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a1000shadesofhurt

Tag Archives: dissociation

Awareness during surgery can cause long-term harm, says report

10 Wednesday Sep 2014

Posted by a1000shadesofhurt in Uncategorized

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anaesthesia, awareness, consciousness, dissociation, muscle-relaxing drugs, operations, paralysis, sensations, surgery

Awareness during surgery can cause long-term harm, says report

At least 150 and possible several thousand patients a year are conscious while they are undergoing surgery in the operating theatre, according to a report which warns that some people suffer long-term psychological damage as a result.

In the vast majority of cases, patients have been given muscle-relaxing drugs that temporarily paralyse them, preventing them from warning theatre staff that they are awake. It happens most often during caesarean sections under general anaesthetic and during heart surgery.

A three-year investigation carried out by the Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland found that usually the experience of awareness was short-lived, at the beginning or end of the operation.

Half of those who were aware of what was happening to them were distressed by the experience, and 41% said they suffered long-term psychological harm. The sensations they experienced included tugging, stitching, pain, paralysis and choking.

Patients described feelings of dissociation, panic, extreme fear and suffocation. Some said they feared they had been entombed, buried alive or were dead.

Prof Jaideep Pandit, consultant anaesthetist at the John Radcliffe hospital in Oxford and one of the authors of the report, said the Royal College and Association had “recognised the problem officially for the first time”.

He said: “For a long time it has been a discussion on the periphery. This is real. We need to understand it and tackle it.”

Not all experiences were traumatising, he said. Some patients spoke of feeling removed from what was happening. The drugs did not cause unconsciousness but made them feel detached. Sometimes they felt this was acceptable, and Pandit said there was an unanswered question as to whether all patients would want oblivion during surgery or whether some might prefer pain-free awareness.

It was vital, however, he said, that patients are told before they have surgery that there is a possibility, however remote, of having some consciousness of what is going on.

Estimates of how often this happens vary, says the report. When patients are asked after surgery whether they had any awareness, one in 600 say yes. But only one in 19,000 will come forward to talk about it voluntarily after the surgery. That would put the numbers at between 150 and 4,500 a year.

The team looked at three million episodes where a general anaesthetic was given in a hospital and reviewed in detail 300 cases of awareness reported by patients.

In 97% of cases, patients received muscle-relaxing drugs as well as the general anaesthetic. This makes it harder for an anaesthetist to be sure the patient is unconscious.

Around 10% of cases were caused by drug errors. In some, the muscle relaxant had been given without the general anaesthetic, which meant the patient was fully conscious but paralysed throughout their operation.

Where that happened, says the report, there were organisational as well as individual errors. “These included ill-considered policies for drug management, similar-looking ampoules, poorly organised operating lists, high workload, distraction and hurriedness,” says the report.

“These patients were severely distressed and severely harmed in the long term,” said Pandit. The report recommends a checklist before surgery, which would require the anaesthetist to line up the drugs they intend to administer and point to each one in turn. Pandit said mistakes “seem to occur in a highly pressured environment”.

 

It’s time to listen to the voices in your head

08 Friday Nov 2013

Posted by a1000shadesofhurt in Uncategorized

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auditory verbal hallucination, dissociation, inner speech, trauma, voice-hearers, voice-hearing

It’s time to listen to the voices in your head

Hearing voices in your head when there’s no one around … that’s a sign of madness, right?

In the popular imagination voice-hearing is often viewed with fear and suspicion, frequently reified as a chaotic, corrupted symptom of illness. But that is changing, with a growing acceptance of voice-hearing as a profoundly human experience that can no longer be reduced to a mere symptom of psychiatric disorder. The work of Intervoice: The International Hearing Voices Network, and the enthusiastic response toEleanor Longden’s 2013 TED talk, which recounts her own journey to recovery from a demoralising psychiatric diagnosis, indicate the growing possibilities for people living with the experience to raise their voices with a sense of power and pride.

