fear."

Does growing up in a dysfunctional family better prepare you to survive during war, chaos and/or insanity? There is no absolute answer to this question, but a dysfunctional family may actually help you endure the unmanageable. No exotic constructs needed here; if you grew up having to dissociate to survive, you may simply have "more practice"- the equivalent of early military training. Conversely, some individuals are less prepared for chaos if they grew up in a "crazy" family. A lot depends upon context, types of stressors, etc.

My personal observation is that a dysfunctional family background may make you stronger during a crisis, but in the long term it might make recovery, or at least a balanced recovery, much more difficult. Early studies conducted at the University of Minnesota described a population of "invulnerable children". These were kids who grew up with schizophrenic and alcoholic parents but did not have overt problems as adults. In fact, many were highly adaptive and showed no signs of outward difficulty. When this population was studied more closely, researchers learned that outward coping masked many harsh consequences. They later gave up their quest and decided "invulnerable" was a flawed concept. On the flip side, growing up in a safe and nurturing family is no guarantee you will not develop harsh symptoms. We need to consider multiple variables- including frequency of exposure to trauma, intensity of the trauma, duration of the trauma and age of exposure. Invulnerability is a seductive illusion, but even those who look intact may endure severe suffering.

  • Clara Barton's father may have had PTSD. This may be mere speculation, but as noted in the article: "Her father, Capt. Stephen Barton, had served under "Mad Anthony" Wayne in the French and Indian War, and "his soldier habits and tastes never left him," she wrote. He and Barton's mother, Sarah, "... fought loudly and often." It is not unusual to see multi-generational trauma transmission. This is something rarely studied but worthy of serious consideration. When PTSD rates in current and past wars are sited, we really should include the family unit. Like so many conditions, PTSD becomes a family problem. Nihilism, cynicism, anger and emotional unavailability are features we often see. Overt family violence is not necessarily an outcome. In fact, emotional distance and avoidance is what we most commonly see, along with intermittent outbursts of anger, often directed at others (road rage is a common phenomenon). The likelihood of physical violence seems directly related to the use or non-use of alcohol and other drugs.
  • Clara may have also struggled with the bipolar disorder, a condition that is now known to have strong genetic foundations. Clara's brother committed suicide and her mother displayed possible features consistent with a mood disorder. Kay Jamison excellent book, Touched with Fire describes many figures of history, including Churchill, Lincoln and Hemmingway who probably suffered with the bipolar illness, often mistaken for simple depression. The swings of mood Clara described followed by fits of amazing endurance fit with patterns observed with the bipolar illness. In addition, risk of suicide is also much, much higher with those who so suffer. It is important to note that the bipolar condition increases risk for alcoholism and addictive disorders. It also increases risk for suicide, and the depth of depression is far in excess of situational depressions. Making this more exotic is the fact that PTSD also mirrors the extreme swings in mood we see with PTSD. Emotions and impulse rule, and dramatic shifts are quite common. Finally, alcoholism mimics the swings in mood observed in PTSD and Bipolar Disorder. And one more addition to this complexity: mild brain trauma (mTBI) mimics symptoms of PTSD, mood disorder and alcoholism. The bottom line for readers and diagnosticians: many of these conditions travel the same path and are hard to differentiate, even in the modern era.
  • She likely had problems with trust, attachment and relationships. Not much detail is provided in the article, but Clara never married. Out of the thousands of young men and officers she encountered, she fell in love with a married Union captain who was already married. I cannot speculate as to her actual attachment pattern, but I can say that individuals with early childhood trauma tend to avoid attachments with those who are available and loving, and too often chase the impossible or abusive partner. More of this will be reviewed in subsequent blogs, but for now, problems with core attachments and "recapitulation" of childhood rejection is an almost classic consequence.
  • Working with those injured or dying can produce PTSD. Originally, it was believed that in order to develop PTSD you had to have first-hand exposure to death and violence. If a bullet or rocket did not come toward you, how could you possibly develop PTSD? We now know that direct violence is sufficient but not necessary in the development of PTSD. Many studies show that those who clean up the aftermath of train wrecks, car crashes and fires have a high rate of PTSD. In fact, medics, nurses and physicians have very high rates of PTSD. It is a core principle we now accept: being witness to or part of the aftermath of violence can be as toxic as direct exposure to violence. Those who prepare or transport the dead are also vulnerable, even if they never heard a weapon fired in combat.
  • She found meaning and relief in her work. This is perhaps the most valuable lesson we can discern. As noted in the article "Her diaries (later discovered behind the wall in her former Glen Echo home, now a national historic site) reveal that she self-medicated through service: She used the most intense, bloody work imaginable to keep the "thin black snakes" of sadness from closing in." While sited in the article as an antidote to depression, Clara's dedication to helping others - at first her brother and later countless others - is a great example of "giving back" as a method of healing. I refer the reader to Victor Frankl for a more complete discussion of this potent factor in human survival and transcendence. Finding meaning by helping others is exceptionally effective, but Clara's story demonstrates another vital lesson. Any single strategy applied in excess may leave you exhausted, alone and struggling in isolation. As with all healing factors, helping others and finding meaning should be done as part of the journey of finding or rediscovering balance- emotionally, interpersonally, cognitively and in terms of meaningful action. Even good work can become excessive, unbalanced and perhaps shift from "self-medication", as noted by Clara, to a near addictive pattern depriving you of the satisfaction and balance originally displaced by exposure to trauma.

