Trauma & Delusions

Most people who work with older men with histories of trauma notice that delusions are commonplace. There is no medication available to treat delusions so I wonder what can be done? 

The literature has found a connection between trauma, dissociation and delusions. In the illness conceptualization of my ancestors, dissociation could be called, soul loss. 

Soul loss is when a part of our soul checks out during a traumatic event. 

Both soul loss and dissociation seem to serve as a form of protection during the traumatic event.

Shamans are entrusted to recover these cast-off soul parts and bring them home for integration and patient wholeness.

I don't yet know or understand the connection between dissociation and delusions - but we are building to bridge that gap. 

Mostly, I just want to know how my dear friends can be helped.

JAMES SCOTT, DAVID CHANT, GAVIN ANDREWS, GRAHAM MARTIN, JOHN McGRATH

Association between trauma exposure and delusional experiences in a large community-based sample

The British Journal of Psychiatry, Mar 2007, 190 (4), 339-343.

DOI: 10.1192/bjp.bp.106.026708

Introduction & Background

Community-based surveys have found that otherwise well individuals endorse items related to psychotic symptoms (Eaton et al, 1991; van Os et al, 2000). 

Previous studies have shown an association between psychotic symptoms and exposure to trauma.

An Australian study identified an increased likelihood of delusional experiences associated with certain demographic variables, including:

• male gender, 
• younger age, 
• unemployment, 
• migrant status (but only those from non-English-speaking backgrounds), 
• urban residence, 
• lower income, 
• lower educational achievement and 
• living alone (Scott et al, 2006). 

Cannabis dependence and alcohol dependence were also found to be associated with delusional experiences (Degenhardt & Hall, 2001). 

A number of studies have now shown an association between traumatic events in childhood and psychotic symptoms (Janssen et al, 2004; Spauwen et al, 2006). 

We had the opportunity to further examine the association between exposure to trauma, post-traumatic stress disorder (PTSD) and delusional experiences in a large, representative community-based Australian sample. 

Results 

Exposure to any traumatic event but without the development of PTSD was associated with increased endorsement of delusional experiences and there was a significant dose–response relationship between the number of types of traumatic events and endorsement of such experiences. The association between PTSD and delusional experiences remained significant after adjusting for factors associated with psychotic symptoms.

Discussion

Based on the largest sample to date, we found that individuals who had been exposed to a traumatic event were more likely to report delusional experiences. There was a dose–response relationship between the variables of interest: those who reported exposure to a greater number of different types of traumatic events were more likely to report delusional experiences. Furthermore, those who had developed PTSD after exposure to traumatic events were also more likely to report delusional experiences. The association between trauma, PTSD and delusional experiences persisted after controlling for factors known to be associated with psychotic symptoms. The association remained significant for each type of trauma examined, including those more likely to occur in childhood (sexual molestation) and those of adult life (direct combat).

Trauma, PTSD and psychotic symptoms

A number of community-based studies from different countries have shown an association between exposure to trauma and psychotic symptoms. Previous community surveys have shown an association between child abuse and psychotic symptoms (Ross et al, 1994; Janssen et al, 2004; Whitfield et al, 2005; Shevlin et al, 2007). Another study has shown an association between PTSD and positive psychotic symptoms (Sareen et al, 2005). Two further studies have reported psychotic symptoms associated with traumatic events other than child abuse (Bebbington et al, 2004; Spauwen et al, 2006).

We found that delusional experiences were associated with all types of trauma. The association was especially strong in those who had reported rape. Bebbington et al (2004) reported a strong association between childhood sexual abuse and psychotic disorder, whereas Spauwen et al(2006) found the association was most strong in people who had exposure to a natural catastrophe.

To the best of our knowledge, this is the first study to show that PTSD complicating exposure to trauma increases the likelihood of endorsement of delusional experience compared with trauma exposure without PTSD. We suggest that people with PTSD have had more adverse psychological adjustments to traumatic events. Our study also found a significant dose–response relationship between exposure to traumatic events (as assessed by the number of different types of traumatic events) and increased likelihood of endorsing delusional experiences. This is consistent with the study of Spauwen et al (2006), who found increased psychotic symptoms in people exposed to a greater number of traumatic events.

