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A couple of weeks ago I was asked by Scientific American to be a Guest Blogger on the subject of PTSD.  The result is now online, and I hope you'll have time to take a look.  Summary is below the orange squiggle.

For a while I've been researching the sequel to Worlds of Hurt, and I've recently hit critical mass, so the essays are going to start flowing.

This Scientific American Guest blog kicks off a series on the limitations of current PTSD research and treatments, and the importance of prevention (which I believe is the only real "cure").

The timing of the essay was good, since the fight to reauthorize the Violence Against Women Act is currently underway — a form of prevention that definitely works.

In the article I make several points, and accompany them with a wealth of linked supporting evidence:

1. Clinical tests of current treatments test their effectiveness on patients who do not represent the majority of those who suffer from PTSD.

2. The weight of powerful institutions is behind the push for short-term treatments: the military, pharmaceutical companies, and insurance companies.

3. Most people who have PTSD also have other hard-to-cure disorders like substance abuse, depression and anxiety disorders  These have fluctuating symptoms that require long-term case management, rather than a 'quick fix' revolving door policy.

4. There is no way to prevent PTSD without preventing violence in the first place. We need to fund violence prevention programs that work, and we need to take a good hard look at what causes violence in the first place.

Here's an excerpt:

Women are not the only population to suffer disproportionately from violence and, hence, from PTSD. Look again at the figures above, and you’ll note that close to half of Native American women have PTSD, as compared to a third of American women in general. Higher rates of PTSD are evident in communities with high rates of violence, low-income communities with poor social support, populations with a high rate of incarceration, and other markers of social and economic disadvantage. Poverty and racial oppression increase the likelihood that an individual will experience one or more traumatic events; PTSD then lowers the life chances of the individual who suffers it. Thus, a seemingly unrelated circumstance, such as unequal sentencing for possession of crack cocaine vs. powder cocaine (especially when it takes place in an environment of unequal policing, prosecution, and sentencing) can have a significant effect on the level of PTSD in a community where a large number of male residents have served time for possession. Much human-caused trauma is systemic, rather than exceptional. Those of us who want to treat PTSD in the U.S. need to ask ourselves how best to treat PTSD in community under siege, where we’re attempting to help patients who were probably traumatized before, and are quite likely to be traumatized again.
I hope you find the article interesting.  And feel free to bring the discussion to SciAm, where I'll be fielding questions.  They tell me 100,000 people read SciAm blogs.  I guess we'll see....

Peace!

Originally posted to White Privilege Working Group on Tue Feb 26, 2013 at 09:52 AM PST.

Also republished by Feminism, Pro-Feminism, Womanism: Feminist Issues, Ideas, & Activism, RaceGender DiscrimiNATION, DKos Military Veterans, Military Community Members of Daily Kos, TreeClimbers, House of LIGHTS, and Barriers and Bridges.

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Comment Preferences

  •  I read the full article and (6+ / 0-)

    it is excellent.  Shared it on FB.  Thank you!

  •  Exceptional. I plan to read it more ... (8+ / 0-)

    ...thoroughly again once the workday is over.

    Don't tell me what you believe, show me what you do and I will tell you what you believe.

    by Meteor Blades on Tue Feb 26, 2013 at 10:24:06 AM PST

  •  What a great article (9+ / 0-)

    Like MB, I'm going to read it again thoroughly later.

    Question: Do you know of any research on PTSD resulting from repeated medical interventions? My 23-year-old daughter seems to be suffering from some form of PTSD after multiple open heart surgeries and (the part that has her most frightened) multiple incidences of an internal defibrillator firing when she gets an erratic heart rate.

  •  amazing (5+ / 0-)

    thank you for this, hepshiba.

  •  A thoughtful, well written exposition (9+ / 0-)

    of the topic, particularly the prevalence outside the traditional 'battlefield induced' model.