Clara Barton, the founder of the Red Cross, and her struggle with the "black snakes" of depression, illustrates the complex consequences of exposure to and immersion in trauma. While she lacked comprehension to describe the extent of her suffering, her self-described "depression" was insufficient in capturing the multiple and complex symptoms of what we would now call PTSD and co-occurring disorders. Ironically, Clara Barton"s symptoms propelled her into an excessive, perhaps addictive attraction to violence and war, providing her partial relief and affording comfort and relief to millions as well.

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

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

The Meadows is pleased to announce a contract with TriWest Healthcare Alliance, a sub-contractor of TRICARE health program. Under this agreement, The Meadows has become an approved TriWest provider for behavioral health and substance abuse inpatient services to eligible beneficiaries.

The TriWest Healthcare Alliance is contracted with the Department of Defense to administer the TRICARE West Region program in the 21-state region. As an approved TriWest provider, The Meadows' inpatient substance abuse and psychiatric services are now available to nearly 2.9 million military members, retirees and their families. The convenient location of The Meadows, just 1.5 hours north of the Phoenix airport, offers easy accessibility to soldiers and their families. This could prove to be extremely beneficial to beneficiaries associated with the seven military bases located in the state of Arizona.

"We are confident that the impeccable reputation of The Meadows combined with our breathtaking campus and state-of-the-art treatment was a critical factor in choosing The Meadows as a network provider," stated Jim Dredge, CEO of The Meadows. "The Meadows has a commitment to servicing our heroes. We have enormous gratitude to those who protect and defend our freedom. It is a great honor to be a network provider for active duty, families and retired enrollees of the TriWest program."

According to Dr. Jerry Boriskin, a Senior Fellow at The Meadows and a consulting expert to the Veterans Administration, this contract is significant because there is a benefit to having as many options available in the various sectors due to the need for occasionally higher levels of care.

Dr. Boriskin, who has worked with the veteran population for 30 years, commented that "The core challenge is to get the veteran or the civilian, for that matter, to work on acceptance, forgiveness, and most importantly self-forgiveness because things were out of control and they were horrible."

Dr. Stephen Brockway, Chief of Psychiatry at The Meadows, explains that treatment for the veteran allows a move to take place from "It's me against the world" to "There are others like me" to "I'm part of the community again."

To learn more about The Meadows' work with trauma and addiction contact an intake coordinator at (866) 856-1279 or visit

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 or 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 psychiatric hospital that is accredited by the Joint Commission.

John Bradshaw, one of the most influential writers on emotional healing in the twentieth century and a Senior Fellow at The Meadows Wickenburg, will give an intensive workshop titled "Homecoming: Reclaiming Your Inner Child" in Mansfield, MA on Saturday May 19 from 8:30am-5:00pm and Sunday May 20 from 8:30am-4:00pm at The Holiday Inn Hampshire Street. The workshop is open to the general public.