Pathways of causality

Although cross-sectional surveys such as this study do not allow us to untangle the web of causation underpinning this association, several potential pathways warrant consideration. Delusional experiences could reflect a final common pathway for a wide range of adverse exposures such as substance misuse, trauma or other general stressors (e.g. migrant status, lack of significant other, unemployment). In other words, delusional experiences may be diffuse, non-specific ‘surface markers’ that emerge from a wide variety of biological and/or environmental risk factors (Degenhardt & Hall, 2001; van Os & McGuffin, 2003; Scott et al, 2006).

From a different perspective, delusional experiences associated with trauma could be viewed as dissociative phenomena (van der Kolk et al, 1996). Other researchers have noted the close links between trauma, dissociation and psychotic symptoms (Startup, 1999). Although conceptually distinct, in the absence of a detailed clinical interview, delusional experience as an expression of dissociation may be phenomenologically indistinguishable from delusions reported in the prodrome of psychosis. The symptomatic overlap of these syndromes and the growing body of evidence linking trauma and psychotic symptoms suggests that the taxonomy of these symptoms warrants closer scrutiny.

It is also feasible that exposure to trauma in susceptible individuals might be a risk-modifying factor (a component cause) for psychosis, through as yet unidentified mechanisms. For example, a number of authors postulate that dysregulation of the hypothalamic–pituitary–adrenal axis with elevated cortisol levels could contribute to the hippocampal changes that are associated with the onset of psychosis (Read et al, 2001; Corcoran et al, 2003). Exposure to chronic stress and elevated cortisol levels are associated with hippocampal changes (Sapolsky, 1996) and reduced hippocampal volume is a relatively consistent finding in imaging studies of schizophrenia (Wright et al, 2000). Thus, trauma might lead to altered stress hormones, which might then ‘ catalyse’ the neurobiological mechanisms contributing to the onset of psychosis. Other mechanisms linking stress (e.g. ‘social defeat’) to risk of psychosis through dysregulation of dopaminergic pathways have also been proposed (Selten & Cantor-Graae, 2005)

Empirical support for trauma as a causal factor for psychosis is inconsistent. One prospective study showed no increase in rates of schizophrenia in adults who had been ascertained by child protection services as sexually abused in childhood (Spataro et al, 2004). However, there were significant limitations in this study, identified by both the authors and others (Read & Hammersley, 2005). In contrast, two studies have prospectively found an increased incidence of psychotic symptoms in those who reported exposure to traumatic events (Janssen et al, 2004; Spauwen et al, 2006). The notion that traumatic events cause delusions is lent some weight by the dose–response relationship identified in this study and in a previous study (Spauwen et al, 2006). Although there is now clear evidence of an association between traumatic events, PTSD and psychotic symptoms (Bebbington et al, 2004; Janssen et al, 2004; Sareen et al, 2005; Spauwen et al, 2006), the explanation for this association requires further investigation.

Hope & College Student Success

Hope is one of the most studied constructs in positive psychology and is defined as a cognitive set based on successful agency and pathways (Snyder et al., 1991). People with higher measureable levels of hope are not only determined to achieve a goal (agency), they devise sophisticated and detailed plans to get there (pathways) (Snyder et al., 1991). 

Even when controlling for intelligence, hope predicts higher academic performance (Curry, Snyder, Cook, Ruby, & Rehm, 1997; Curry, Maniar, Sondag, & Sandstedt, 1999; Snyder et al., 2002). 

Hope is related to higher test scores in elementary school children and adults (Snyder, Cheavens, & Sympson, 1997). 

In a six-year longitudinal study with college students, high hope in students’ first semester was related to higher cumulative GPA and higher rates of graduation (Curry et al., 1997). 

Hope has been shown to influence goal-specific expectancies college students make regarding their academic performance, such as a class or assignment grade (Rand, 2009), and actually predicts higher overall grades and higher rates of graduation (Curry et al., 1997; Rand, 2009). 

Several studies suggest an overlap between the constructs of hope and optimism. 

Hope is about pathways thinking (plausible routes and confidence meeting them) and agency thinking (capacity to move along pathway). 

