PTSD: The pain of reliving trauma years after the event

Tags

anxiety, Depression, dissociation, flashback, Memory, PTSD, rape, Refugees, reliving, sexual abuse, stress, Therapy, Torture, trauma, war

http://blogs.independent.co.uk/2012/03/29/ptsd-the-pain-of-reliving-trauma-years-after-the-event/

One of my first experiences of PTSD came as a psychologist working with African and Kurdish refugees.

Many had fled oppressive regimes and been referred to our service by their GP suffering severe anxiety, depression and stress. We discovered the root of the problem often lay in terrible personal experiences including rape, torture and witnessing the murder of loved ones.

These mental scars have a long and insidious reach in the shape of PTSD whose victims can repeatedly relive a traumatic event years after the original incident took place.

I remember my shock the first time I worked with a woman who, as she described what had happened to her, lost all sense of where she was. She verbally and physically tried to fend off an imaginary attacker as well as crying and shaking with fear as part of her episodic ‘flashbacks.’

The problem can be complicated by people having great feelings of shame and guilt about what happened as if they were somehow to blame. PTSD’s victims can also include perpetrators of violence who, on reflection, feel enormous regret for their actions.

Soldiers are the most high profile casualties of PTSD but it is even more prevalent among the civilian population.

It can affect anyone involved in a near death experience and includes ‘single incident’ traumas, such as a car crash, earthquake or tsunami.

The recent sinking of an Italian passenger ship that made headline news is another example as were the terrorist bombings on London’s transport network.

It’s important to recognise that PTSD symptoms are a perfectly normal part of the healing process when they occur immediately after a trauma. Our mind is often too pre-occupied with survival to process what happened at the time so revisits the experience helping us make sense and gain perspective on what happened. In the normal process of producing memories the mind knits the various strands of an experience together based on our senses, such as sight, sound, touch and taste as well as other aspects of what we were experiencing at that time.

It also puts a ‘date stamp’ on the memory so we know when and where something has happened. When a trauma is occurring the mind is using all of its energy to keep us alive so memories often don’t get properly formed.

In the hours, days and weeks following the trauma bits of the semi-formed memory will ‘pop’ into consciousness. This can be upsetting but gives the mind the opportunity to link the various fragments together to form a normal memory.

In cases of PTSD, the healing process effectively gets stuck and, like a scratched CD, the mind repeatedly replays the trauma.

This produces a vicious circle in which the distress generated by the memories continues to stop the brain’s ability to process the memories to a level that they cause less discomfort. As a result, patients find themselves vividly reliving the experience over and over with the same intense feeling of fear they experienced during the original incident. These ‘flashbacks’ can be triggered by something that the victim associates with the original trauma, such as a sound, colour or smell.

Sensory triggers can create powerful positive and negative anchors in our minds. You could be having a bad day at work when an old friend rings and your mood switches in an instant because the sound of their voice triggers a past association of feeling good. Likewise, hearing a favourite song on the radio often makes you feel better because you associate it with a previous experience of wellbeing.

This is also true of traumatic experiences, particularly when the ‘date stamp’ has not been associated with the memory so rather than being reminded of the events it can feel exactly as if they are happening again.

A refugee suffering PTSD may link the sound of footsteps echoing down a corridor with those of events years before when their protagonist came to torture them. The smell of burning rubber and smoke may bring back the experience of watching the family home burnt to the ground by soldiers or a family member killed in front of you.

PTSD creates a vicious circle in which the distress caused by the partially formed memories stops the brain from processing them to a level where they are less intrusive. This round-robin can lead to a number of associated conditions including anxiety, depression and stress as well as ‘avoidance’ where someone will increasingly isolate themselves to avoid triggering a flashback.

Flashbacks or vividly ‘re-living’ aspects of past events are one upsetting response to trauma. Another is ‘disassociation’ where the victim’s mind psychologically removes them from an experience. This can be emotionally protective at the time but if this dissociation happens when memories of the trauma are triggered it can be hugely upsetting and disruptive to normal day-to-day life. People experiencing this can often ‘lose’ pieces of time from their day and have no recollection of what happened to them unless someone tells them.

In our clinical work we tend to see this type of response in people who have gone through repeated trauma as a child, such as prolonged periods of sexual or physical abuse.

You can imagine that to ‘remove’ themselves mentally may be the only way that a child is able to escape what is being done to them. It serves to protect the child when nothing else can but also leads to problems later in life.

Medication can help reduce stress in some patients but the main treatment for PTSD is a ‘talking therapy’ in which the patient works with the therapist to help their mind find a way process the bits of trauma memory in a more complete way.

A number of question marks remain. Why are some of us more resilient to the effects of PTSD than others? And what role do the corrosive effects of guilt, grief and shame have on recovery?

It is an often distressing area to work in as a therapist but also incredibly rewarding in helping patients first understand what is happening to them and then interrupt the cycle of PTSD symptoms.

It is, for some, the start of the long journey back to more ‘normal’ day-to-day life helping them regain control over aspects of their lives they thought they may have had lost forever.