Bradshaw is a world-famous educator, counselor, motivational speaker, television personality, author and one of the leading figures in the fields of addiction, recovery, family systems and the concept of toxic shame. Bradshaw has had a long and productive association with The Meadows- giving insights to staff, patients, speaking at alumni retreats and lecturing to mental health professionals at our workshops and seminars. Mr. Bradshaw's work has influenced the treatment programs at The Meadows and Mellody House.

Selected by his peers as one of the 100 most influential writers on emotional health in the 20th Century, Bradshaw has literally changed the lives of millions of people around the globe through his best-selling books and sold-out workshops and seminars. Over the years, Bradshaw has written several New York Times bestselling books, including, Homecoming: Reclaiming and Championing Your Inner Child, Creating Love and Healing the Shame That Binds You. In 2009 Bradshaw was nominated for The Pulitzer Prize for

"Three things are striking about inner child work," said John Bradshaw. "The speed with which people change when they do this work; the depth of the power and creativity that result when the wounds from the past are healed."

Event Information:

  • Saturday May 19, 8:30am-5:00pm and Sunday May 20, 8:30am-4:00pm
  • Cost: $175 before April 30 (group and student discounts available)
  • Holiday Inn, 31 Hampshire Street, Mansfield, MA
  • 12 CEU's approved
  • Register online

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

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 or 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 is a Level 1 psychiatric hospital that is accredited by the Joint Commission.

The Meadows is pleased to announce that Sean Walsh has joined The Meadows as Executive Director. An extensive search was conducted to find a leader that would honor the trauma and addiction treatment work that is done at The Meadows.

For the last 16 years Walsh has committed his work towards giving back and helping people heal, including positions as CEO and COO for two treatment programs. Prior to his executive leadership roles, Sean has worked in several clinical service and leadership positions, including launching two successful programs specifically designed to meet the unique needs of young adults. Walsh retains a post as an adjunct faculty member at Rio Salado College in Tempe, Arizona, teaching two different chemical dependency seminars on street drugs and adolescent substance abuse. His industry experience and passion for the field make him uniquely qualified to assume day-to-day leadership of The Meadows Wickenburg campus and improve The Meadows services to meet the growing demand from the young adult patient population.

"Sean is the right person for this position because of his experience, clinical expertise and personal passion to lead a quality organization that is committed to changing lives," said Jim Dredge, The Meadows CEO.

Dredge created the Executive Director position to allow him to focus time and attention to the growth plans for The Meadows organization. Dredge is excited to expand the continuum of services offered from The Meadows so that they can reach more people in need of the healing solutions offered from The Meadows Model. Dredge will continue to have an office on the Wickenburg campus and at the Phoenix business office. He and Walsh will work closely together during the transition period.

Walsh has long admired the reputation of excellence enjoyed by The Meadows and actively sought training at the workshops and events hosted by The Meadows in the Phoenix area. "I came to The Meadows because the reputation and work at The Meadows is world class and it is an honor to join this team of skilled practitioners," Walsh said.

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

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 centers or 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 is a Level 1 psychiatric hospital that is accredited by the Joint Commission.

Recovery programs are replete with catchy little quotes and sage-like sayings, but perhaps none of them are used more often than the time-honored phrase: "One day at a time." Have you ever wondered why people struggling with addictive behaviors find it necessary to remind each other to take recovery one day at a time? (Some go as far as saying: "One moment at time." Wouldn't it make more sense to actually use our highly evolved neocortex to construct a comprehensive, future-oriented plan for recovery and healing? After all, how can a person reach a desired destination or accomplish a goal without considering several days, weeks, or even years at a time?

As it turns out, people recovering from addiction aren't the only ones who need to be reminded to take life one moment at a time. By in large, modern humans are addicted to "future-tripping" (one of those catchy little terms used in our recovery program). Most of us spend large swaths of our days, stuck in our thoughts, trying to plan, control, and manage our lives. The human brain naturally fixates on what is wrong, both in ourselves and others, and then ruminates and perseverates on how to avoid the unpleasant what-ifs that haven't yet materialized. This unrelenting mental chatter is often coupled with a pervasive sense of discontent, as if we are waiting for something else to happen so that we can finally be fulfilled. We habitually lean into the future, hoping that the next moment will contain what this moment does not.