This movement towards a better public understanding of voice-hearing has been mirrored by an increased interest in the scientific issues it raises. In recent years, academics from such diverse disciplines aspsychology, philosophy, medical humanities, cognitive neuroscience, anthropology, theology and cultural studies have begun to reclaim it as a rich, diverse and complex human experience – one that offers abundant possibilities for scientific inquiry.

Take, for example, the idea that voices often relate to trauma or adversity, particularly those suffered in childhood. This view, which has found expression in the personal stories of many voice-hearers, has been supported by a growing body of scientific evidence. But why should traumatic experiences early in life lead many years later to the experience of hearing a voice, or what psychiatrists call an auditory verbal hallucination?

Recent investigations suggest that voice-hearing may provide fresh insights into traumatic memory, and how real-life conflicts become embodied in voices via dissociation (a defensive psychological response to trauma in which thoughts, emotions and memories become disconnected from one another). In turn, the experience that many voice-hearers describe – that of a disembodied “other” dynamically interacting with and intruding upon one’s sense of self – invites exploration into how representations of selfhood are generated and maintained.

Another approach that has proved fruitful is the idea that voice-hearing relates to one very ordinary aspect of people’s experience: their inner speech. Most of us report talking to ourselves silently in our heads as we go about our business, and it has been proposed that voices result when a person generates a bit of inner speech but, for whatever reason, doesn’t recognise it as their own. This view has received support from numerous studies with voice-hearing psychiatric patients, including findings that similar networks in the brain are activated when people hear voices as when they produce inner speech.

Many problems remain however, including the fact that we know very little about the phenomenal properties of ordinary inner speech, such as whether it has the qualities of a dialogue or a monologue, whether it is fully expanded like ordinary conversation or whether it sometimes has a compressed, note-form quality. Voice-hearing itself comes in an even more baffling array of varieties, from experiences that have the fullperceptual force of listening to a person speaking to those that are much more ephemeral and thought-like.

Perhaps most importantly, the view of voices as disordered inner speech does not ring true with many voice-hearers’ experience. And yet, at some level, an explanation of voice-hearing must have something to do with how language operates in the brain. Perhaps the biggest challenge facing research in this area is to try to link, and draw on the relative merits of, the trauma and inner speech models. How can adverse experiences early in life, perhaps through the complex, multifaceted mechanisms of memory, lead to alterations in the way words are processed in the brain, and in turn to the sense that one’s self has been overtaken by other selves? Whatever the future for research in this area, it will require a continued focus on voice-hearing as a complex, heterogeneous phenomenon with many scientific secrets to reveal.

I was sold by Mum and Dad to make images of child abuse

05 Saturday Oct 2013

Posted by a1000shadesofhurt in Trafficking, Young People

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abuse, Children, dissociation, family, parents, relationships, sexual exploitation, support, Trafficking, trauma

I was sold by Mum and Dad to make images of child abuse

One of Raven Kaliana’s earliest memories is being taken to a family portrait studio by her parents, at around the age of four. The studio was in the basement of a department store in a town 50 miles from their home. Once they had arrived, they waited for another couple to arrive with their own child.

“Would you like to have your picture taken with this cute little boy?” her mother asked, before the parents left the kids with the photographer and retired to the cafe upstairs. But while they sat eating ice cream, the images being made in the studio down below were far from happy family portraits. Raven and her companion had just been sold into the child abuse industry.

It was to be the beginning of a 15-year ordeal, which saw Raven regularly trafficked by her parents and other members of an organised crime ring from her home in a middle-class suburb in the American north-west to locations all over the US and abroad. In her teens, the crimes were often perpetrated in Los Angeles, where many film studios provided ample opportunity for the underground child abuse industry in the 70s and 80s.

Her father, precariously self-employed after losing his teaching job, was violent towards her younger brother, but since she had become the family breadwinner, Raven was granted a peculiar status. “My father always favoured me because I brought in the money – I was supporting our whole family. My younger brother was jealous because of my dad’s special treatment of me.