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Bully: Documentary Film

Tags

Bullying, Children, documentary, film, parents, suicide

More info:

http://www.huffingtonpost.com/marlo-thomas/bully_b_1382354.html?ref=uk

I’m not a movie reviewer, but I strongly recommend that you take your child by the hand this weekend — or several children — to see the new documentary film, Bully. The only problem is, you might not be able to find the film at your neighborhood cineplex. That’s because the Motion Picture Association of America has stamped the film “Unrated,” after a long and noisy battle over its original R-rating. So now it is up to the individual theatre owners to decide whether or not they will exhibit Bully. I urge them to do so.

But make no mistake, even if you have to drive your kids across state lines to see the film, your kids need to be in the audience — because, whether you know it or not, they may be among the 13 million American children affected by bullying every year. For them, this is more than just a movie. It is real life.

And in this real life, parents have been all but invisible — invisible in the school cafeteria, invisible on the playground, invisible on the school bus and online — unwittingly abandoning their children to face this torment alone. The film makes this painfully clear, whether it’s the dad who confidently recites that timeworn rationalization about bullying — “Kids will be kids” — or the school administrator who blindly insists to a worried parent that her students are “good as gold on that school bus” — intercut with a clip of a small boy being choked on that very bus. We come away from Bully feeling defeated and enraged.

Interestingly, the MPAA’s controversial decision about the film’s rating — based on its use of profanity and other violent language — could end up working in the children’s favor. Research indicates that bullied kids are not comfortable revealing their dangerous predicaments to their parents. But now that the rating has forced kids to see the film with an adult, the movie can do the revealing for them. And children will at last feel their parents there, by their side, seeing and understanding what it’s like to leave their house and wander unprotected into a scary world.

Adults may be horrified by what they see in Bully, but the kids know this world all too well. Directed by Lee Hirsch, the film captures the wrenching drama of schoolyard bullying — the hitting and harassing, the tormenting and tears, the grave suffering — in unflinching detail, as it zooms in on the daily battles waged by five bullied children, two of whom ultimately commit suicide. But sitting through the film will be worth every harrowing minute, especially to the children, whose only hope against this ever deepening crisis is the visible and vocal support of the adults in their lives.

The MPAA’s decision has incited a storm of protest. When Bully was first given an R-rating, a 17-year-old Michigan high-schooler, Katy Butler — who has been bullied herself — posted a petition on Change.org, demanding that the MPAA change the rating. When such high-profile and conscientious activists as Meryl Streep and Johnny Depp joined in the protest, the MPAA was effectively arm-twisted into changing the movie’s rating to a still restrictive “Unrated.”

But while all of this debate continues, the sad fact is: children are still dying at the hands of bullying.

This is why I am urging all adults — parents, guardians, caregivers — to take your kids to see Bully this weekend. I also encourage educators and school administrators to arrange school-wide field trips. Because if there’s one thing we’ve learned since launching our anti-bullying campaign last year — with the Ad Council, the Department of Education and funders like AOL, Facebook, the Waitt Family Foundation and the Free To Be Foundation (who have been major funders of the Bully Project) — it’s that, if we are ever to eradicate this deadly, modern-day scourge, we need to face the problem head-on — and together.

Working with Interpreters in Healthcare Settings

Tags

Interpreters, Refugees, Therapy

GPs devise new treatment to beat depression. It’s called gardening

Tags

anxiety, Depression; Gardening, Exercise, stroke

http://www.independent.co.uk/life-style/health-and-families/health-news/gps-devise-new-treatment-to-beat-depression-its-called-gardening-7584583.html

Doctors are to swap pills for the potting shed under plans to prescribe gardening on the NHS as a way to help patients beat depression.

Time spent planting, pruning and propagating can be more powerful than a dose of expensive drugs, according to Sir Richard Thompson, president of the Royal College of Physicians.

He claims the Government’s health reforms will give GPs more choice in how to treat patients, and allow them the freedom to embrace the physical and mental health benefits of horticulture.

“Drug therapy can be really expensive, but gardening costs little and anyone can do it,” said Sir Richard, who is a patron of Thrive, a national charity that provides gardening therapy.

The idea is the latest in a long line of offbeat ideas aimed at improving the nation’s health, from dance lessons that can combat obesity to sending depressed people on camping trips. Under the coalition’s health reforms, clinical groups led by GPs will commission services and Sir Richard, who spoke out in favour of the changes, believes patients could benefit more from gardening classes than extra medication.

“I have, for some time, thought doctors should prescribe a course of gardening for people who come to them with depression or stroke,” Sir Richard said. “The new commissioning structures about to be introduced might allow more innovative treatment approaches to be put in place, including the opportunity to try gardening rather than prescribe expensive drugs.”

Too often, appointments are rushed and doctors are unable to spend time talking to their patients. “There are definite benefits to longer consultations – I would much rather a doctor had time to listen to patients and, instead of prescribing anti-depressants, prescribe a course of gardening.”