    Two minor questions, and two quibbles: First, the diary begins with a brief discussion of treatments that do or don't 'work.' In that context how is 'work' defined? Second, less importantly, the sidebar graph depicting VHA service utilization fails to explain what "OCO" veterans are. That information would be quite helpful in evaluating what the graph means here on the ground.

    Third, perhaps connected to the question of defining what 'works,' there is a considerable body of evidence that mind-body medicine is quite effective in dealing with comorbid conditions like anxiety and depression, as well as at least anecdotal evidence about substance abuse. As a practicioner of a mind-body approach who has greatly relieved all those conditions as well as PTSD I wonder if the discrepancy doesn't lie in that 'works' definition.

    Finally, sharing the author's view that the best PTSD cure is prevention, I'd like to have seen some discussion about why, for example, some soldiers exposed to a battlefield event will develop PTSD and their fellows, exposed to the same event, do not. From what I've seen and heard the answer to that question is probably mostly about what inner resources they bring to the traumatic event, it seems the best buzzword these days is 'resiliency.'

    'Resiliency' appears to be a teachable skill. I'd like to see more research in PTSD prevention dedicated to examining that connection and developing reliable instruments for selecting out those too damaged to learn it.

    “Perhaps the most 'spiritual' thing any of us can do is simply to look through our own eyes, see with eyes of wholeness, and act with integrity and kindness.” Jon Kabat-Zinn

    by DaNang65 on Tue Feb 26, 2013 at 11:33:23 AM PST

    •  From a non-professional with PTSD diagnosis... (6+ / 0-)
      I'd like to have seen some discussion about why, for example, some soldiers exposed to a battlefield event will develop PTSD and their fellows, exposed to the same event, do not.
      I recently recalled a long-buried memory of a childhood trauma / accident, and the similarity between that event and my military trauma were striking.  So striking, in fact, that I've subsequently discussed it with my therapist a couple of times.  I'm wondering (as is my therapist) if that's at least a part of the answer to the situation you pose - people react differently to life-threatening events based on past experiences (or lack thereof).

      "Mitt who? That's an odd name. Like an oven mitt, you mean? Oh, yeah, I've got one of those. Used it at the Atlas Society BBQ last summer when I was flipping ribs."

      by Richard Cranium on Tue Feb 26, 2013 at 11:56:00 AM PST

      [ Parent ]

      •  People who were traumatized in childhood (4+ / 0-)

        (particularly those who were sexually abused) tend to get more severe forms of PTSD when they are retraumatized as adults.  This is because they probably already have PTSD (though the symptoms may be in remission), and the retraumatization compounds the initial trauma.

        "If you fake the funk, your nose will grow." -- Bootsy Collins

        by hepshiba on Tue Feb 26, 2013 at 12:03:40 PM PST

        [ Parent ]

        •  Judith Herman has a whole section in her research (3+ / 0-)
          Recommended by:
          DaNang65, llbear, SwedishJewfish

          about C-PTSD or Complex Post Traumatic Stress Disorder as it relates to traumatic experiences, including long-term child sexual abuse.

          Many traumatic events (e.g. car accidents, natural disasters, etc.) are of time-limited duration. However, in some cases people experience chronic trauma that continues or repeats for months or years at a time. The current PTSD diagnosis often does not fully capture the severe psychological harm that occurs with prolonged, repeated trauma.

          Dr. Judith Herman of Harvard University suggests that a new diagnosis, Complex PTSD, is needed to describe the symptoms of long-term trauma (1). Another name sometimes used to describe the cluster of symptoms referred to as Complex PTSD is Disorders of Extreme Stress Not Otherwise Specified (DESNOS)(2). A work group has also proposed a diagnosis of Developmental Trauma Disorder (DTD) for children and adolescents who experience chronic traumatic events (3).

