I believe that to pursue the American Dream is not only futile but self-destructive because ultimately it destroys everything and everyone involved with it. By definition it must, because it nurtures everything except those things that are important: integrity, ethics, truth, our very heart and soul. Why? The reason is simple: because Life/life is about giving, not getting. 

Hubert Selby Jr., Preface to Requiem for a Dream

 

The problem's not that the truth is harsh but that liberation from ignorance is as painful as being born. Run after truth until you're breathless. Accept the pain involved in re-creating yourself afresh. These ideas will take a life to comprehend, a hard one interspersed with drunken moments.

Naguib Mahfouz, Palace of Desire

Both of these quotes appear as epigraphs in Gabor Maté, In The Realm of Hungry Ghosts.

Governor Brown: Please End the Statute of Limitations for Rape

Posted 9/27/2016

In part because of the sexual assault cases against Bill Cosby, some states have eliminated the statute of limitations for rape and other felony sex crimes, including child sexual abuse.

In California, State Senator Connie Leyva (D-Chino) authored SB 813 to do this in California. The bill was passed overwhelmingly in the legislature. California Governor Jerry Brown has until September 30 to act on the bill. He has rejected two past bills that would have allowed for more lawsuits regarding child abuse.

Below is the email I sent Governor Brown today in support of SB 813.

If you'd like to write to him, here's contact information.

Here's an L.A. Times article about the bill.

 

Dear Governor Brown,

I strongly urge you to sign SB 813, passed overwhelmingly by the CA Legislature and now on your desk. The bill would eliminate the statute of limitations for rape and several other felony sex crimes.

In the U.S., although an accurate count of sexual assaults is very difficult to obtain, it is very likely that more than a million women and men are raped every year.

Studies conducted by the Crimes Against Children Research Center suggest that 20% of adult females and 5-10% of adult males recall an incident of sexual abuse or assault in their childhood.

Rape and child sexual abuse have a strong potential to traumatize the victim/survivor.

It is in the nature of trauma for memory to be fragmentary and repressed. This is well understood and shown in brain imaging studies. Traumatic memory is held in emotional and sensory memory and not easily integrated. The memories of these horrible events may take years to surface clearly.

It is in the nature of violence perpetrated by intimate partners, parents and close relatives to be denied. If the perpetrator is in a position of power, able to affect the life, work and safety of the survivor, fear is likely to keep the survivor from speaking out even if she or he remembers the event. On top of that, significant stigma is still cast onto survivors of sexual assault. Going through the legal process has a huge cost in time, money and emotional suffering.

And then there is the statute of limitations. Maybe a survivor of child sexual abuse doesn't start remembering what happened until she or he is over 40. Maybe a rape survivor doesn't expect her word to be believed when set against the word of a man with more wealth and power, and it takes many years for her to muster the courage to speak out. But in those cases, the survivor now has no access to the criminal justice system.

There are already so many barriers preventing survivors of sexual violence from reaching for justice. Please sign SB 813 and take down just this one of them.

Sincerely,
Liz Schiller

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Women and Children Last? Mac McClelland's Irritable Hearts: A PTSD Love Story

Posted 3/29/2015

One of the many things that David Morris gets right in The Evil Hours is our cyclic interest in PTSD (by whatever name we're calling it at the time). Maybe it's just that I'm paying especial attention, but it seems like there has been a surge in interest in PTSD lately, as the Iraq and Afghanistan conflicts wind up. Interest peaks in the years after a war, Morris observes, as men (and women) come home with wounds external and internal. Veterans' external damage makes them more visible. Their visibility and numbers lead to a ripple of concern that starts with the families affected by their psychic and emotional damage and ends with hearings in Congress about the inadequacy of systems at the Veterans Administration and the resignations of high level appointees.

My musical may in fact end up being identified as part of this wave. The truth is, I've interacted very little with any of the current round of war veterans and my interest had nothing to do with those recent conflicts.