This is not to say that we should all get lobotomies and retreat to the nearest cave to live in solitary present-momentness. After all, critical thinking and future planning are important survival skills in this complex, fast-paced world. Our rational, thinking mind is not the enemy, but if left untrained, it can be a demanding taskmaster instead of a loyal servant. Through various contemplative practices, we discover that the brain is also capable of deep, non-conceptual awareness of the mind and body, other living creatures (including people), and the natural world around us. Many have found that this present-moment awareness can bring a profound sense of contentment and joy.

Here are 3 suggestions for living in the present moment:

1. Intention Cultivate a sincere intention to wake-up from the hypnotic hum of our racing minds and to rest in the natural reality of the present moment. Consider making this intention part of a daily meditation, prayer, mantra, affirmation, shower routine, morning commute, etc. The strong conditioning to mentally trip into the future requires that we bring a sincere intention to live one moment at a time.

2. Pause: Like a wheel in the wind, the mind will spin and spin if we don't help it to pause. Take a deep breath... pause... and drop into the present moment. At times, our lives can seem like an unpunctuated page of words, all jumbled together in a meaningless run-on sentence. Pausing allows us to punctuate our experience, put some clear space around our thoughts and emotions, and make sense of the life that is right here.

3. Stay: Like a good retriever, the mind can be trained to stay. There is a habitual tendency to move away from the here-and-now, often because we are uneasy with what we find in the now and/or we desire something different than what is right here. However, if we can learn to stay with the raw reality of the present moment, we tap into an ocean of awareness that can allow for the various waves of our moment-to-moment experience.

Living one day or one moment at a time is an important part of recovery, and life more generally, because the fullness of this impermanent life unfolds dynamically in the present moment. Tripping into a future that we can't control means that we miss out on the authentic, singular experience of our own life. Fostering awareness of our moment-to-moment experience enriches our emotional understanding, deepens intimacy with others, and connects us to something bigger than our best thought-out plans for the future. Whenever we can free ourselves of the incessant urge to plan and manage our lives, we open to the mystery and wonder of living in the present moment.

Already Here

All that we yearn for is already here.

Right now, right here.

In the unconditional awareness of what is,

we find a deep blue ocean

into which all rivers flow.

Endlessly reaching downstream,

eyes fixed to the hazy horizon,

we miss the wonder and mystery

of life's currents all around us.

Insatiable desire for something more,

grasping at fading twilight,

our hands remain empty,

our hearts closed.

Look inside, we are already here.

-poem by Jon G. Caldwell

The Meadows hosted a Free Recovery Lecture Series on April 17th in London at the Radisson Edwardian Vanderbilt Hotel. Presenters Barbara Pawson and Chris John gave a brilliant presentation on Healthy(re)parenting: It all starts with me! The lecture defined how through adverse childhood events and hidden trauma we have learned debilitating ways to parent ourselves and how damaging it can be on our adult relationships. Using The Meadows Model, Barbara and Chris provided insight on how to "Re parent" ourselves in Healthy ways.

Barbara Pawson is an accredited addiction counselor and highly regarded clinical supervisor. Barbara is also a lecturer at the London South Bank University and has been a consultant for the implementation of programs in Britain, Belgium and Holland.

Chris John is a qualified integrative therapeutic counselor who works with individuals, couples and groups. Chris runs a successful private practice helping his clients deal with a range of issues including, anxiety, somatization, trauma and addictive disorders as well as co-dependency.

John Graham, an attendee at the lecture, shared the following:

"I am a therapeutic counselor working with traumatized individuals who use substance abuse and behavioral process as a compensatory coping mechanism resulting in active addiction and the impact the addiction has on their self-esteem causes a vicious circle which is difficult to deal with.

However, the topic that was explored at the Meadows London Free Lecture recently - Self-Parenting - was delivered by the presenters in a humane manner within the Meadows Model and Pia Mellody's work was the primary focus that allowed me to further recognize the value of the establishment within a residential structured setting of personal boundaries for individuals compromised by the trauma they struggle with, and the self-parenting focus is most meaningful, allowing individuals to give themselves permission to be kind to themselves, which starts a chain reaction that effectively replaces the vicious circle of cruel active addiction."

A special thanks to Barbara and Chris for their time in delivering an insightful presentation. Their passion, enthusiasm and dedication are very much appreciated.