          Examples of such traumatic situations include:

          ■Concentration camps
          ■Prisoner of War camps
          ■Prostitution brothels
          ■Long-term domestic violence
          ■Long-term child physical abuse
          ■Long-term child sexual abuse
          ■Organized child exploitation rings

          References
          1.Herman, J. (1997). Trauma and recovery: The aftermath of violence from domestic abuse to political terror. New York: Basic Books.
          2.Ford, J. D. (1999). Disorders of extreme stress following war-zone military trauma: Associated features of Posttraumatic Stress Disorder or comorbid but distinct syndromes? Journal of Consulting and Clinical Psychology, 67, 3-12.
          3.van der Kolk, B. (2005). Developmental trauma disorder. Psychiatric Annals, 35(5), 401-408.

          "...I am the master of my fate/I am the captain of my soul" Invictus - William Ernest Henley Please donate to TREE Climbers, our 501(c)(3).

          by Roxine on Tue Feb 26, 2013 at 12:11:05 PM PST

          [ Parent ]

        •  Appreciate your response (3+ / 0-)
          Recommended by:
          Roxine, llbear, Actbriniel

          I'm going to chew over your superb SA article for a bit.

          Thanks so much for sharing it here.

          "Mitt who? That's an odd name. Like an oven mitt, you mean? Oh, yeah, I've got one of those. Used it at the Atlas Society BBQ last summer when I was flipping ribs."

          by Richard Cranium on Tue Feb 26, 2013 at 12:14:47 PM PST

          [ Parent ]

    •  Heya, DaNang, (8+ / 0-)

      thanks for the comments/questions.  

      The whole article is really about defining what "works." Sorry if I didn't make that clear enough.

      First, I start with the definition of effectiveness used by clinical trials, which is symptom alleviation, and I explain why that's not a good measure, and it's important to cover other outcomes like daily function.

      Then I explain the importance of daily function and reintegration: any therapy that "works" would ensure that function and reintegration remained high on an ongoing basis.  So far, no tested therapies actually do that.

      But I notice that you have a problem similar to mine -- you say that mind-body medicine is "quite effective in dealing with..." but you don't make its exact effects clear, or state what you mean by "dealing with."  I'm not getting on your case here; I'm just saying that clarifying terms is tough when people are playing in different ballparks.

      I just read a soon-to-be published study that shows that non-targeted therapies like meditation, mindfulness, yoga, etc. give as much relief as trauma focused therapies for some groups of patients.  In this sense, they fall into the "I think it will work, and my therapist thinks it will work, and so we're all enthusiastic about it working, which makes it work" category.  I like mind-body and somatic therapies myself, and credit them with providing good coping techniques and strategies for managing my own PTSD.  But I've also noticed that those techniques work when they work, and that they don't protect against recurrence of symptoms in times of severe stress.  They also don't "cure" problems like my hyper vigilance, which are now hardwired into my wetware.

      The whole "resiliency" thing is questionable.  Previous traumas predict the likelihood of future PTSD arising from a new trauma, for sure.  Effective civilian violence prevention programs would also reduce the number of combat vets who were sexually abused as kids, and who were thus more susceptible to chronic and severe PTSD.  But I've always had a problem with resiliency arguments that are based on philosophical notions of "character" or on "basic nature."  The army loves to promote those, because it can foster the illusion that it can figure out who is susceptible and screen out those recruits.  So far, though, that hasn't been possible -- in large measure, I think, because our neurological makeup (like the expression of our genes) is a result of a combination of heredity+environment.  The resiliency rhetoric is too much like the "weakness" rhetoric that the military adopted after WWI.  I don't think it benefits veterans or other people with PTSD.

      Also, let's think about what it means to teach people to be "resilient" to PTSD.  Toughen 'em up and they can take more abuse?  I know that's not what you mean, but it's one of the arguments the military makes about soldiers.  And that's no more of a solution than preventing PTSD by turning soldiers into psychopaths with conscience-suppressing drugs.  So I embrace healthy coping strategies, but reject the notion that some innate weakness causes people to break under extreme circumstances.