Optimism is about goal importance (value) and overall confidence in achieving it (expectancy). 

Both high hope and optimistic people pick alternate routes instead of giving up and report similar motivating self-talk like “I can” (Rand, 2009). 

From "The Relationship Between College Student Success and Well Being Determinants: An exploratory study of measures," a dissertation by Mark D Shishim.

Is it just me or does this kind of talk really turn you on - you know, pump you up and make you happy?

Joy, Flow & Purpose

Positive psychology is described as the “study of ordinary human strengths and virtues” (Sheldon & King, 2001) 

There are three routes of study: each of which is skill-based and can be taught (Seligman, 2002). 

1.  The first is positive affect (emotions such as joy, pleasure, love) that fulfill hedonic needs for comfort. 

2.  The second route is enjoyment, also known as flow. These are states that completely envelop one’s attention and thinking. Flow is described as being lost in an activity, experiencing an altered sense of time, and using one’s strengths to meet a certain level of challenge (Csikszentmihalyi, 1990). 

3.  The third distinct route is meaning, or a sense of purpose and connection with others (Seligman & Csickszentmihalyi, 2000). To pursue meaning is to understand and apply one’s strengths to something larger than the self. Meaning, unlike positive affect or enjoyments, cannot be fulfilled in trivial ways. 

Pursuing each of these distinct routes, referred to as the full life, is considered fundamental and ultimately more useful than vague definitions of happiness (Seligman & Csickszentmihalyi, 2000).

From "The Relationship Between College Student Success and Well Being Determinants: An exploratory study of measures," a dissertation by Mark D Shishim.

 

 

 

From "A Course in Miracles"

"All expressions of love are maximal."

"Miracles occur naturally as expressions of love."

"The real miracle is the love that inspires them. In this sense everything that comes from love is a miracle."

"Miracles are natural."

"Miracles are everyone's right, but purification is necessary first."

"[Miracles] bring more love both to the giver and the receiver."

"Prayer is the medium of miracles. It is the means of communication of the created with the Creator. Through prayer love is received, and through miracles love is expressed."

"Miracles are thoughts."

"Miracles bear witness to truth."

"Each day should be devoted to miracles."

"A miracle is a service...It is a way of loving your neighbor as yourself. You recognize your own and your neighbor's worth simultaneously."

"Miracles are natural signs of forgiveness. Through miracles you accept God's forgiveness by extending it to others."

"Miracles enable you to heal the sick and raise the dead because you made sickness and death yourself, and can therefore abolish both."

"You are a miracle, capable of creating in the likeness of your Creator. Everything else is your own nightmare, and does not exist. Only the creations of light are real."

"Miracles represent freedom from fear...The undoing of fear is an essential part of the Atonement value of miracles...It is the privilege of the forgiven to forgive."

"...thank God for what you really are. The children of God are holy and the miracle honors their holiness, which can be hidden but never lost."

"Miracles honor you because you are lovable. They dispel illusions about yourself and perceive the light in you. They thus atone for your errors by freeing you from your nightmares. By releasing your mind from the imprisonment of your illusions, they restore your sanity."

"Wholeness is the perceptual content of miracles. They thus correct, or atone for, the faulty perception of lack."

Love, Truth & Peace

"It does aim, however, at removing the blocks to the awareness of love's presence, which is your natural inheritance. The opposite of love is fear, but what is all-encompassing can have no opposite."

"Nothing real can be threatened.
Nothing unreal exists.
Herein lies the peace of God."

A Course in Miracles

do it now

If you had faith as small as a mustard seed,
what would you have the audacity to do?
show me.

Love & Gratitude

The antidote to the anxiety and depression that grips us is a brave and consistent commitment to love and gratitude.

There is only fear or love. Which do you choose? 
Isn't it horribly beautiful that you have the right and power to choose?

Loving depressed folks has made me keenly aware that a common mindset and practice among this crowd is that of constant complaining - seeing only the negative when the good and bad live side by side.

No matter what the circumstances - be they living in a concentration camp or on vacation in Malta and Miami - the depressed brain generates negative thoughts that make one sound downright ungrateful, even when surrounded by water and beauty!

