The Meadows Blog

Over the years, I've had several persons who wanted my counseling, whom I found ravished with shame that manifested in an unusual kind of grandiosity. I connected with them because I have it in a different way myself. Over the years, I came to recognize what I call "reverse grandiosity." Sometimes after I had been working the 12 step program (at least five years), I noticed that details of my story had changed. Instead of sneaking out of Catholic seminary (where I was studying for the Catholic priesthood) and walking ten (sometimes 15, once even 20) miles to buy my drug of choice, I was really only walking three blocks! Ten to 15 miles make the story sound more dramatic and made my addiction worse that I really was. I wanted to make it sound worse. In fact I wanted to be the "best worst" in the program. Being the "best worst" was my "reverse grandiosity." I was the Star, Hero child in my dysfunctional family (capitalized because of the family systems need to have its shame diminished).

The clients whom I recognized with "reverse grandiosity" were somewhat different. They were people who claimed that their problems were so complex and unusual that no one had been able to help them. One man expressed it as clearly as possible. He said, "I';m just here to have someone to talk to, my problem is too unique to be alleviated by therapy." In other words, I'm special that I'm beyond what any humanly designed system of therapy can do. I let him rattle on and offered a follow-up visit. When he returned, I told him that after reflecting on his last visit, I found him pretty boring and quite ordinary. He became enraged when I called him ordinary. He started quickly enumerating every possible abuse that he had endured.

When he ran out of steam, I told him "you take pride in your abuse; you've made it sacred and in so doing make yourself superior to everyone else." These truths stung and my client kept coming back. I relentlessly called him ordinary, and one day he broke down crying. He told me how scared and small he felt. He said he realized that his idealization and attachment to his abuse made him feel like he was somebody superior. I took him to a 12 step meeting where he was introduced to the concept of anonymity. He soon realized that there were people of every sort in the group - men, women, rich, poor, middle class, lawyers, university professors, artists, laborers, mothers raising children, even a priest and two ministers. All had the same addiction and while their stories differed in details and they had different IQs, their common problem was the same - they had to stop using the drug they were addicted to that had caused their lives to become unmanageable. We were all simply ordinary human beings ravaged by drug addiction.

Anonymity is the great spiritual gift of the 12 step program. A Tibetan monk, Tara Tulku Rinpoche once said "the intensity of our sorrow will vary in direct proportion to the intensity of our feeling that "I am important.""

The practice of anonymity is the practice of being nobody special and that is the essence of humility. After 46 years of being free from my addiction, I can testify to the fact that those who know they are nobody special are busy doing the work that all ordinary humans are called to do in order to flourish. Gandhi constantly attested to being an average, ordinary person. When Erik Erikson wrote Gandhi's Truth (an autobiographical account) he found that Gandhi's wife and children attested to his flaws and his demanding profections of perfection on them.

Anonymity asks us to give up the idea and energy of trying to be special and different (so that we can be set apart from our fellow humans). Accepting being nobody special freed me from having to live up to demanding images. It freed me to do something I didn't have to work at, just being myself. Think of what you could let go of and the energy you would have if you stop trying to be somebody special, separate from the rest of us. Take on the amazing spiritual gift of anonymity and allow yourself to relish in the freedom of being ordinary.

Mr. Bradshaw has enjoyed a long association with The Meadows as a Senior Fellow, 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. His New York Times best-selling books include Homecoming: Reclaiming and Championing Your Inner Child, Creating Love, and Healing the Shame That Binds You.

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

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

The Meadows Alumni Association is pleased to host monthly alumni workshops in Houston, Texas, for alumni, family and friends. Meadows' trained professionals will lead the meetings May 22 through July 24, 2012, from 7:00 to 8:30pm. It will be held at The Council on Alcohol and Drugs in Houston and no registration is required to attend.