      "If you fake the funk, your nose will grow." -- Bootsy Collins

      by hepshiba on Tue Feb 26, 2013 at 11:57:45 AM PST

      [ Parent ]

      •  Thanks for the detailed and cogent response. (4+ / 0-)
        Recommended by:
        hepshiba, llbear, drnatrl, Actbriniel

        With the proverbial acuity of hindsight, and your expansion of the explicit meaning, I'm a lot more comfortable with how you're defining what 'works,' if a little sheepish about having clung to my confusion right through reading what I was missing.

        While writing I was aware that I was being more than a little opaque with the "effective in dealing with" language, at least that was intentional. The form I practice, Mindfulness Based Stress Reduction, developed by the author of my sig line, leaves me hard put to address that question briefly easily. Let me give it an attempt: if we start with, say, John Brierre's 'three legged stool' of "re-experiencing, hyperalertness, and avoidance" as the hallmarks of PTSD, while the first two of those indicia might not significantly decrease with mindfulness practice they can certainly be 'under new management' so that they need not present the function and reintegration problems you cite. 'Avoidance,' of course, is best extinguished by finally garnering the courage to turn toward our monsters. Being with the mind-body connection can help us find that courage.

        Your view of 'resiliency,' at least the way the brass sees it, closely parallels my own. Nevertheless I believe there's a valuable core concept there, whether or not it can be as easily packaged and marketed as a pharmaceutical. And I couldn't agree with you more that framing that core in language about 'weakness,' 'character,' or 'basic nature' is worse than not helpful.

        Rather than talking about folks 'breaking' under extreme circumstances I believe it's far more useful to consider that we have a completely understandable reaction to extreme stressors, and internalize that reaction to take with us in great measure according to the psycho-physical, nature and nurture, experience we bring to it. But in the end it's not our experience of stress, but how we relate to it that determines our outcomes.

        “Perhaps the most 'spiritual' thing any of us can do is simply to look through our own eyes, see with eyes of wholeness, and act with integrity and kindness.” Jon Kabat-Zinn

        by DaNang65 on Tue Feb 26, 2013 at 12:45:31 PM PST

        [ Parent ]

        •  Agree with you *almost* completely... (3+ / 0-)
          Recommended by:
          DaNang65, llbear, Lonely Texan

          What I'd take issue with is the statement: "But in the end it's not our experience of stress, but how we relate to it that determines our outcomes."  There's a bit too much presumption that "we can get better if we want to get better and if we're putting the work in to get better."

          Mindfulness is great, and I practice it with diligence, but I'm always aware that I have the luxury to be mindful.  Many -- possibly most -- survivors of human-made trauma live in environments where resources and moments of peace are scarce, and where violence threatens daily. The bottom line is that some people have more resources than others, and the ability to cope is at least as much resource-based as it is based in individual will and effort.

          So for me, mindfulness is useful, but I recognize the constraints on its practice.

          "If you fake the funk, your nose will grow." -- Bootsy Collins

          by hepshiba on Tue Feb 26, 2013 at 01:01:11 PM PST

          [ Parent ]

          •  Certainly the ability to cope is "at least as (3+ / 0-)
            Recommended by:
            hepshiba, drnatrl, Actbriniel

            resource-based as it is based in individual will and effort." I'd even agree with the statement that "we can get better if we want to get better and if we're putting in the work to get better." Or more exactly, I'd agree that "we're not likely to get better unless we want to and put in the work."

            Curiously, I find Mindfulness Based Stress Reduction to be the least resource intensive approach available for dealing with stress and stressors. Big Pharma's "we got a pill for that" requires the expenditure of considerable resources, if not necessarily those of the patient. Similarly psychotherapy, which requires a huge outlay of education, time, and capital which must be recouped from somebody.

            At it's essence MBSR requires no more than some learning, eight weeks seems to do it for most people, and then nothing more is necessary than the breath, which is with us for life, and setting aside, no, making the time to meditate, to do the work.