In my third year of medical school, I was mentored by a brilliant surgeon who routinely pontificated about the virtues of his profession, with clear intent to dissuade me from entering psychiatry. On one such occasion, he disrupted my tense and halting approach at a long abdominal incision with the question: "Do you know what makes a surgeon great?" I looked up from the patient's pale, still body - scalpel still poised. "It's not the suturing; you can teach any monkey how to sew." (That didn't boost my fledgling surgical confidence.) He went on to say, "When you open someone up, it rarely looks like the textbook. It's messy, unpredictable. Great surgeons effectively respond to each new situation as it arises... they adapt."

Although this gifted surgeon didn't dissuade me from the practice of psychiatry, I was persuaded to believe that effective treatment of the body and the mind requires an ability to adapt to each new situation as it arises. Most people enter The Meadows with some idea of their underlying problems and what they want to accomplish in treatment. However, as people give themselves to the recovery process, often the mental and emotional landscape changes in unpredictable ways, presenting new challenges and new opportunities for healing and growth. The following case history highlights the dynamic unfolding of one patient's experience at The Meadows and some of the treatment modalities that were adaptively employed on the patient's behalf.

Susan, as I will call her, was a 32 year-old, single, female from Denver, Colorado who was referred to The Meadows by her outpatient therapist. She initially reported symptoms of anxiety and depression that had contributed to significant problems in her close relationships and work performance as a financial consultant. She identified pervasive feelings of uneasiness and tension, with debilitating spikes of episodic panic and fear. Also, she noticed that her self-confidence was very low and that she was uncharacteristically tearful, emotional, and sad. After discussing her condition at length with her psychiatrist at The Meadows, they both agreed to explore the symptoms further before deciding if a medication was necessary.

Forming relationships of trust with peers and providers allowed Susan to acknowledge that her symptoms of depression and anxiety were partially related to worsening addictive behaviors with alcohol, food, and sex. She admitted to a life-long struggle with binge eating, excessive dieting, and shame about her body. She also shared that, after ending a ten-year, co-dependent romantic relationship in the months prior to admission, she immediately turned to compulsive sexual encounters via phone, internet, and night clubs. With the help of her outpatient therapist, she was able to reduce her sexual acting-out, but she then turned to excessive and reckless use of alcohol. Her life had become unmanageable.

In response to this additional information, Susan was reevaluated by the medical doctor to monitor and treat any symptoms of alcohol withdrawal. She spoke with the dietician so that the treatment team could better understand the nature of her disordered eating patterns and could help her establish an eating and wellness plan. In collaboration with her primary therapist, Susan set clear limits on her use of communication devices and her interactions with fellow peers, so that she could effectively address her compulsive tendency to rely on unhealthy relationships. Susan was also encouraged to attend 12-step meetings and to make use of important mind-body activities, such as yoga, tai chi, and meditation.

Although Susan had acknowledged a history of sexual trauma during the intake process, she was unsure of its significance in her life. Starting in the second week of treatment, she participated in a unique five-day experiential form of therapy that specifically addresses childhood trauma and early family relations. For the first time in her life, she began to see how her mother's tragic death at six-years-old led to years of depression and social-withdrawal on the part of her father. She was able to see herself as a scared and lonely child who tried not to worry her already distraught father, even when she was molested by the babysitter at nine-years-old. She discovered that during those lonely years, food was a trusted ally, but by the time she reached her teen-age years, food had become the enemy and she was at war with her own body.

As Susan's second week of treatment came to an end, years of shame, anger, and self-hatred gave way to profound sadness and grief. Long-held defenses began to relax, and as a result, she touched into another source of pain and sorrow connected to a date-rape in her early twenties that resulted in miscarriage. With guidance from peers and providers, she realized that this additional trauma and loss had contributed to soaring alcohol use and plummeting self-worth. In response to Susan's evolving treatment needs, she was offered several visits with an individual therapist trained in Somatic Experiencing to specifically address her adult trauma-related symptoms.  Also, her focused work in 12-step recovery during the third week became more meaningful as she explored further the links between her past trauma and her addictive behaviors.