Mac McClelland's Irritable Hearts: A PTSD Love Story is in the wave but also not of it. McClelland is a journalist (like Morris) but her trauma resulted mostly from her reporting from disaster zones, including New Orleans after Hurricane Katrina and Haiti after the devastating earthquake in 2010.

There is another significant difference between Morris's experience and McClelland's that reflects a profound difference in the world of trauma. McClelland is a woman, and the pain she witnessed and experienced was explicitly gendered. The city of New Orleans and a swath of the Gulf Coast was shattered by the violence of nature, and then the survivors were ignored by the institutions that were supposed to help, a lot like (disproportionately female) rape and domestic abuse survivors are often ignored. In Haiti, McClelland's reporting focused on the violence that was done by people, in particular by men, perpetrated upon women, especially rape.

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The Evil Hours by David J. Morris: My thoughts

Posted 3/6/2015

The Evil Hours is billed as a biography of PTSD. The writer, a former Marine and war journalist who covered the U.S. conflict in Iraq, may have been inspired to frame the book that way in part by Siddhartha Mukherjee's sprawling book on cancer, The Emperor of All Maladies. Morris's book is by no means as exhaustive as Mukherjee's, but it does cover many of the bases: history, PTSD in literature, a sampling of current research, and his own experience.

Morris's focus on combat related PTSD is one aspect that makes the “biography” label something of a misnomer. He does acknowledge that there isn't as much in history and literature about the effects of trauma that happens to occur in childhood or as a result of rape. He touches briefly on hysteria but doesn't include a story about Freud that really stuck in my mind when I first read it. Freud saw many female patients who he diagnosed with hysteria. In treatment, it emerged that these women reported having been sexually abused by their fathers. Freud at first posited a causal relationship between childhood sexual abuse and hysterical symptoms such as disassociation, anxiety, and physical pains with no apparent cause. However, when he diagnosed his sister with hysteria, which would have implicated his own father in abusive behavior, he abandoned the idea of a causal relationship. (Looking into this story now, I read that he observed hysterical symptoms in himself, his brother and younger sisters, and rejected the notion that he himself might have been abused.) Judith Herman has suggested that hysteria was a form of PTSD resulting from abuse, including sexual abuse, in childhood, and domestic abuse. Morris doesn't go there. In fact, he argues that despite the prevalence of nightmares, substance abuse and lawless violence that followed the American Civil War (for example) and similar symptoms documented all the way back to Homer, PTSD is a modern illness. Yes, the way societies handled the psychic wounds of warriors has been different and perhaps more healing in other eras and cultures. But veterans still had nightmares and drank too much.

Morris is effective in covering some of the history of military trauma and the military's, and larger society's, responses to it. He also connects some of the threads found in literature and memoir with his own experiences of post-trauma symptoms and with research findings. These are connections which, he observes, are not often made. He finds the people he interacts with at the Veterans Administration hospitals to be particularly tone deaf, ignorant of the complexity of thought about trauma, the moral and philosophical questions.

Those moral questions are prominent in his mind as he reflects on his experiences in Iraq and his life after his return, particularly his sense of betrayal as he sees young men being maimed and killed as a result of idiotic military strategies in a conflict built on government lies. He writes compellingly about the disconnect he feels upon returning to the United States, not only because he's out of the war zone and in a place where things don't blow up, but because the urgent political questions he was living with are not even on the radar back at home.

Two things especially stood out for me.

First, Morris writes about his treatment experiences at the VA, from taking the CAPS test, used to evaluate whether he has PTSD, to using prolonged exposure therapy, and then going through a group therapy process derived from Cognitive Behavioral Therapy called Cognitive Processing Therapy (CPT).

This section was infuriating. The VA has put most of its eggs into the baskets of prolonged exposure therapy and CPT. What the hell are they thinking? We follow Morris as he is required to go over and over a particular incident, while his symptoms get worse and worse. When he has other events he'd like to bring up, his therapy provider insists he stick with the one isolated incident he selected, as per protocol.