Half an hour spent working in the garden can burn off some 200 calories, according to a study published last year. Sir Richard added: “I always wonder why people go to the gym when there is a ‘green gym’ outdoors for us all – and, what’s more, it’s free. Gardening burns off calories; makes joints supple and is fantastic exercise. It is a physical activity that has been shown to be helpful in the treatment of anxiety, depression and dementia.”

Ian Rickman, who suffered a stroke at the age of 40 which left him paralysed down one side, has since been helped by Thrive.

He said: “At first, I burst into tears a lot. I couldn’t see a way I would ever be able to live my life again, to walk out into a garden, let alone work in a garden. Therapy through gardening is a powerful tool – it helped me come to terms with my stroke, and it helped me learn how to live again.”

The idea of gardening as a therapy is gaining high-profile backing from other quarters. The TV presenter Alan Titchmarsh has hailed horticulture for being “great as a therapy” that can “make a real difference to disabled people’s lives”. And the Health minister Paul Burstow added: “There is plenty of evidence to show the benefits of exercise on people’s health and well-being. I’m sure gardening brings those benefits.”

Just the job: How you can enjoy the health benefits of gardening this weekend:

Seedy business Sow vegetable seeds such as carrots, turnips, radishes, rocket and lettuce outside, and try some herbs in pots or trays.

First cut Take advantage of the warm weather to fire up the mower for the first time. It will help create a denser carpet for the summer.

Dead ends Finish pruning any roses, and remove dead leaves and old stalks from perennials. Cut back ivy.

Carry the can Consider buying a water butt: it may be a long dry year.

Water works Clear ponds and reinstall pumps and lights.

Heatwave Enjoy the sun!

Sniffing device allows paralysed woman to communicate

Tags

Locked-In Syndrome, paralysis, stroke

2010:

http://www.guardian.co.uk/science/2010/jul/26/sniffing-device-paralysed-woman-communicate?INTCMP=ILCNETTXT3487

A 51-year-old woman who was left paralysed and unable to communicate following a massive stroke has written for the first time in seven years, scientists say.

The Israeli patient, who was diagnosed with “locked-in syndrome”, typed an emotional email to her six children using a revolutionary device that is controlled by sniffing.

The woman was so badly brain-damaged by the stroke that she cannot move any of her limbs or even blink in response to simple questions. She wrote the letter within a few days of being taught how to use the device.

The technology, developed by scientists at the Weizmann Institute in Rehovot,Israel, is now being used by other severely disabled people to surf the internet and even control a wheelchair. One, a 63-year-old quadriplegic woman who can barely speak, wrote her first letter in 10 years with the device and has started using it to send emails.

“The most moving thing has been witnessing this technology give people a means of communication when they haven’t had it,” said Noam Sobel, a neurobiologist at the institute, who helped develop the technology.

The device works by detecting slight changes in pressure that are produced when a person opens or closes their soft palate, the tissue at the roof of the mouth that controls air flow through the nose. Many patients with serious disabilities are still able to move their palate voluntarily, and so can use the device, said Sobel.

When the sensor is connected to a computer, a person wearing the device can use sniffs alone to select letters on the screen and build up words, phrases and sentences.

One patient, a 42-year-old man who was diagnosed with locked-in syndrome after a car crash 18 years ago, used the sniff-controlled device to say he preferred it to a previous disability aid that performed a similar function by tracking his eye movement, writing that it was “more comfortable and more easy to use”.

The speed at which patients can write with the new device varies between around 20 seconds and a minute for a single letter of the alphabet. The 1997 book, The Diving Bell and the Butterfly, was written by Jean-Dominique Bauby at a rate of roughly one word every two minutes. Bauby, who became locked-in after suffering a stroke, selected letters by blinking his left eye.

In another test of the device, a 30-year-old man who was paralysed from the neck down in a car accident six years ago, used the device to steer a motorised wheelchair along a winding path 30 metres long. After one trial attempt, the patient completed the course as fast as healthy volunteers.

Sobel said he was anxious what locked-in patients might write after being unable to move or communicate for so long, but he said none wrote about wanting to end their own lives. “I was afraid that the minute we could communicate, all that might come out,” he said. “What’s important is giving the person the ability to express themselves.”

The findings are published in the latest issue of the Proceedings of the National Academy of Sciences.

How joggers can help the housebound

Tags

elderly, Exercise, Housebound, stroke

http://www.guardian.co.uk/lifeandstyle/2012/mar/04/good-gym-exercise-community-work

Every Thursday evening, whatever the weather, Harriet Cawley runs two-and-a-half miles from Shoreditch, east London, to the home of her coach, Michael Mulcahy. Cawley regularly undertakes half-marathons but this is no ordinary training session. Mulcahy is a house-bound widower who enjoys receiving a London Evening Standard from Cawley and having a chat for half-an-hour. After which, Cawley runs home again.

Cawley is a member of the Good Gym, a not-for-profit organisation that encourages people to combine their exercise regime with a spot of social care, matching busy workers with elderly “coaches”, who receive a daily paper or other modest delivery and, in turn, provide an incentive for their weekly visitors to keep on running. Set up two-and-a-half years ago, the Good Gym is this year expanding across all Olympic boroughs, part-funded by the Olympic Park Legacy Company.