            While I've certainly been in worse places, where I live now would probably meet most folks standards for a dangerous, even violent environment. It's difficult to go out my door without seeing a drug deal happening right before my eyes. About three weeks ago a dealer was shot dead on the sidewalk a few doors up from my house. A day or two later the SWAT team camped outside what they feared was a meth lab for several hours before making their entrance accompanied by flashbang grenades. Hardly a combat zone, but hardly what most people would consider 'safe' either.

            The point being that I have no difficulty practicing in this environment. Maybe I couldn't always have, maybe I didn't want it badly enough. Maybe the only ones we can save are ourselves.

            “Perhaps the most 'spiritual' thing any of us can do is simply to look through our own eyes, see with eyes of wholeness, and act with integrity and kindness.” Jon Kabat-Zinn

            by DaNang65 on Tue Feb 26, 2013 at 01:57:01 PM PST

            [ Parent ]

          •  Resources are key, and not everyone has those. (2+ / 0-)
            Recommended by:
            hepshiba, DaNang65

            There are times when the horror is so overwhelming that no control of the mind is possible. (I know this, unfortunately.)

            Excellent article.  It's the first time I've heard about treatment modalities being developed in the military and then used in civilian populations.  It explains a lot.  I will definitely be referring to your article again!

    •  Oh, and OCO (4+ / 0-)
      Recommended by:
      DaNang65, Roxine, Richard Cranium, llbear

      means Overseas Contingency Operations.  I'll see if the editor can insert that into the article, though it's clarified in the link to the source (excellent PDF to download, btw).

      "If you fake the funk, your nose will grow." -- Bootsy Collins

      by hepshiba on Tue Feb 26, 2013 at 11:59:30 AM PST

      [ Parent ]

      •  That's what I get for being an old fart, (2+ / 0-)
        Recommended by:
        hepshiba, llbear

        and not up on current jargon. Thanks.

        “Perhaps the most 'spiritual' thing any of us can do is simply to look through our own eyes, see with eyes of wholeness, and act with integrity and kindness.” Jon Kabat-Zinn

        by DaNang65 on Tue Feb 26, 2013 at 12:47:25 PM PST

        [ Parent ]

  •  Tipped recced and republished to Tree Climbers and (6+ / 0-)

    House of Lights.  

    Thank you for this excellent resource and all of the work you have done.

    Now back to finish reading (did a speed read earlier!)

    I republished to Tree Climbers with this quote from your piece in my editor's note:

    There is no quick fix for PTSD. There is only the slow fix: stopping violence before it starts. Whatever treatments you advocate and provide, if you aren’t working to prevent violence, you aren’t working to cure PTSD.

    "...I am the master of my fate/I am the captain of my soul" Invictus - William Ernest Henley Please donate to TREE Climbers, our 501(c)(3).

    by Roxine on Tue Feb 26, 2013 at 11:49:12 AM PST

  •  I'm glad people finally recognize that witnessing (4+ / 0-)
    Recommended by:
    llbear, SwedishJewfish, hepshiba, BusyinCA

    violence is traumatic, too. Back when I had PTSD in the mid-90s, I couldn't find anything about it and it added to my trauma.

    I wonder if people are considering how gun violence contributes to PTSD rates, especially in places like Chicago where murders and shootings happen every week.

  •  One-yay, I'm so glad to see you again! (4+ / 0-)
    Recommended by:
    hepshiba, BusyinCA, DaNang65, Lonely Texan

    and I'm sending you a PM in a few...

    Two-I am so incredibly thrilled to hear this:

    For a while I've been researching the sequel to Worlds of Hurt, and I've recently hit critical mass, so the essays are going to start flowing.
    I can't even tell you what a resource Worlds of Hurt has been for me. That and Trauma and Recovery by Dr. Herman are my top 2 works on the subject.