The following is the schedule for the upcoming workshops:

May 22

Doug Sorensen, LCSW, LCDC, CSAT

"Needs and Wants"

June 26

Joni Ogle, LCSW, CSAT and Taruno Steffensen, ICADAC, SEP

"Perfectly Imperfect"

July 24

Cara Weed, LCSW

"Boundaries"

Additional alumni workshop dates will be announced in the future. For more information, contact Betty Ewing Dicken, LCDC, at 972.612.7443 or bdicken@themeadows.com or visit www.themeadows.com/alumni.

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

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

The Meadows is now teaching Emotional Freedom Techniques (EFT), a gentle and effective tool for trauma, addiction, anxiety, depression and physical discomfort. EFT involves tapping certain acupressure points along the face and body while using an affirmation. Tapping on these points produces a relaxation response and helps release energy associated with trauma. The result is that memories remain intact, but disturbing emotional energy associated with these memories is lowered.

EFT is being taught to patients at The Meadows in combination with expressive arts therapy. Patients create a visual map of the body, then label and rate areas of discomfort. EFT tapping is then used while patients focus on these areas. After several rounds of tapping most patients report that the discomfort levels have significantly decreased. Patients are being given this tool for self-regulation and managing triggers in the future.

Sandra Lehmann, MC, LAC, evening and weekend counselor at The Meadows, is teaching EFT. Sandra first came to The Meadows as an intern while attending Arizona State University where she was working on her Master's degree in counseling. Since interning, she has taught at the college level and worked as a clinician with adults and adolescents experiencing mental health disorders, substance abuse issues and co-occurring disorders. Sandra also has a Bachelor of Fine Arts degree and is currently working on her Certificate of Advanced Graduate Study in Expressive Arts Therapy.

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

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

The Meadows is a sponsor of the 23rd Annual International Trauma Conference on June 6-9, 2012, at the Seaport World Trade Center in Boston, Massachusetts. The conference director, Bessel A. van der Kolk, M.D., is a Senior Fellow at The Meadows and the Founder and Medical Director of the Trauma Center at Justice Resource Institute.
The focus of the conference is "Psychological Trauma: Neuroscience, Attachment, and Therapeutic Interventions." The objective of the conference is to present current research findings on how people's brains, minds, and bodies respond to traumatic experiences. Post-traumatic responses at different developmental levels, as well as the treatment implications of these findings, will also be explored.

Keynote conference presenters include, Vincent Felliti, James Pennebaker, Peter Levine, Stephen Porges, Britta Hozel, Richard Schwartz, Diana Fosha, Pat Ogden and Jessica Stern

"The 23rd Annual International Trauma Conference will once again feature the leading edge neuroscientists and treatment developers to bring you the latest research on how trauma affects mental and brain functioning, as well as how effective treatment can reverse the profound affects of trauma on mind, brain, body and soul," said Bessel A. van der Kolk.

For information regarding the conference, please contact The Meadows at 800.240.5522 or info@themeadows.com.  For fast registration, register online at www.themeadows.com. Attendees can earn up to 27 Continuing Education Credits.

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

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

Thursday, 10 May 2012 20:00

Dr. Shelley Uram on Different Trauma

Dr. Shelley Uram on Different Trauma

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 "Different Trauma," the psychologist and Meadows senior fellow discusses the different types of trauma individuals can experience.

Dr. Uram first distinguishes overt trauma (which she refers to as "the big T") from covert trauma ("the little T"). While overt trauma results from large, perceivable events such as combat or natural disasters, the most extreme cases of trauma generally stem from subtler, or covert, situations that don't appear dangerous to the casual observer. To illustrate covert trauma, Dr. Uram speaks of a toddler whose mother becomes mildly depressed for a month or two. The child's survival instinct interprets his caretaker's depressed state as a significant threat to his well-being, and his developing brain locks this trauma into place. Because covert trauma forms an unconscious framework in the brain, trauma symptoms can emerge without the sufferer knowing why. Dr. Uram notes that this phenomenon makes treatment particularly challenging.


In other videos in the series, Dr. Uram shares her expertise on trauma triggers and the effects of emotional trauma on brain development, among other topics.
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 also includes interviews with other prominent figures in the mental health field, including John Bradshaw and Maureen Canning; see www.youtube.com/themeadowswickenburg.  To learn more about The Meadows' innovative treatment program for trauma and other disorders, visit wwww.themeadows.org or call 800-244-4949.