The Good Gym was the brainchild of Ivo Gormley, 29, who discovered that combining a weekly run with a visit to a housebound friend of the family was just the motivation he needed to keep him exercising; it helped that his elderly friend was a former boxer who could offer training tips. As Gormley did his prescribed situps, he thought about how best to link up a series of very modern disconnects: how few people have the time or energy to volunteer and yet use gyms to burn off excess energy; and how little dialogue there is between working people and the elderly, particularly in densely populated urban communities.

“Gyms are this ridiculous invention,” says Gormley. “People have got too much energy and go to these weird places where they get purged of it by machines. I thought we could channel the energy from people’s exercise into something more productive.”

Through working with the NHS, charities and local community centres, including The Sundial Centre in Bethnal Green and Toynbee Hall, the Good Gym matches runners with an individual coach – a housebound elderly person who would like a regular visitor. They are encouraged to take a newspaper or a modest gift to the value of £1.

There are also monthly group runs around east London, to perform useful activities along the way. So far Good Gym members have distributed flyers for a local hospice, tidied up community gardens and hauled compost on to a school roof. Two runners are now being sought for a somewhat unusual task: taking donkeys from Stepney City Farm for a trot. (The donkeys need the exercise to keep their hooves down; donkey handling training will be provided.)

Cawley, 38, a costume stylist, heard about the Good Gym through Twitter. “It seemed such a brilliant idea,” she says. It took four months for her to be checked by the Criminal Records Bureau (the Good Gym now uses a company to speed up this process and claims it takes just a couple of weeks), then she was assigned Mulcahy to run to, based on the distance she requested.

Having a break in her running works well from a training point of view: she does a speed run to Mulcahy’s house, rests there, then a does a more gentle, warm-down jog on the way home. Cawley is from Stockport and has no grandparents in London, so enjoys chatting to her elderly coach – “someone I would never have met,” she says. While the Good Gym advises runners to stay for about 10 minutes, Cawley sometimes chats to Mulcahy for an hour. Although he has family, and regular visits from professional carers, Cawley thinks he enjoys a visit from someone who does not worry like relatives and is not there out of professional duty. She didn’t really know what he made of “this random person turning up and chatting to him” until she told him she was going away on holiday. “He said: ‘I’ll really miss you.'”

Terry Duncan, 67, a retired printer from Stepney, uses an electric wheelchair after a stroke. He is regularly visited by Sally, another Good Gym member. “It’s lovely. I look forward to her coming,” he says. He played football when he was younger, but is not sure how much use he is as a coach. “I don’t coach her,” he says. What about a mid-run cup of tea? “She normally has a glass of water. She’s a bit hot and sweaty but sits down and has a chat. We’ve become good friends.”

Duncan has recommended the Good Gym to several immobile neighbours, but says they are “a bit dubious about strangers coming into their house”. Despite these fears, the Good Gym is expanding, with interest in Edinburgh and a Good Gym run in Chicago. Most significant this year will be its Olympics expansion. As organisers hope the Games will leave a more enduring legacy in east London, Gormley wants his enterprise to become a social norm for the young professionals moving into the new housing around the Olympic Park. “It’s an amazing opportunity to shape the culture of a new area,” he says. “And link it to the existing community.”

International criminal court to deliver its first judgment

Tags

Child Soldiers, DRC, Genocide, Tribunal, War Crimes

http://www.guardian.co.uk/law/2012/mar/13/international-criminal-court-first-judgment

Nearly a decade after its inception, the international criminal court is due to deliver its first judgment on Wednesday.

Thomas Lubanga, a Congolese alleged warlord, stands accused of enlisting and conscripting child soldiers.

Prosecutors allege that Lubanga, 51, sought to maintain and expand his control over the eastern Democratic Republic of the Congo‘s Ituri region, home to one of the world’s most lucrative gold reserves.

Children as young as 11 were allegedly recruited from their homes and schools to take part in brutal ethnic fighting in 2002-03. They were taken to military training camps and beaten and drugged, prosecutors claim, while girls were used as sex slaves.

Lubanga, the alleged founder of the rebel group the Union of Congolese Patriots (UPC) and chief commander of its military wing, went on trial in January 2009. Closing arguments were heard last August. Lubanga pleaded innocent to charges of war crimes.

Wednesday’s verdict will be closely watched by global rights groups. Géraldine Mattioli-Zeltner, the international justice advocacy director at Human Rights Watch, said: “Guilty or innocent, the ICC’s first verdict is a landmark moment for international justice. Leaders of countries and rebel groups should take note that crimes committed today may put them in the international dock tomorrow.”

The ICC, the world’s first permanent war crimes tribunal, opened in July 2002 to prosecute the perpetrators of genocide and crimes against humanity.