It's never enough because with anxiety and depression, one is always and everywhere worried and sad for no reason, despite the circumstances and not necessarily because of them.

When negative thoughts are your oldest friends, it takes courage and faith to do something different - to betray these familiars and make new friends.

The fear that grips us at the thought of it isn't real. It will dissipate as we take steps toward the truth and our freedom.

You coming?

Lay health workers effectively reduce PTSD symptoms

Brief intervention delivered by lay providers effective in a high conflict setting

There is a great need for mental health treatment in low-income countries that have limited mental health personnel. 

The implementation of interventions by lay health workers may be one solution. 

A team led by investigators from University of Liverpool tested the efficacy of a brief intervention for psychological distress delivered by lay providers in Pakistan.

Participants were 346 adults (79% women) with psychological distress and functional impairment recruited from three primary care clinics in Pakistan. 

Patients were randomized to an intervention based on established problem-solving and behavioral techniques, Problem Management Plus (n = 172), or an enhanced usual care condition (n = 174) consisting of contact with a primary care physician trained in mental health issues. 

Lay health workers who had no previous mental health background delivered the intervention in 5 weekly 90-minute sessions. 

Participants were assessed 1 week and 3 months following treatment. 

Compared with enhanced usual care, participants who received the intervention had greater improvements in PTSD symptoms, depression, anxiety, and functioning (effect sizes at 3 months ranged from .6 to .9). 

By showing that lay workers can successfully implement effective psychological interventions even in a challenging, high-conflict environment, these findings offer hope for increased access to mental health care for trauma survivors around the world.

Read the article: https://doi.org/10.1001/jama.2016.17165

Rahman, A., Hamdani, S. U., Awan, N. R., Bryant, R. A., Dawson, K. S., Khan, M. F., ... van Ommeren, M. (2016). Effect of a multicomponent behavioral intervention in adults impaired by psychological distress in a conflict-affected area of Pakistan: A randomized clinical trial. JAMA. Advance online publication. PILOTS ID: 45815 

The more things change, the more they stay the same...

"Like Jim Crow (and slavery), mass incarceration operates as a tightly networked system of laws, policies, customs, and institutions that operate collectively to ensure the subordinate status of a group defined largely by race" (Alexander, 2012, p. 13).

A New System of Racialized Social Control

"What is completely missed in the rare public debates today about the plight of African Americans is that a huge percentage of them are not free to move up at all.

It is not just that they lack opportunity, attend poor schools, or are plagued with poverty. They are barred by law from doing so. And the major institutions with which they come into contact are designed to prevent their mobility.

To put the matter starkly: The current system of control permanently locks a huge percentage of the African American community out of the mainstream society and economy.

The system operates through our criminal justice institutions, but it functions more like a caste system than a system of crime control.

Viewed from this perspective, the so-called underclass is better understood as an undercaste - a lower caste of individuals who are permanently barred by law and custom from mainstream society.

Although this new system of racialized social control purports to be color blind, it creates and maintains racial hierarchy much as earlier systems of control did" (Alexander, 2012, p. 13).

Talking About It

"We avoid talking about caste in our society because we are ashamed of our racial history. We also avoid talking about race.

We even avoid talking about class. Conversations about class are resisted in part because there is a tendency to imagine that one's class reflects upon one's character.

What is key to America's understanding of class is the persistent belief - despite all evidence to the contrary - that anyone, with the proper discipline and drive, can move from a lower class to a higher class.We recognize that mobility may be difficult, but the key to our collective self-image is the assumption that mobility is always possible, so failure to move up reflects on one's character.

By extension, the failure of a race or ethnic group to move up reflects very poorly on the group as a whole" (Alexander, 2012, p. 13).

#banthebox

"This larger system, referred to here as mass incarceration, is a system that locks people not only behind bars in actual prisons, but also behind virtual bars and virtual walls - walls that are invisible to the naked eye but function nearly as effectively as Jim Crow laws once did at locking people of color into a permanent second-class citizenship.

The term 'mass incarceration' refers not only to the criminal justice system but also to the larger web of laws, rules, policies, and customs that control those labeled criminals both in and out of prison. 