“My father was also quite affectionate towards me whereas he would beat my brother to a pulp. Although he did hit me, he wanted me to stay intact because the less scars I had, the more I was worth.”

Inevitably, as she grew older, Raven’s value to her abusers decreased and subsequently the kinds of films she was required to take part in became more extreme and violent.

Yet from a young age, she had learned from her parents to rationalise and deny what was going on within the family. “It’s the same way that someone who has a problem with alcohol will rationalise their behaviour – ‘It’s only this many drinks. It’s before noon but, oh well, just today’.

“I remember my mother saying things like, ‘Oh, they’ll never remember it,’ like people do when they get their babies’ ears pierced. I told myself that my parents meant well, that what I was going through was what was necessary to help my family. It was paying our mortgage.”

As we sit talking in a central London cafe, there are two large suitcases on the floor next to us, both full of puppets she has made. A graduate of the puppetry course at the Royal Central School of Speech & Drama in London, Raven turned to this artform as a way of telling her story without the gaze of an audience focusing on her directly – something she finds too uncomfortable.

Her adult life has been driven by the belief that it is important for survivors of child sexual exploitation and trafficking to tell their stories, in order to make people realise that these aren’t crimes that happen “somewhere else, to someone else”. She moved to the UK to create Hooray for Hollywood, an autobiographical play in which the children are represented by puppets, while the adults – their parents – are only shown up to waist height, from a child’s eye view. This critically acclaimed drama has toured the UK, Poland and France, and has been made into a film.

One of the most shocking aspects of Hooray for Hollywood is the banality of the adults’ conversation, as they rationalise the choice they have just made to sell their children, from the cosy confines of a cafe. These appear to be ordinary people, struggling a little to make ends meet; not monsters or weirdos, but the kind of people who might be your nextdoor neighbours.

“You hear about a perpetrator being processed in a certain way, you hear about the police getting hold of the images, but you don’t hear about the reality for the children in those images – whose children are they? How did they come to be in this situation? And how have they been traumatised or damaged by what happened?”

Through her organisation Outspiral, Raven recently launched a national campaign to raise awareness of sex trafficking and familial abuse. She now uses the film of Hooray for Hollywood for public education and training for professionals working in social services, education, law enforcement and children’s charities.

The biggest challenge, she says, is getting the bystanders in the child’s life – neighbours, relatives, teachers, care workers, counsellors – to consider the possibility that a child might be a victim of this form of abuse. Child abuse is such a taboo subject, and the concept of parents being complicit in the crime so unthinkable, that frequently there is a failure to recognise that it might be going on. Yet since Raven’s childhood, the internet has led to an explosion in the industry, which now has a worldwide market value of billions of dollars, according to the UN.

Britain’s Child Exploitation & Online Protection Centre, a division of the police, says the number of indecent images of children in circulation on the internet runs into millions, with police forces reporting seizures of up to 2.5m images in single collections alone, while the number of individual children depicted in these images is likely to be in the tens of thousands. The commonest way that offenders found their victims was through family and personal relationships.

A report by the NSPCC highlighted the particular psychological suffering that children who have been sexually abused within the child abuse industry endure, especially through the knowledge that there is a permanent record of their sexual abuse: “There is nothing they can do about others viewing pornographic pictures or films of themselves, and sometimes their coerced sexual abuse of others, indefinitely.”

For Raven, the psychological effects of her abuse have been extreme. From an early age she began to experience dissociative amnesia – a psychological phenomenon common in victims of inescapable trauma, in which painful experiences are blocked out, leading to gaps in memory. “I started putting things into little rooms in my mind, and it was like: OK, we don’t look in that room,” she says. “When there’s no relief, there’s no one stepping in to save you, and it’s clear you’re just going to have to endure something, then your mind just does that. As a child, dissociation is a serious survival advantage, but in adulthood it can become a disability.”