But progress has been too slow in the eyes of critics. Lubanga, seen as a relatively “small fish” compared to the likes of President Omar Hassan al-Bashir of Sudan, was first transferred to the ICC headquarters at The Hague six years ago.

William Schabas, professor of international law at Middlesex University, told Reuters: “The prosecutor is woefully behind schedule. We are all relieved we got to this point.

“But the big legal judgments, of the kind we had at the Yugoslav, Rwanda and Sierra Leone tribunals, we are still waiting for from the ICC right now. The ICC has not yet done that.”

Backed by 120 countries – but not China or the US – the ICC has launched investigations in seven conflict regions, all of them African, since it opened.

Schabas criticised the lead prosecutor, Luis Moreno Ocampo, for a narrow focus. “He avoided situations where he would be likely to step on the toes of permanent members of the UN security council, from Afghanistan to Gaza to Iraq to Colombia.”

The court has no police force and relies on the support of states to deliver suspects for trial. Last December Ivory Coast’s Laurent Gbagbo became the first former head of state to appear at the ICC.

The verdict due from a three-judge bench on Wednesday is also the first at an international trial focused exclusively on the use of child soldiers.

The case will set legal precedents that could be used if the likes of Joseph Kony, the elusive leader of the Ugandan rebel group the Lord’s Resistance Army, are captured and brought to justice.

Tragic end of the boy who was brought up as a girl

Tags

Gender Identity, Hermaphroditism, suicide, surgery

2004:

http://www.independent.co.uk/news/world/americas/tragic-end-of-the-boy-who-was-brought-up-as-a-girl-6170071.html

Two weekends ago, 38-year-old David Reimer told his parents in their shared hometown of Winnipeg, Canada, that although he was going through a rough patch – recovering from the death of his twin brother two years ago and from his separation from his wife – things would getter better very soon. He didn’t explain how.

Now his family knows. On 4 May, Reimer took his own life. While his recent ills surely contributed to the despair, his mother knows there was more to it than that. His death was the final coda to a life that became a world-renowned case study in the perils of tampering with gender. During the span of his life he had been a boy, then a girl and then a boy again. “I thought I was an it,” he once said.

The wrenching story of David (baptised as Brian) Reimer began with a freak snowstorm in 1966. His parents, working-class people from the plains of Manitoba, drove him to the local hospital for a routine circumcision. He was eight months old. But the regular surgeon had not made it in and an assistant took over. She botched the job. A cauterising implement burned David’s penis – and it fell off. A witness later said that when the mistake was made there was a sizzling sound, like a steak being seared.

Left with a child with testicles but no penis, his parents were unsure what to do. Then, one day when the boy was more than a year old, they learned about a doctor in Baltimore who had gained a reputation of helping people of ambiguous gender. His name was John Money and they went to see him.

It was Money, a native of New Zealand and the author of some 40 books on human sexuality, who persuaded them that the best course of action was to transform their son into a daughter. He recommended surgery, including clinical castration, and hormone treatment to turn young Brian into a girl. His parents agreed and the treatment began. Brian became Brenda and long trousers gave way to skirts.

For Money, who had pioneered studies in sexology at Baltimore’s prestigious John Hopkins University, it was an irresistible challenge. He was a main proponent at the time of the theory that was briefly popular in the Sixties and Seventies, that gender identity was not necessarily predetermined in the womb. It was more about environment. In the controversy that still rages today over the balance between nurture and nature in determining our sexual selves, Money was a hero of the camp favouring nurture.

Better still for Money, the Reimer case offered an unheard-of opportunity to prove his theory. The patient had an identical twin brother, who was indisputably male. He had an experiment, therefore, with a readily supplied control subject. Two human beings conceived in the same womb with the same genetic profile. But nurture, with help from the knife and some pills, would demonstrate how their gender paths could be separated for ever.

And all seemed to go well. All remnants of Brenda’s male genitalia were gone and her parents did all they could to raise her as a daughter. All the while, the so-called John/Joan case, expounded with pride by Money, a fine writer and charismatic lecturer, was celebrated by science and sociologists everywhere. The gender-fixing procedure was adopted at hospitals worldwide. And the Money theory was also embraced by the then burgeoning feminist movement as proof that social expectations of gender were misplaced. The male-female axis, they declared, was not set in stone. It was fluid and dynamic.

The John/Joan case also helped inform treatment of hermaphrodites, who are born with genitalia so ambiguous that hospitals cannot determine whether at birth the babies are boys or girls. In the vast majority of these cases, parents are told that their children should be raised as girls. Meanwhile, Money’s reputation continued to grow. Considered one of the world’s leading sexologists, his books included The Breathless Orgasm(1991), Venuses Penuses (1986) and Gay, Straight and Inbetween (1988.)

But things in the Reimer household were not as people imagined. It was only in 2000 that the true story of Reimer’s experience reached a wide public. By then, out of dresses and bras and back in the world as a boy, Brian – by then renamed David Reimer – had decided that enough was enough. The truth had to be told. By going on Oprah Winfrey’s show and collaborating on a book with a well-known New York journalist, he revealed that Money had consigned him to a childhood of humiliation, confusion and misery.