    The article you published (which I haven't read yet, but skimmed) is especially of interest to me, because I'm supposed to start EMDR within a few weeks. And in general, this focus on the fallacy of the "quick fix" is important, because I'm growing increasingly frustrated by the lack of options. It could just be me, but I find that the traditional approaches can ultimately be just another form of dissociation. I do not think it's healthy to live your life in a state of dissociation, disconnected to your past and avoiding it. To do so is basically just constriction, which is one of the cardinal symptoms of PTSD.  

    I have a very good trauma therapist, and she is trying to get approval for the 3 step approach as laid out by Judith Herman in Trauma & Recovery-which requires the reconstruction of a trauma narrative in its entirety. But she's having a hard time, because the goal of the insurance company of course to get me  "cured" as quickly as possible. So they want me to do EMDR, and to keep taking the zoloft and the clonopin and the ambien and the prazosin, and to be trained in "seeking safety". Only problem is, I don't want "safety"-I want freedom.

    I think another effect is that those who do not respond to the "quick fix" treatment are made to feel like there must be something inherently wrong with them. Hence the continued usage of stigmatizing diagnostic labels like "Borderline Personality Disorder". The very definition of a personality disorder is that it is an inherent character trait, something you were born with. And yet, despite the volumes of evidence that show a direct correlation between BPD (and other personality disorders) and childhood trauma, we continue to use them. Which of course reinforces everything abused children believe inherently-that they are the cause of their own suffering. That their own inner badness causes the adults in their life to act out against them and the people in their world.

    The fact that Borderline Personality Disorder is in the DSMV, but Complex PTSD is not just blows my mind.

    Also it occurs to me that in the wider context, these quick-fix approaches are perhaps more palatable not just for insurance companies, but for society in general. Because as long as we can keep survivors "safe", we can keep them silent. We can pretend that the damage of psychological trauma isn't really that bad, if it can be cured with a few pills and therapy sessions. This seems to play right in to the hands of the predators mindset-that what he or she is doing isn't really harmful.

    So no, I don't want to just "seek safety" and learn to avoid triggers, or make my flashbacks less frequent and often. I want to remember everything that happened to me, and expel it from my body. I have entire chunks of my memory that are missing, and I want them back. And I want  my story, in its entirety, to become a historical document-a testament to the damage that CSA, rape, and other forms of abuse (because like a lot of CSA survivors, it didn't stop when I ended childhood) does to a human being.

    But as Margaret Randall said (and I think I got this quote from your book)

    The oppressor's language sometimes sounds beautiful, always dies hard. Let us move on

    OK, off to read your article now :)

    You must work-we must all work-to make a world that is worthy of its children -Pablo Casals Please support TREE Climbers for victims of child sexual abuse and exploitation.

    by SwedishJewfish on Tue Feb 26, 2013 at 02:02:30 PM PST

    •  Actually let me expand on this (4+ / 0-)
      Recommended by:
      Roxine, hepshiba, DaNang65, Lonely Texan
      Also it occurs to me that in the wider context, these quick-fix approaches are perhaps more palatable not just for insurance companies, but for society in general. Because as long as we can keep survivors "safe", we can keep them silent. We can pretend that the damage of psychological trauma isn't really that bad, if it can be cured with a few pills and therapy sessions. This seems to play right in to the hands of the predators mindset-that what he or she is doing isn't really harmful.
      The flip side of this-as long as we can stigmatize those who do not respond to treatment and label them as inherently flawed from birth, we can also keep them silent. And this plays into the hand of the predators mindset-that their victim was just asking for it.

      So everyone wins! Trauma isn't a big deal. Most people are easily cured, those who aren't were just freaks to begin with. Ergo, nothing to see here, move along.