The Meadows is sponsoring a free lecture in Dallas, Texas on Tuesday, May 15 given by Rev. Daniel Gowan, M.Div., M.A., LCDC, LPC-S, on the topic of "Pathways to Victimhood: Enmeshment and Triangulation." It will be held at the Unity Church of Dallas Sanctuary from 7:00 to 8:30pm and no registration is required.

Lecture topics include: How much scorekeeping goes on in your relationships? Are you keenly aware of the rules with your partner and how fair things are? Do double standards frustrate you to the point of conflict? Do you find yourself managing what others think/say/do? Attendees will learn the three roles in a relationship triangle and how to gracefully step out of them to move participation in relationships to a healthier level.

"Most of us confuse love with the craving to be loved," said Gowan. "If we rely (even unknowingly) on enmeshment to get our needs met we set ourselves - and our relationships - up for failure. Move your relationships to a model of love not enmeshment."

The Meadows sponsors free lectures in various cities throughout the country. Speakers include local therapists familiar with The Meadows' model. Lectures are free and open to the public. Attendees can earn 1.5 Continuing Education Credits. For more information, contact Betty Ewing Dicken at 972.612.7443 or bdicken@themeadows.com.

The Meadows, located in Wickenburg, Arizona, 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 http://www.themeadows.com/.

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

Often, during the first week of treatment at The Meadows, people will skeptically inquire, "Do experiences in childhood really continue to affect my life as an adult?" While social scientists and mental health clinicians have been exploring this question for decades, other fields of science and medicine have been slow to recognize the effects of childhood adversity on adult health and well-being. However, this trend may be changing, in part due to a very influential study by a group of researchers at the Centers for Disease Control and Prevention that are examining the long-term effects of adverse childhood experiences (ACE) on various health outcomes in over 17,000 members of a managed healthcare organization in California.

In general, the results of the ACE study1 show that adverse childhood experiences (e.g., abuse, neglect, abandonment) are relatively common and are associated with higher rates of early initiation of tobacco use and sexual activity, adolescent pregnancy, multiple sexual partners and STD's, intimate partner violence, alcoholism, illicit drug use, depression, and suicide attempts. Of course, this resonates completely with our clinical experience and treatment model at The Meadows. However, these investigators also found that adverse childhood experiences are related to elevated rates of liver disease, autoimmune disease, chronic obstructive pulmonary disease, ischemic heart disease, and lower levels of health-related quality of life.

These compelling data suggest that childhood maltreatment is associated with a variety of mental, emotional, social, and physical health problems in adulthood. In fact, results such as these have led some people to elevate childhood maltreatment to the level of a "public health threat". Yet, as indicated by the conceptual model used in the ACE study (see Figure 1), there are considerable gaps in our scientific understanding of the mechanisms and mediating pathways connecting adverse childhood experiences to the host of deleterious outcomes mentioned above.

Attachment theory has proven to be a useful framework for understanding how early relational experiences influence developmental pathways and adult functioning (see earlier article on attachment). Over fifty years ago, John Bowlby (the "father" of attachment theory) studied adverse childhood experiences in delinquent and homeless children and found that a warm, continuous, and secure attachment relationship between caregiver and child was of critical importance, not only because this biologically-driven bond enhances survival and reproductive fitness, but also because it establishes the foundation for successful social-emotional development and resiliency throughout the lifespan.

One way that attachment security may contribute to positive health outcomes is by fostering an open, flexible, and optimistic approach to life's diverse and often unpredictable challenges. The development of such a resilient approach to life may come about as repeated experiences in secure attachment relationships organize and optimize emotion-regulation strategies and cognitive representations of self and others (i.e., internal working models). Consistent with this view, attachment insecurity has been associated with rigid, maladaptive responses to environmental demands and difficulties in appropriately understanding, expressing, and regulating emotions.