“David was a hero,” said Milton Diamond who collaborated on the first scientific papers to expose the disaster of the John/Joan case. Commenting on his death, he said: “David didn’t give permission for what was done to him. Even though he didn’t have a penis, he still knew he was male.”

It was when Reimer was 13 and in therapy with a counsellor provided by the Winnipeg school system that he learned for the first time what had happened to him. Already he had been stigmatised by fellow classmates. They had seen his ungainly gait, the muscles that, despite the removal of his testicles, had begun developing on his neck and arms, and his lack of interest in boys. “They wouldn’t let him use the boys’ washroom or the girls’,” his mother, Janet Reimer, recalled. “He had to go in the back alley.”

That was when he rebelled, demanding that he be allowed to go through more surgery to restore his manhood. It was a transition that would be traumatic for any person, let alone someone in their early teens. The breasts that had developed because of the hormone injections were removed by mastectomy. And he opted for reconstructive surgery to build back the penis of which he had been robbed after birth.

The debunking of what Money had wrought first began with the publication of the paper written jointly by Diamond and also Dr Keith Sigmundson, who was the supervising psychiatrist for Reimer from the age of eight until 20. Published in the relatively obscure Archives of Pediatric and Adolescent Medicine in 1997, it outlined Reimer’s rejection of being a girl.

“By the time Reimer was 11, the whole experiment was falling apart,” noted Sigmundson. “From that point on he sought out all the surgery. He totally changed how he was presenting himself and struggled with a number of operations. He eventually lived his life as a man.”

Sigmundson added that the case should serve as a caution to those still drawn to the nurture over nature idea. “There are certain immutable things that happen in your chromosomes andin utero that develop the gonads that have an impact. Reimer didn’t adjust well to being a girl at all and began having difficulties at school.”

Most experts today contend that there is no overriding the gender determinants that are in a person before birth. But that does not mean that environment does not play some part. “The Reimer case has taught a lot of people in the field that things are a lot more complex when it comes to gender than people originally thought 30 years ago,” argued Ken Zucker, who is chief psychiatrist at the Toronto Center for Addiction and Mental Health.

“Where we’ve really had a lot of advances is in recognising biology has a predisposing influence on gender identity and gender roles. But the environment is also important.”

Diamond was shocked by the news of Reimer’s death. But he hoped lessons had been learned. “His life was very difficult. I think the legacy is the whole issue of how people identify and see themselves as male and female. It’s not as simplistic as putting people into blue rooms and pink rooms. Certainly our environment makes a difference and how we’re brought up makes a difference. But we come to the game with our own inherent natures and how those things interplay can’t be predicted.”

It was the book, written with Rolling Stone journalist John Colapinto, entitled As Nature Made Him: the Boy who was Raised as a Girl, that brought the calamity of Reimer’s situation to the attention of the world. He was inspired to write it after seeing an account of the Diamond-Sigmundson paper in the New York Times. Colapinto cast Money as the villain of the story, although the doctor, who is now 83, never publicly responded to it. The appearance with Oprah Winfrey coincided with its publication. “I thought the Reimers were just the most dignified, fantastic people,” Colapinto commented in an interview at the time. “I think in a way these wonderful working-class people from Winnipeg just kind of stepped onto the world stage onOprah and were a lesson to us all in dignity and survival and openness and courage.”

“Scientists had just relied on this case as being a precedent for the fact that you could assign the sex and gender to children,” Colapinto added. And his book had a strong impact. “Those who believed that and taught it and based their clinical practice on it, and who actually performed similar procedures, were scandalised.”

The same sense of scandal was what drove Reimer to collaborate with the journalist and expose his pain to the world. He was angry about what had happened to him and by the discovery that Money’s tampering with him was being replicated in clinics and hospitals around the world. He wanted it to stop.

“I was surprised that other people wound up going through what I had, because of my so-called ‘success story’ that wasn’t so much of a success,” he said. “You were expected to wear girl’s clothing and to behave in a certain manner and you were expected to play with girl’s toys.” But he never believed he was a girl. “I thought it was very ignorant for them to think I was no longer a male because my penis was burned off. A woman who loses her breasts to cancer doesn’t become any less of a woman.”

His family is left now to grieve for a loved one who was subjected to such humiliations without his consent. For a while, there had been hope that he had put his life back on the rails. While the years of treatment had given his features the fine lines of femininity, he was widely accepted in Winnipeg as a man once more. He got menial jobs and finally found a wife. He became stepfather to her three children.

The loss of his brother, his family said, hit him hard. His twin had also taken his own life and for the past two years, David had made the pilgrimage to his brother’s grave every day to arrange fresh flowers. Then the wife with whom he had established the traditional male role walked away, with her children. He slumped into depression. Worse came soon after when he lost his job. His mother, Janet, came closer than anyone at the funeral last Sunday to blaming Money for what had happened to her child.