      You must work-we must all work-to make a world that is worthy of its children -Pablo Casals Please support TREE Climbers for victims of child sexual abuse and exploitation.

      by SwedishJewfish on Tue Feb 26, 2013 at 02:13:01 PM PST

      [ Parent ]

      •  This does sum it up rather concisely :-/ (4+ / 0-)

        And that's an underlying point that I'm wrestling with all the time.  The whole culture is built on perpetrating violence against specific populations, and the drive to prevent that violence is always already political. Violence prevention isn't some barrier we throw up to protect people.  It's actually a form of revolution -- power has to change hands before it can happen.

        "If you fake the funk, your nose will grow." -- Bootsy Collins

        by hepshiba on Tue Feb 26, 2013 at 02:16:37 PM PST

        [ Parent ]

        •  Yes, this!! (3+ / 0-)
          Recommended by:
          hepshiba, DaNang65, Lonely Texan
          he whole culture is built on perpetrating violence against specific populations, and the drive to prevent that violence is always already political. Violence prevention isn't some barrier we throw up to protect people.  It's actually a form of revolution -- power has to change hands before it can happen
          And as much as I've been struggling to grasp this enough to put it into words, I've started making those connections-there is so much intersection. Violence is the universal tool of enforcing oppression. It is, as you say, inherently political.

          This actually finally clicked for me during a recent project. I have been working on a diary series about the child victims of gun violence-tracking every victim in 2012, and every one since Sandy Hook as well. I placed all of them on a google map-every location of every child homicide or fatal gun accident that I could find reported. Quoting from my own diary draft here:

          In every case where it was possible, I placed pins on the exact location of the crime scene. This means that, through the power of street view, you can look into the world these children inhabit. You can see where they spent their last moments on earth. These glimpses serve more than a morbid curiosity-they allow you to see the world through the eyes of the child who died. The broader issues come into sharp focus-violence can happen anywhere, and you see the tony neighborhoods in which it sometimes strikes. But the landscape is overwhelmingly bleak, either isolated or oppressively crowded. These are places where no child should have to live, let alone die. It becomes clear that this is more than just a gun issue. It is a disparity issue. It is a racism and classism issue. It is the ugly offspring of our broken economy, and the hopelessness and despair left in it's wake. At it's core, this is about oppression.
          Another thing that struck me as I researched this: obituaries, headstones, funerals, newspaper articles. Not every child who dies gets these things. Many families are too poor to afford them. I can't even tell you how many times I had to read about car washes and other fundraisers being held in poor communities to pay for the burial of children.

          And then I started reading about shrines:

          It’s one thing to do to go to a funeral and sit quietly, but a shrine is a chance for people to really express their feelings in a more public way than a funeral,” explains director Steve James. “They serve a lot of functions for mourners, but they are also fleeting.”

          Once the funeral takes place, the police often remove the shrine. “Understandably,” James adds, “because if they didn’t, the shrines would be everywhere in some of these neighborhoods"

          And my mind instantly went to what I've read about the uncounted victims of drone strikes. How when and if journalists arrive on the scene of such a strike, most of the victims are already long buried.

          We "disappear" most victims of atrocities. It's a universal thing.

          You must work-we must all work-to make a world that is worthy of its children -Pablo Casals Please support TREE Climbers for victims of child sexual abuse and exploitation.

          by SwedishJewfish on Tue Feb 26, 2013 at 03:08:50 PM PST

          [ Parent ]

          •  Disappearing and dehumanizing (3+ / 0-)

            are about preserving our own beliefs about how the world works at the expense of others, despite overwhelming evidence that our beliefs are fallacious.  The horror of it is that so many of us are willing to let other people die — or even to actively kill them — so that we don't have to face the consequences of our own actions or see ourselves clearly in the mirror.

            "If you fake the funk, your nose will grow." -- Bootsy Collins

            by hepshiba on Tue Feb 26, 2013 at 03:21:34 PM PST

            [ Parent ]

            •  OK, can I steal this? (4+ / 0-)
              Recommended by:
              hepshiba, DaNang65, Lonely Texan, a2nite

              lol! You just said it so perfectly.