Morris is far from the only one who became more anxious, more agitated and more dissociated during the course of exposure therapy. He cites at least one study documenting those negative results with many more vets. I went looking for a clear number on the dropout rate of exposure therapy and found 20-25%, a figure that the writers of these papers emphasize is similar to the dropout rates for other PTSD treatments. However, Morris quotes writer-therapist Gary Greenberg, who noted that subjects who don't complete a study may not be included in the bottom line. Roger Pitman and Bessel van der Kolk, both Harvard professors of psychiatry who have studied trauma and PTSD for many years, are highly skeptical of exposure therapy, Pitman from direct experience seeing veterans get worse, just as Morris did.

Prolonged exposure therapy is torture. It makes people with past trauma worse. And yet when he rejects this treatment, he is labeled “noncompliant.” What the hell?

Then he goes through CPT. It's mostly useless. He doesn't get worse, as he did with exposure therapy, but he doesn't get much better. Then the VA transfers one of his group's two facilitators halfway through, which any person who knew anything about trauma would recognize is a terrible idea. Take a room full of people who have difficulty with trust and encourage them to bond with someone, and then take that person away in the middle of the process. How is that healing?

By what logic did the VA decide that exposure therapy and CPT are the therapies of choice for all those thousands of veterans with PTSD? Do they feel the tremendous pressure of those numbers of vets who are desperate for help? Now they've got a protocol for diagnosis and a protocol for treatment, and if the patient decides that he or she doesn't want to continue with either torture or a therapy that is mostly ineffectual, you can stamp the file NONCOMPLIANT and move on to the next one. In the process, virtually nobody is helped and many are made worse. Is this military intelligence at work?

It's not currently my work, and I'm not sure it will ever be my work, to bash my body against the colossal and impenetrable edifice that is the VA, but oh how I wish I could give the responsible party a good shaking, in the hope that some clues regarding actual evidence-based treatment might drop into his brain. Exposure therapy is supposed to be evidence-based. It does work for some people and for some situations, but it seems the height of irrationality to make it the VA's first choice in light of all the evidence of harm.

The other thought I wanted to respond to is this. Morris includes a section about propranonol, a drug that can dampen the adrenaline response and the memory of a traumatic event if it is administered within six hours of the event. Morris writes that if there is a straightforward, easy cure for trauma and PTSD, “then we as a society don't have to deal with the events that cause trauma, which have deep roots in social justice issues.”

I would argue that having the tools to heal PTSD, and using them, and working to reduce the incidence of traumatic events that are caused by human actions are not mutually exclusive.

Trauma is incredibly widespread, much more common than Morris or almost anyone else acknowledges. People are not just traumatized by being in combat, by being raped, or by being abused as children or as adults. We can be traumatized by any chronic stress. There is evidence that living with racism can be traumatizing. Living in poverty, feeling helpless to take care of your family, being uncertain whether you will have a roof over your head from week to week, can be traumatizing. Being the constant target of hatred because you're fat, because you're gender nonconforming, because you're different in some way, can be traumatizing. Countless people are suffering every day. Thousands and millions are unable to live their lives fully because of fear, anxiety, or anger, because their whole bodies are thrumming with it, because they can't focus, they can't think clearly, they can't trust, they feel alone and they have no idea what to do about it, if they even recognize that this is not how a person should have to live.

Healing those wounds does not mean that we don't also teach respect, that we don't also challenge racism and misogyny and homophobia and transphobia and the systems that enforce the gaps that exist in wealth, in access to education, all the other cultural and structural ills of our society. It doesn't mean that we struggle against the march to war.

I would argue that healing those wounds is an essential part of fixing our world. Too often, we don't listen to the voices of those who are demanding justice and peace and fairness and equal treatment. There are hundreds and thousands more people whose voices we don't hear because they are too wounded to speak, to even consider speaking. But what if they weren't? The sound of those voices calling for justice and for peace would swell louder and louder, too loud to ignore. Those voices, and the weight of all those people speaking, might truly move the levers of power and fill the whole world with compassion.

 

 

 

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