“He was a hero,” she whispered to a reporter. “He showed the doctors, he was a worldwide hero.” Asked why she thought he had finally taken his own life, she responded: “I think he felt he he had no options. It just kept building up and up.” His father, Ron, shook his head when approached by reporters and said he had nothing to add.

Janet, however, tried to pay tribute. “He was the most generous, loving soul that ever lived. He liked music. He liked jokes. He was a very funny guy. He was so generous. He gave all he had.”

Hoarding: The art of letting go

Tags

hoarding, OCD, Therapy

http://www.independent.co.uk/life-style/health-and-families/features/hoarding-the-art-of-letting-go-7562760.html

Oh, I wonder how that got there … What is it?” Layla Jade (not her real name) has picked up a folded silver chewing gum wrapper, that has fallen, somehow, onto her carpet. She holds it close to her face, squinting, trying to work out its origins and whether it can be salvaged. After a few moments she places it carefully onto a side table.

A glamourous-looking woman, aged 58, Jade is a recovering hoarder. She is a member of the UK’s first therapy group for hoarders, run by Orbit Housing Group, a community housing organisation based in Coventry. Her homely living room is now covered with comfy cushions and cat-themed knick-knacks, but it was once almost uninhabitable. A narrow path from here to the kitchen and on to the bedroom was forged through towers of clutter, piled high in each room.

“I can’t throw anything away. I’m just sentimentally… I’m attached to everything.” She sighs. “It could be a piece of paper a friend has written on and I won’t get rid of it.”

Each object here has a story, from the print of Jack Vettriano’s “The Singing Butler” hanging in the bedroom – a whimsical scene of a couple dancing in formal wear on a beach, given to her by her mother for Christmas – to the bejewelled ruby lampshade, purchased on a whim on the way to a blood test at the local hospital, to the less practical things, like her collection of 22 dressing gowns, mostly in animal prints, or the pile of perfumes that she has owned for 40 years and never used. “I have all this, it’s perfectly nice, but I won’t use it and I can’t get rid of it. When I think about throwing things away, I think, ‘but I got that when I was at so-and-so place,’ or, ‘my ex brought me that.’ Oh, if I could get him out my head…”

There is surprisingly little research available on hoarding, so little that the current version of the Diagnostic and Statistical Manual of Mental Disorders (the psychologist’s bible) doesn’t recognise it as a disorder in its own right, merely a possible symptom of obsessive-compulsive disorder (OCD). But new research has shown it is a separate problem and its sufferers will show “persistent difficulty discarding or parting with possessions, regardless of the value others may attribute to them”. Jade’s distress at the thought of throwing things away is a symptom that’s very hard to overcome. The limited data available says hoarding affects around three per cent of the population, although this seems a conservative estimate, as hoarders tend to be very secretive about their hoarding and only those who admit to it and seek help can be monitored.

“Clutterers don’t like to be called hoarders. It makes you think of an old miser,” says Arthur Porter, 63, during the group therapy session, “we’re not greedy or anything like that.” Porter has “what is termed as high-performing clinical depression”, he explains. Like Jade, whose difficult marriage and persistent depression led to agoraphobia and then hoarding, he also has a collection of different, yet interrelated, problems. His father was bi-polar and also a hoarder. After Arthur’s father died, he found bits of wood and thousands of rolled-up plastic bags in the loft, one inside the other. Right in the centre of the layers of bags were rolls of old one-pound notes from 1982. “I’m like him, but he was better with plastic bags. I think it’s genetic,” says Porter.

It could indeed be genetic, says Gail Steketee, a professor at Boston University School of Social Work and an expert in researching the disorder. “We know that there does seem to be a genetic link, but so far, we don’t have good information about whether hoarding is more likely to occur in someone who grew up in a hoarded home, but was not genetically related,” so it could also be a learnt behaviour.

Arthur certainly emulated his father. He collected plastic bags, but also books and DVDs. They piled up in his home until the piles became towers and the towers touched the ceiling. Then one day, “I had a little fire,” he says, “in a student cooker as the main cooker packed up.” The fire department arrived and saw there was just a foot-wide path to walk to some rooms in the house – others were blocked completely with his “collections” (over five tons of books and DVDs) and a “great load of plastic bags”. Porter was used to navigating through the mess, but the fire officials didn’t approve. “I said, ‘are you going to fine me?’.”

That’s when Orbit became involved. Porter attends the group session once a week, where he and the other members are assigned tasks like doing the washing-up or throwing away one DVD that they don’t like. It’s a very gradual, often frustrating process, but without it the members risk becoming imprisoned in their homes, not to mention the health and safety risks like vermin and blocking fire exits. “When Sheree [one of the Orbit helpers] went away, I went to pieces,” says Porter, with a nervous chuckle. “I need Orbit to cope. It’s someone there who knows where you are at.”

Another group member, Beverley Drummond, 60, denies she has a problem. “I’m not a hoarder, I’m a collector,” she says. “My mum died four years ago. She wouldn’t allow a DVD player in the house, but now I have my John Wayne and my Octonauts … OK I’ve got some DVDs but I’ve boxed them all up. OK, there are mice, but they’ve not caused me any problems.” A helper at the group interjects, saying, “And how many teddy bears have you got?”