              Another example that sprang to mind just now-how rape was used to oppress black men, women and children during slavery and in the antebellum south. The rape of black women and children used as a tool to dehumanize and humiliate them, often in front of black men who were forced to stand by helpless. The portrayal of the black man as a sexual predator, used as a justification for lynchings.

              Rape itself is always a dehumanizing experience. And black women who were victimized never saw their perpetrators brought to justice. If they even tried to report being raped, they were usually subjected to further degradation by the police. Dehumanizing and disappearing.

              Black men who were lynched were usually made into a public spectacle first-and nothing gets more dehumanizing than the torture and death of a human being as a form of entertainment. And of course, they ultimately ended up dead. Dehumanizing and disappearing.

              The stereotypes used to keep these myths alive-to justify both forms of violence (the black woman as a Jezebel, the black man as a super predator) enabled those beliefs to be preserved. Rape doesn't exist-these women were whores. Lynching is justice-these men were predators.

              I can think of so many modern day examples of this-from how we treat combat vets with PTSD, rape victims, prisoners, the mentally ill, protesters, the list goes on and on...

              You must work-we must all work-to make a world that is worthy of its children -Pablo Casals Please support TREE Climbers for victims of child sexual abuse and exploitation.

              by SwedishJewfish on Tue Feb 26, 2013 at 03:49:47 PM PST

              [ Parent ]

              •  You are welcome to it! (3+ / 0-)
                Recommended by:
                SwedishJewfish, Lonely Texan, a2nite

                And don't forget that African American men were also sexually humiliated and abused in a slave system, and in a system that justified and excused lynching (which often included sexual torture). Just as helpless and disempowered men are brutalized today, as children, and as adults trapped in oppressive systems that dehumanize them, like prisons or some schools and churches. Patriarchy may be the bedrock on which rape cultures are built, and feminization may be the language of brutalization, but no one without power is immune, male or female.

                "If you fake the funk, your nose will grow." -- Bootsy Collins

                by hepshiba on Tue Feb 26, 2013 at 04:23:23 PM PST

                [ Parent ]

  •  This comment would have been posted sooner (2+ / 0-)
    Recommended by:
    Lonely Texan, hepshiba

    but I spent most of the day dealing with a family whose son and brother is on dialysis and contracted double pneumonia. He is now in intensive care. He has tried since 1971 to get help and a disability rating from the Veterans Benefit Administration.

    While he has been diagnosed with a panic disorder, he also has post traumatic stress in my opinion.

    In the 20+ years I've been helping veterans with PTS, it seems to me that peer counseling has helped most of them through the first stage of coming to terms with their problems. That stage is one where not only do they accept the fact that they have Post Traumatic Stress, but that they can live in spite of it. VA is not buying into my contention . . . yet.

    The next stage is discovering their triggers. That's where professional help is required - and mostly beneficial in one-on-one sessions. For some people many of the new techniques seem to work and give relief for brief periods of time.

    The third stage, I think, is learing how to manage their Post Traumatic Stress.

    Those who fought the war in Afghanistan won it. Get them out of Afghanistan NOW . . . It's long past time. Those who want to wage the next war in Afghanistan are condemned to lose it.

    by llbear on Tue Feb 26, 2013 at 07:08:57 PM PST

    •  Sounds like a tough day... (0+ / 0-)

      I agree that peer counseling is a good option -- I wish more studies of its effectiveness existed, but I suspect that it plays the same valuable role as community and social support. And I also agree that the trauma focused therapies do relieve symptoms in the short term for many people -- lasting relief, though, is harder to find, as you point out, and requires managing the condition.

      I do wish the VA would listen to you, but their structure and mission make it unlikely.

      "If you fake the funk, your nose will grow." -- Bootsy Collins

      by hepshiba on Thu Feb 28, 2013 at 11:19:54 AM PST

      [ Parent ]

  •  Excellent diary (1+ / 0-)
    Recommended by:
    hepshiba

    Thank you for this.

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