It was at the age of 15 that the coping mechanisms of denial and dissociation began to break down. “At school, I started getting flashbacks – like remembering being in a warehouse the night before – and I could feel in my body it was true, but it was terrifying because I didn’t want those things to be true.”

Astonishingly, she passed through most of school without anyone picking up on what was happening at home. “I got good marks at school, so teachers tended to think everything was fine. Most survivors I’ve known who experienced extreme abuse did very, very well at school, actually, because that was their sanctuary, a place they could go to be safe.”

Eventually, however, a teacher noticed that Raven was getting thinner. Her mother, by now separated from her father but still facilitating the abuse, had simply stopped buying food for her. “The teacher invited me to stay after school and talk with her one day, and she asked, ‘Tell me the truth, are you anorexic? Bulimic?’ And I started laughing.”

Raven confided some but not all of what was happening at home, but begged the teacher not to report it for fear of reprisals. What the teacher did do, however, was to help her find the wherewithal to move out of home eventually, get a job in a restaurant, and start saving up for college.

At university, Raven finally made a break from her family, changed her name and started to get counselling – the beginning of a long road to recovery that still continues. “I got into a support group for rape survivors, and it was a great help because all of a sudden I was around other people healing from abuse, too. It also gave me some perspective about how the things that had happened to me were really on the extreme end. I saw people completely devastated by one experience of being raped by a stranger, so it was sobering to realise, ‘Oh, I’ve been raped by hundreds of people.'”

Once she was in a safe environment, finally the rage about what had happened to her bubbled to the surface. “I couldn’t believe how angry I was when I first escaped – so angry. In one support group they let us take a baseball bat to a punching bag and told us to think about a specific abuse event and imagine that we were fighting back against it, and that was very helpful.”

She also saw an integrative bodywork therapist, who used touch, guided movement and vocal expression. “Her premise was that post-traumatic stress is a physical reaction in your body, and that reconnecting the symptom to the source helps you let it go, helps you release it, and that you don’t have to talk out every single thing that ever happened to you. It was very helpful for me because there were a lot of strange things that my body was doing. For example, I used to find any kind of physical touch excruciating – even if someone brushed me in the street I would shudder. She told me that was called armouring, which happens when your body makes a shield out of its muscles to protect the bones and internal organs during physical abuse.”

The therapy made it possible for her to move on and start to enjoy life. “I realised that it is possible to get your life back. I started to gain an appreciation for life and a recognition that I only have so many breaths, so I’ve got to use them well.”

But Raven believes she will always need counselling and that her experiences have made it difficult not to fall into a pattern of emotionally abusive romantic relationships.

Perhaps surprisingly, sex has not been a significant issue, but love is inextricably connected for her with betrayal, as the people who were meant to love her most as a child were the ones who orchestrated her abuse.

Yet, incredibly, she says she felt love for her parents as a child and still does, although she has cut all contact with them. Despite their behaviour, she believes they did love her.

“When I screen my film, a lot of times in the Q&A session afterwards people want to know: how could parents do this to their own children? I tell them that abuse is generational: my parents were also abused themselves, so that was normal to them. They had dissociated in the same way I did; they were in denial. Unlike my generation, they didn’t have access to counselling when they were young, and weren’t born in a time when child abuse was beginning to be acknowledged by society. It’s important to recognise that they weren’t born evil – they were damaged.”

Raven thinks that the way in which child abusers such as Jimmy Savile are demonised is counterproductive. “Demonising the perpetrators elevates them to the realm of the surreal. We need to shift that, so people recognise that they are very sick humans and that there’s a context for their crimes.

“Only then can we tackle the source of this suffering.”

 Outspiral.org.uk

PTSD: The pain of reliving trauma years after the event

29 Thursday Mar 2012

Posted by a1000shadesofhurt in PTSD

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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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