As a central feature of attachment theory and resiliency, the regulation of emotion may be an important variable linking childhood adversity to the various mental, emotional, physical, and social problems described in the ACE study. To address this clinically relevant question, my mentor and esteemed colleague, Phil Shaver, and I conducted a research study2 that has been accepted for publication in the journal of Individual Differences Research. In this study, 388 young adults completed questionnaires regarding adult attachment style (e.g., secure, avoidant, anxious), emotion regulation tendencies (e.g., emotional suppression, cognitive rumination, negative affect, emotional clarity, mood repair), and resiliency (i.e., an open, flexible, and adaptive approach to life).

Consistent with our hypotheses, the results indicated that, compared to attachment security, the two dimensions of attachment insecurity (i.e., anxiety and avoidance) were associated with lower levels of emotion regulation and resiliency. Interestingly, attachment-related anxiety and avoidance were connected to these outcomes through distinct cognitive-emotional pathways. For example, people scoring high in attachment-related anxiety reported a greater tendency to ruminate on negative thoughts and experience negative emotions, while people scoring high in attachment-related avoidance frequently relied on suppression of emotion and reported problems in clearly understanding their emotional states.

These results are very congruent with general theories on attachment and with my clinical experience at The Meadows. Attachment-related anxiety (similar to Love Addiction in The Meadows model) is characterized by hyperactivation of the attachment system, involving energetic and insistent attempts to attain proximity, support, and love. Generally, these individuals are hypervigilant to possible relationship threats (i.e., rejection or separation) and respond to such threats with intense mental rumination and high levels of negative emotion (e.g., anxiety, fear, shame, or anger). On the other hand, attachment-related avoidance (similar to Love Avoidance) involves deactivation of the attachment system, inhibition of the quest for support, and a commitment to deal with threats alone. These individuals divert attention away from possible relationship threats and tend to suppress their emotions, which contributes to a lack of understanding about the nature of their emotional states.

In contrast, repeated experiences with sensitive and responsive attachment figures increase a person's general sense of safety and security and foster optimistic beliefs about others' trustworthiness and one's own ability to effectively manage distress. Security-based strategies integrate cognitive and affective processes so that emotions can be openly acknowledged and clearly understood, while at the same time, metabolized and expressed without one's becoming excessively distressed or disorganized. In summary, the results of our study suggest that secure attachment relationships optimally organize emotion regulation capacities in a manner that enhances flexible adaptation to life's demands. This relationally acquired resiliency may be underdeveloped in people who have experienced childhood adversity and may contribute to diminished health and wellness.

Fortunately, recent evidence suggests there is considerable plasticity in the neurobiological systems underpinning social-emotional processes, which means there can be meaningful changes in emotion regulation and intimate relationships. Therefore, people who have experienced childhood adversity and relational trauma are not destined to experience the negative outcomes described in the ACE study. In fact, many professionals think of the alliance between therapist and patient as a type of attachment relationship where the capacity for emotion regulation, intimacy, and resiliency can be cultivated in an environment of safety and security. Treatment is available and there is hope for recovery.

1. Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, Marks, JS. The relationship of adult health status to childhood abuse and household dysfunction. American Journal of Preventive Medicine, 1998;14:245-258.

2. Caldwell JG, Shaver PR. Exploring the Cognitive-Emotional Pathways Between Adult Attachment and Ego-Resiliency. Individual Differences Research, 2012 (Manuscript accepted for publication; available upon request).

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 www.youtube.com/themeadowswickenburg.  To learn more about The Meadows' innovative treatment program for PTSD and other disorders, visit www.themeadows.org 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 www.themeadows.com.

For over 35 years, The Meadows has been a leading trauma and addiction treatment center. In that time, they have helped more than 20,000 patients in one of their three 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, (http://www.washingtonpost.com/lifestyle/magazine/clara-bartons-enemy-depression/2012/04/04/gIQAdryXzS_story.html), 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 http://www.jerryboriskin.com/.

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

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Intensive Family Program • Innovative Experiential Therapy • Neurobehavioral Therapy

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