“Well I collect them to cheer me up. I’ve cut down, though. I used to buy four a day, now I only buy them if they’ve got a nice face.” It transpires that Drummond has collections of calculators and mobile phones, too – in fact she collects anything that her mother used to disapprove of. Her collection of bears is close to 900 and growing, and the DVD collection caused a problem for the housing association because it filled several rooms; it was a safety hazard.

Orbit is working with a team of therapists and researchers from Coventry University to come up with a “toolkit” to give out to fire services and housing organisations across the country on what to do if they encounter a hoarder. Darren Awang, an occupational therapist working with the hoarders’ therapy group says that through its work, Obit has found that hoarding can be triggered when a controlling parent dies, as in Drummond’s case, and also by more general sudden traumatic events.

“Many local councils will try to empty the property when they encounter hoarding, but this can cause the hoarder inordinate distress and then they often revert back to the behaviour anyway,” explains Cathy Sharman, a staff member at the self-help group. She says it requires a more “long-term approach” and that a combination of methods is needed to help, because each hoarder is different.

Part of the reason hoarding seems more prevalent now is due to profile-raising shows, such as Hoarders, an American TV series that goes into hoarders’ homes, and Channel 4’s Cutting Edge series, which recently highlighted the problem in a documentary, called Obsessive Compulsive Hoarder. But another reason could be that the ready availability of cheap goods is actually triggering the impulse to hoard in more people than before. For someone who grew up with rationing, or in a poor family, it requires a totally different mindset not to be seduced by cut-price offers. So does today’s environment make it harder for hoarders?

“Yes, I think it does,” says Professor Steketee, “the media urges us to buy, buy, buy and markets are flooded with cheap items. We have become a throw-away society and many people react against this, wanting instead to save and repair, rather than be wasteful. Others are attracted to the colours, textures and shining objects. This cannot be helpful to people with even a slight tendency to hoard.”

Certainly, Jade’s love of disposable fashion will strike a chord with many people. “I feel I’ve got too much stuff, especially clothes,” she says. “It’s ridiculous, ordering it all out of catalogues when I know I’m not going out anywhere, I’ve got nothing to dress up for!” Then why, some might wonder, does she get it? “Because I look forward to it coming through the door.”

Although the group is helping them with their disorders, there is a sense that the compulsion to hoard will never completely die out. Jade will still feel sentimental about her possessions, Drummond will want to collect bears and Porter will continue his father’s legacy, maybe one day becoming as good as he was with plastic bags. It’s as essential and ingrained for them as going to work or doing grocery shopping. Plus, as Porter puts it, it’s not all doom and gloom. “It would take something out of your life if you just stopped,” he says.

App To Help Deaf Communicate Instantly

Tags

Deaf Community; App; BSL

http://www.huffingtonpost.co.uk/2012/03/12/app-helps-deaf-communicate_n_1338395.html?ref=uk

A computer programme that translates sign language into written text could revolutionise the lives of the deaf and hard of hearing, scientists said today.

The software, which can be used on portable devices and provides near instantaneous translation, would be the first of its kind.

Researchers at the University of Aberdeen hope the move will help young deaf people find work and communicate with colleagues.

Dr Ernesto Compatangelo, a lecturer in computing science at the university, said: “The aim of the technology – known as the Portable Sign Language Translator (PSLT) – is to empower sign language users by enabling them to overcome the communication challenges they can experience, through portable technology.

“The user signs into a standard camera integrated into a laptop, netbook, Smartphone or other portable device such as a Tablet. Their signs are immediately translated into text which can be read by the person they are conversing with.

“The intent is to develop an application – an ‘app’ in Smartphone terms – that is easily accessible and could be used on different devices, including Smartphones, laptops and PCs.”

The technology can be used with a range of sign languages including British Sign Language (BSL) and Makaton, and can be tailored to the individual user so it recognises terms that they use.

Dr Compatangelo said: “One of the most innovative and exciting aspects of the technology is that it allows sign language users to actually develop their own signs for concepts and terms they need to have in their vocabulary, but they may not have been able to express easily when using BSL.”

He said the technology could “transform the lives of all sign language users”, research into which has been funded by the Department of Business, Innovation and Skills to improve the lives of young deaf people over the age of 16 who are in education or training.

Dr Compatangelo continued: “The key intent is to enable sign language users of this age, and beyond, to overcome the communication disadvantage they experience, allowing them to fulfil their education potential and enter the job market.
“The personalised aspect of the technology is crucial to making this happen.

“For example, for a student who is being trained in joinery, there is no sign in BSL which means ‘dovetail joint’.

“A student using PSLT can create their own sign to mean ‘dovetail joint’ allowing them to communicate easily with their tutor or other students in their class, without the limitations imposed by communications solely with BSL.”

Scientists said the device could have other purposes, including allowing a person with limited mobility to control appliances in their home, such as opening curtains or changing the channel on their television.
The service is expected to be on the market towards the end of 2013.