Once released, former prisoners enter a hidden underworld of legalized discrimination and permanent social exclusion. They are members of America's new undercaste" (Alexander, 2012, p. 12-13).

#banthebox

"Currently, 12 states and some 70 cities and counties have "ban the box" legislation on the books, according to the National Employment Law Project. The laws are meant to fight back against the widespread, automatic exclusion of job applicants with criminal backgrounds."

http://www.colorlines.com/articles/californias-ban-box-law-could-aid-7-million-job-seekers

Mass Incarceration is the New Jim Crow

"One in three young African American men will serve time in prison if current trends continue and in some cities more than half of all young adult black men are currently under correctional control - in prison or jail, on probation or parole. 

Yet mass incarceration tends to be categorized as a criminal justice issue as opposed to a racial justice or civil rights issue (or crisis)...

...This book argues that mass incarceration is, metaphorically, the New Jim Crow and that all those who care about social justice should fully commit themselves to dismantling the new racial caste system. 

Mass incarceration - not attacks on affirmative action or lax civil rights enforcement - is the most damaging manifestation of the backlash against the Civil Rights Movement (Alexander, 2012, p. 9-11)."

Racial Caste

"The aim of this book is not to venture into the long-running, vigorous debate in the scholarly literature regarding what does and does not constitute a caste system.

I use the term 'racial caste' in this book the way it is used in common parlance to denote a stigmatized racial group locked into an inferior position by law and custom.

Jim Crow and slavery were caste systems. So is our current system of mass incarceration" (Alexander, 2012, p. 12)

Racial Caste in America - Redesigned

"Although crime rates in the United States have not been markedly higher than those of other Western countries, the rate of incarceration has soared in the United States while it has remained stable or declined in other countries.

Between 1960 and 1990, for example, official crimes in Finland, Germany, and the United States were close to identical. Yet the U.S. incarceration rate quadrupled, the Finnish rate fell by 60 percent, and the German rate was stable in that period. Despite similar crime rates, each government chose to impose different levels of punishment.

Today, due to recent declines, U.S. crime rates have dipped below the international norm. Nevertheless, the United States now boasts an incarceration rate that is six to ten times greater than that of other industrialized nations - a development directly traceable to the drug war.

The only other country in the world that even comes close to the American rate of incarceration is Russia, and no other country in the world incarcerates such an astonishing percentage of its racial or ethnic minorities (Alexander, 2012, p. 7-8)."

Finally...

I got this email and screamed! My co-workers down the hall got concerned for me and then cheered when I told them why I'd screamed.

It still blows me away to see myself addressed as "Dr." In person, I rarely respond to it because I don't even hear it - I don't register it as part of my name.

I emailed all my mentors to thank them for their support and guidance. They were all proud and immediately told me to go on to the next one.

I will! But first some champagne :)

On December 11, 2003 (exactly 13 years ago), my mom died from complications of Non-Hodgkins Lymphoma. She would have been beyond proud to read this email, to know how far I'd come, and that her sacrifices had paid off.

This is my first peer-reviewed publication - finally!
I'm a late bloomer sometimes.

Moving on to the next one...

Mass Incarceration of Men of Color

"The racial dimension of mass incarceration is its most striking feature.

No other country in the world imprisons so many of its racial or ethnic minorities.

The United States imprisons a larger percentage of its black population than South Africa did at the height of apartheid.

In Washington, D.C., our nation's capitol, it is estimated that three out of four young black men (an nearly all those in the poorest neighborhoods) can expect to serve time in prison. Similar rates of incarceration can be found in black communities across America (Alexander, 2012, p. 6-7)."

Dubious Distinction

"The impact of the drug war has been astounding.

In less than thirty years, the US penal population exploded from around 300,000 to more than 2 million, with drug convictions accounting for the majority of the increase.

The US now has the highest rate of incarceration in the world, dwarfing the rates of nearly every developed country, even surpassing those in highly repressive regimes like Russia, China, and Iran.

In Germany, 93 people are in prison for every 100,000 adults and children. In the US, the rate is roughly eight times that, or 750 per 100,000 (Alexander, 2012, p.6)."