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.

#BraveWrite: A Lifetime

I’ve spent a decade in therapy to recover from an emotionally needy, gaslighting  narcissist, who raised her Jewish Son among abusive, anti-Semitic, fag-bashing racists, some of them pedophiles, who considered themselves good Christians.

Ironic, isn’t it?

I’m the one with the diagnoses.

What have I learned?

I am a human being,

I have a right to be alive.

When the trauma is drawn out over a number of years, dissociation becomes a way of life. Once learned, it is a fixed part of the personality that asserts itself long beyond the original dangers that prompted it.

This is an illustration of the principle that C-PTSD is essentially a learning process gone awry as a consequence of the child developing in a dangerous environment.  Dissociation and C-PTSD


The effects of long-term child abuse last a lifetime.

This post inspired by the #BraveWrite hashtag on Twitter.

Rob Goldstein 2019

“Los Portales’ (c) Rob Goldstein 2016

Guilty of Being Sick: Mentally Ill behind bars

The U.S. mental health system treats all mental illness as short-term, easy to solve problems of ‘behavior’.

Most mental health coverage in the U.S. rules out long-term hospital stays, as well as long-term psychotherapy.

For profit psychiatry took the treatment protocols for substance  abuse disorders and decided to use them for everyone, regardless of diagnosis.

I am the first to concede that practicing mindfulness makes life better in general.

But it is not the first line treatment for illnesses that rob the brain of its ability concentrate and use reason.

People sick enough to become homeless need intensive case management and long-term structured treatment facilities.

The ‘prison industry’ wants to fill that need for ‘long term’  treatment.

“Mental health problems are rampant in local jails, often because the illness was a primary factor in the offensive conduct. The cost of caring for and supervising mentally ill inmates makes them two to three times more expensive to house. Once released, they often stop taking their medications, which lands them in trouble with the law and back behind bars.” NYT FEB. 27, 2017

Mental Illness, untreated Behind Bars

Image of an American Flag behind Barbed Wire
Reprocessed Video Grab from Institutionalized-Mental Health Behind Bars by VICE News

An alarming trend has emerged giving private prison profiteers control of person’s fate for life, not just the term of a prison sentence.

The CEOs who built billion dollar empires as partners in ‘tough on crime’ policies are adapting to prison reforms by re branding themselves ‘treatment’ providers.

They see the collapse of our public mental health system as an opportunity
to expand and profit from long-term psychiatric hospitals, civil commitment centers, and ‘correctional’ treatments.

Correct Care Solutions, formerly known as GEO Care, a spin-off of GEO Group, has deep roots in the private prison industry. Although the company has shifted and changed numerous times over the last few years, CCS currently runs seven “treatment” facilities in Florida, Texas and South Carolina, including five mental health facilities and two civil commitment centers.

See more at: Incorrect Care


(c) Rob Goldstein 2017 All Rights Reserved

I do not own the image

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Mental Health: An Autobiography in Five Short Chapters for People with PTSD and CPTSD.

The “Autobiography in Five Short Chapters,” by Portia Nelson is a mainstay of 12 Step Programs.
It is primarily used as an allegory to describe the addictive process. i.e. the insanity of repeatedly and consciously making the same mistake with the hope of getting different results.
The “Autobiography” goes like this:
“I walk down the street.
There is a deep hole in the sidewalk.
I fall in.
I am lost… I am helpless.
It isn’t my fault.
It takes forever to find a way out.
I walk down the same street.
There is a deep hole in the sidewalk.
I pretend I don’t see it.
I fall in again.
I can’t believe I am in the same place.
But, it isn’t my fault.
It still takes me a long time to get out.
I walk down the same street.
There is a deep hole in the sidewalk.
I see it is there.
I still fall in. It’s a habit.
My eyes are open.
I know where I am.
It is my fault. I get out immediately.
I walk down the same street.
There is a deep hole in the sidewalk.
I walk around it.
I walk down another street.”
Portia Nelson, There’s a Hole in My Sidewalk: The Romance of Self-Discovery

I received my copy of “Autobiography in Five Short Chapters” in a clinical setting, as part of a treatment group for people with C-PTSD.

For me, that’s a problem. Here’s why:

In my experience, people with primary substance abuse disorders know they are in a hole, even in their denial. They not only know where the hole is, they know how they fell in, and they know the way out.

Our for profit medical system sees “behavioral” health and 12-Step Programs as a cheap alternative to providing the more expensive services required by people with mental illnesses.

Some people with severe mental illnesses have substance abuse disorders, but they are secondary to our illness, and to the artificially induced poverty, that forces us into slum housing and into the arms of aggressive drug dealers.

I did not fall into a hole.

I was placed in a hole as an infant.

Any attempt to crawl out that hole was met with violent beatings.

After she solemnly read the ‘Autobiography in Five Short Chapters’ to us, the therapist who was running the group asked us what we thought.

I raised my hand:

“What if we were stuffed into a hole before we knew we were alive?”

She had no answer.

Behaviorism has few answers for people who need intensive psychotherapy.

***

For those of us with mental illnesses related to childhood sexual assault and trauma, I offer this Autobiography in Five Short Chapters for People with PTSD and CPTSD.”


Chapter One
“I wake up and I am in a hole. I don’t know that I am in a hole. The hole forms the circumference of my world. I base my options in life on its width and depth. It is uncomfortable but the hole is all I know.
I feel constrained and helpless.
One day I look up and see that light enters the hole through an opening at the top.
My eyes are so dazzled I cover them.
***
Chapter Two:
I live in a hole in the sidewalk but I am not certain of this.
I try to pretend that It isn’t true but I see that there are edges at the top of the hole through which the Sun shines.
I decide to climb toward the light to look beyond the edge.
I climb to the top.
It takes a long time.
I see that beyond the hole is a vista that is more rich with possibility than anything I have ever imagined.
My fear is so profound I fall back into the hole where I know I am safe.
***
Chapter Three:
I live in a whole in the sidewalk, which is where I was placed as an infant.
I try to forget what I saw when I climbed toward the light and looked over the edge.  The hole feels small and cramped but the thought of leaving fills me with dread.
I try to pretend that I don’t know that I am stuck but pretending doesn’t work anymore.
I am furious.
Why am I in this hole?
 It isn’t my fault.
I contemplate climbing out
***
Chapter Four:
I live in a hole in the sidewalk. My world is in this hole yet I feel I must leave this tiny world for the larger one above: the real world.
I slowly climb to the top of the hole and slowly pull myself out.
I stand at the edge of the hole, terrified and uncertain of what to do next.
***
Chapter Five:
There is a hole in the sidewalk. I’ve spent my life in this hole and once believed  it was the entire World. I am terrified and want to throw myself back into the hole, but enter psychotherapy instead.
Rob Goldstein 2014 – 2019