DID: The ACE Study

A new and profoundly important paradigm for understanding overwhelming emotional pain has emerged over the last few years, with the potential to change the way we conceptualize human suffering across the whole spectrum of mental health difficulties. It is an evidence-based synthesis of findings from trauma studies, attachment theory and neuroscience, which offers new hope for recovery. It also presents a powerful challenge to the biomedical model of psychiatry in that it is based on scientific evidence that substantiates and attests to what many individuals with first-hand experience of mental health problems have always known — that the bad things that happen to you can drive you mad.

A New Paradigm for Understanding Severe Mental Distress

The CDC-Kaiser Permanente Adverse Childhood Experiences (ACE) Study revolutionizes the way we think about the body and mind.

The ACE Study settles the question of whether we are shaped by genetics or the environment: we are shaped by both.  Nature Versus Nurture: Where We Are in 2017

The ACE study proves that child abuse causes enduring neurological damage that can affect a person’s health and quality of life throughout the lifespan.

The body of a frightened child floods with hormones and prepares to fight, run, or die.

In less than an instant, the amygdala sends an alarm to the hippocampus, which tells the adrenal glands to release adrenaline.

Adrenaline increases heart rate and breathing, oxygen goes to the muscles and brain, which increases hearing and sharpens eyesight.

Adrenaline wears off and cortisol takes over; cortisol is a longer acting stress hormone designed keep the body alert.

Illustration from Harvard Medical School
Understanding The Stress Response, Harvard Medical School

If a child fears for his life, he may freeze and go numb.

For a prey animal in the wild, numbing is a blessing.

For abuse survivors, it means gaps in memory

During the fight, flight or freeze response the brain inhibits the prefrontal cortex.

The prefrontal cortex is responsible for retrieving memories. 

The memory is there but the brain can’t retrieve it.

A chronically abused child lives in fear which damages the structure and
functioning of a the brain. Harvard University

The toll of chronic fear on physical health includes:

  • Immune system dysfunction
  • Endocrine system dysfunction
  • Autonomic nervous system alterations
  • Sleep/wake cycle disruption
  • Eating disorders

The toll of chronic fear on emotional health includes

The Pyramid of effects of abuse on the lifecycle
Abuse Affects the Life-cycle

It takes nine months for the fetus to become a baby that can survive beyond
the womb.

Between birth and the age of two, we have no words; for the first ten years of our  lives, we are helplessly dependent on our parents and communities for our physical and psychological well being.

Child abuse is a betrayal of unconditional trust.

You don’t just ‘get over it’.

People with dissociative disorders report the highest occurrence of abuse and childhood neglect among all psychiatric disorders. This suggests dissociation is the ultimate reaction to significant trauma. Links between Trauma, PTSD, and Dissociative Disorders

A 2018 review found changes in the structure of the brain in people with DID. These changes are complex and  include decreased limbic activity, increased frontal lobe activity, and changes in communication between these two regions.

An illustration depicting a little boy glaring at his drunken mother, passed out on the floor
Child Abuse Lasts a Lifetime

DID is something done to you, like the rapes and daily beatings.

One must accept what happened and make peace with it.

Acceptance means seeing what might have been and grieving the loss.

Acceptance means letting go of the idea that I brought it on myself, that I am shameful and not good enough, and it means not letting the dismissive arrogance I sometimes encounter gnaw at my soul.

Acceptance means holding abusers accountable for the messes they make.

Acceptance means believing the abuse will end.

I am not completely there.

How do I accept the evil of child abuse when the abuse never ends?

For now, broken but better is the best I can do.

DID: When Everything is a Trigger

Get Your ACE Score

(C)Rob Goldstein 2019

‘Child Abuse Lasts Forever” (C) Rob Goldstein 2019

All other graphics were found online and are used here for educational purposes.

#FlashFiction: Shoot me for Jesus

In this piece, a homeless vet writes to a friend. I used a composite of the stories I heard as a therapist who worked with homeless vets in San Francisco.

7/04/2012

Hey Kev

Thought I’d drop you a few lines since this week makes
five years since we left Iraq.

I know you say you ain’t the same without ur leg but I hope
ur feeling better.

I’ll feel hella better when I throw out these pills for crazies.

Why does the fuckin’ V.A. give me pills when I say I need food?

Why don’t shrinks know people go crazy from hunger?

My partner died of AIDS last year, so I got no one to talk to, so I
went to Reno last month.

The ticket was a free one way, so I figured I’d go see family.

That was a big mistake.

My bitch of a sister wouldn’t let me meet my nephew ‘cause I came out gay.

Her Holy Roller husband kept sayin’ he’d shoot me for Jesus.

I told them to kiss my faggot ass!

I spent the rest of my money for a one way back to Frisco.

That’s life for uppity fags and burnt out war heroes.

I keep hoping you’ll send me a card so I know ur alive.

I’d call but I can’t buy a phone.

I get $300 a month General Assistance and it costs $200 for a week in a crap hotel, so’s I won’t have a place for the next three weeks, but please write to that address I sent anyways.

Please.

Love,

Zack

Homelsss people leave messages of anguish on the walls of alleys.
Homeless people write on the walls when they bed down to sleep in Clarion Alley.

(c) Rob Goldstein 2018 – revised August 2019

A Flight of Ideas: Little Reagan

I was under powerful witchcraft and hoped I was possessed.

I thought of little Reagan; the tricks he did with the crucifix.

He was light in the head and rose by circumstance.

Were I novelist, I’d have written a story, but instead I spun
and spewed garlic.

Judy asked if I was trying to vomit and I snarled, “No! I need a
fucking exorcist!”

Judy said what I really needed was a time out until I learned
to behave.

I’m starting to think Judy doesn’t love me.

The staff carried me off before I could levitate.

Rob Goldstein (c) 2017 All Rights Reserved

Note: Seclusion is a
nursing intervention defined as the solitary containment of an agitated patient in a fully protective environment.

Politics: The Art of Michael D’Antuono

Art is not made to decorate rooms. It is an offensive weapon in the defense against the enemy. Pablo Picasso, 1943-03-24

I saw the ‘Diversity’ poster by Michael D’Antuono in a tweet from Malcolm
Nance.

 

Diversity Makes America Great

 

Michael D’Antuono’s art is reminiscent of Norman Rockwell.

 

“”Freedom from Fear” by Norman Rockwell 1943

But these are different times:

Cold as Ice

Like Rockwell, D’Antuono uses his art to make a powerful case for American Democracy and the Rule of Law.

 

“”Freedom of Worship” by Norman Rockwell 1943
Patriots
The Talk
Make America Hate Again
If We Can’t Trust the President we need to Impeach

I post these images because I agree with them. I do not know the artist and do not profit from sales of his work.

Planned Prisonhood

Art by Michael D’Antuono

I do not own these images.

Rob Goldstein 2019