As a result of many lectures and hands-on practice regarding interpersonal communication and boundaries, Susan felt prepared to engage in family therapy with her father and two sisters during the fourth week of treatment. Relying on the inner-child work from her second week, she was able to talk openly with her family about the bewilderment and loneliness she felt after her mother's death. For the first time in her life, she shared the deep emotional pain associated with her experiences of sexual trauma, her ten-year, unhealthy relationship, and her addictive behaviors. Susan's family members responded with concern, but also with an outpouring of love and acceptance. Together, she and her family received information and practical tools to move forward in a way that could support Susan's recovery and a healthier family system.

As Susan entered her fifth week of treatment, she was invited to participate in a special grief workshop to specifically address lingering feelings of loss and pain regarding her mother's death and her miscarriage. Also, after weekly meetings with her psychiatrist about her particular condition and possible treatment options, she decided to start a medication for symptoms of depression. Several discussions with her providers, discharge coordinators, family, and outpatient therapist resulted in an aftercare plan that fit her therapeutic needs. Susan finished her treatment with a new lease on life - ready to face old challenges and embrace new opportunities.

Of course, there are additional elements of The Meadows' treatment program that are not discussed here and not everyone's experience is like Susan's... but that is the whole point; the human psyche rarely conforms to overly-simplistic, textbook universals and treatment often unfolds in unpredictable and complex ways. As my mentor suggested, this requires that treatment professionals recognize and adaptively respond to situations as they arise. This means that providers must have the appropriate training and therapeutic techniques to effectively respond to the dynamically changing landscape of each person's recovery process. The Meadows has a proven track-record of providing this kind of treatment.

The political and emotional complexities of PTSD (post-traumatic stress disorder) and TBI (traumatic brain injury) can lead to stigmatization and inaccurate attributions. It has long been assumed that soldiers, especially those who have served in combat, are at higher risk for violence. Following WW II several congressmen introduced proposals to send returning combat troops to islands for "retraining" before returning to civilian life. Following Vietnam we had Rambo movies and veterans "going postal". The facts are both simple and confusing: sudden outbursts of violence are rare and very hard to predict.

The article referenced above summarizes some of what is clear: PTSD and TBI can produce shifts in emotional management and changes in "executive brain function" resulting in possible impulsiveness. Complex phenomena like PTSD and TBI are difficult to study and data is scattered, sometimes inconsistent or contaminated by selective sampling or agency agendas. What is clear is that spectacular episodes of sudden violence are extremely rare, despite media attention. There are often multiple factors involved and these include co-occurring disorders, use of drugs or alcohol, lack of sleep, number of tours, severity of symptom or injury, just to name a few. We would love to have instruments that predict these rare outbursts, but they do not exist. We are reduced to the old maxim I learned decades ago: "the best predictor of future behavior is past behavior".

I do not wish to oversimplify; however, I want to reassure readers, especially military readers, that they are not likely to explode in some horrific headline-grabbing fashion. The title of the Washington Post article is generally accurate. Put aside the complexities of multiple tours, diminished capacity, head injury, partial recall, fugue episodes, sleep deprivation, isolation, and alcohol, and let's focus on the reassuring take-away message. There is no data supporting the worst fear carried by many. Most veterans are well trained, restrained, disciplined, highly ethical, and filled with a sense of justice, loyalty and honor. Most veterans I have treated live with the dread that they could lose control of their impulses and inadvertently hurt someone. Newspaper headlines about sudden violence and suicide add to their burden of fear. As a 66 year old combat Marine with severe health and mobility problems recently stated, "I am still afraid of what I could do to others.- That's why I need to stay away from others." The fear of losing control results in isolation, self-medication, avoidance, and a whole host of symptoms we see with PTSD.

I would argue that the most common symptom is not violence but extreme dedication to work or mission. I do not have the statistics, but from my years of experience I see pro-social zealousness- not antisocial outbursts- as the most common coping mechanism. Over dedication to work/mission becomes almost addictive. It is easy to get lost in working excessive hours, and it is rewarded by recognition and increased revenue. Channeling one's anger is difficult, but workaholism is an extreme response rewarded in our culture. However, family members can be angry and confused, and the internal burden remains hidden. Sleepless nights, avoidance, occasional road rage and other symptoms flourish, often visible only to a few. Spectacular outbursts are rare. PTSD tends to be a condition that most often fits the following: "Great souls suffer in silence." (Friedrich Schiller). The articulation of suffering is often the first step toward recovery.

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 information about Dr. Boriskin, please visit his website at

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

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