To Come Alive Eric C. Arauz MLER Trauma Institute of New Jersey Adjunct Faculty Instructor Department of Psychiatry Rutgers Robert Wood Johnson Medical School Loss of Narrative Subjectivity the difference between the patient s experience of the disease and the doctor s attention to the disease Arthur Kleinman, MD Psychiatrist Harvard Medical School Professor, Anthropology Harvard University Kleinman, A. 1988. The Illness Narratives: Suffering Healing and the Human Condition. NY, NY: Basic Books. 3
Trauma-Informed Storytelling Language As Organizing Paradigm For Implicit and Explicit Memory of Psychosis and Trauma Exploratory Narrative Processing and Coherent Positive Resolution (Pais, Jennifer L., (2006) Narrative Identity Processing of Difficult Life Experiences: Pathways of Personality Development and Positive Self-Transformation in Adulthood) TRAUMA-INFORMED STORY TELLING (BERTHA PAPPENHEIM: SIGMUND FREUD AND JOSEF BREUER STUDIES ON HYSTERIA) EFFECTIVE TREATMENT IS A MATTER OF HELPING INDIVIDUALS KEEP THE OBSERVING PREFRONTAL CORTEX ONLINE AS IT SIMULTANEOUSLY EXPERIENCES THE RAW PRIMITIVE SENSATIONS GENERATED IN THE ARCHAIC PORTIONS OF THE BRAIN (THE LIMBIC SYSTEM, HYPOTHALAMUS AND BRAIN STEM.) SECONDARY TRAUMATIC STRESS THERAPEUTIC WORKERS A PERSISTENT RAISED STRESS RESPONSE Meta-Analysis of Risk Factors for Secondary Traumatic Stress in Therapeutic Work with Trauma Victims. Jennifer M. Hensel, Carlos Ruiz, Caitlin Finney, and Carolyn S. Dewa. All out of Toronto, Ontario, Canada. Volume 28, Number 2, April 2015 of the Journal of Traumatic Stress. Published by the International Society for Traumatic Stress Studies.
Porges SW. Int J Psychophysiol. 2001;42(2):123-146. Porges SW. Clev Clin J Med. 2009;76(3):S86-S90. Reactive Partners in Relational Dyad Reciprocal Neural Interaction across Afferent circuits Jensen KB, et al. Mol Psychiatry. 2014;19(3):392-398. Physiological State Determines Psychological Experience SAFETY (Certainty/Efficacy) DANGER (UNCERTAINTY/HELPLESSNESS)
Functional Hierarchy of the Brain Neocortex Limbic Diencephalon Brainstem Abstract Thought Concrete Thought Affiliation Attachment Sexual Behavior Emotional Reactivity Motor Regulation Arousal Appetite/Satiety Sleep Blood Pressure Heart Rate Body Temperature C O M P L E X I T Y Perry BD. In: Murberg MM (Ed.) Catecholamine Function in Posttraumatic Stress Disorder: Emerging Concepts. Washington, DC: American Psychiatric Press; 1994:253-276. Perry BD. In: Coffey CE, et al (Eds). Textbook of Pediatric Neuropsychiatry. Washington, DC: American Psychiatric Press; 1998. State Dependent Functioning of the Brain ABSTRACT SAFETY (Certainty/Efficacy) EMOTIONAL REACTIVE REFLEXIVE DANGER (UNCERTAINTY/HELPLESSNESS) Perry BD. In: Murberg MM (Ed.) Catecholamine Function in Posttraumatic Stress Disorder: Emerging Concepts. Washington, DC: American Psychiatric Press; 1994:253-276. Perry BD. In: Coffey CE, et al (Eds). Textbook of Pediatric Neuropsychiatry. Washington, DC: American Psychiatric Press; 1998.
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A FUTURELESS MAN: THE INTEGRATION OF A TRAUMATIZED LIFE ERIC C. ARAUZ MLER TRAUMA INSTITUTE OF NEW JERSEY ADJUNCT FACULTY INSTRUCTOR DEPARTMENT OF PSYCHIATRY
ABSOLUTE SHATTERING OF THE SELF PHYSIOLOGICAL COGNITIVE SPIRITUAL SOCIAL FAMILIAL Humiliated Fury Helen Block Lewis Self Stigma Continuum of Identity MOKROS HB. SUICIDE AND SHAME. AM BEHAV SCI. 1995;38:1091-1103. 21
) My soul is lost, my friend Tell me how do I begin again? My city's in ruins My city's in ruins My City of Ruins Bruce Springsteen 23 PROCESS OF TRANSFORMATION Ideas vs. Beliefs 24
PROCESS OF RECOVERY 25 ADVERSE CHILDHOOD EXPERIENCES STUDY (ACES) Physical abuse by a parent Emotional abuse by a parent Sexual abuse by anyone An alcohol and/or drug abuser in the household An incarcerated household member Someone who is chronically depressed, mentally ill, institutionalized, or suicidal Domestic violence Loss of a parent Emotional neglect Physical neglect Felitti, V. J., Anda, R. F., Nordenberg, D.F., Williamson, D. F., Spitz, A.M., Edwards, V., et al. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventative Medicine, 14(4), 245-258. 26 LIFE SPAN IMPACTS OF ACES Effects of Childhood Trauma on Lifetime Health. June 12, 2015. http://allergiesandyourgut.com/2015/06/12/effects-of-childhood-trauma-on-lifetime-health/. Accessed January 24, 2017.
Center on the Developing Child, Harvard University. http://developingchild.harvard.edu/resources/three-core-concepts-in-early-development/. Accessed January 24, 2017. Anda RF, et al. Eur Arch Psychiatry C lin N euro sci. 2006;256(3):174-186. Center on the Developing Child, Harvard University. http://developingchild.harvard.edu/resources/three-core-concepts-in-early-development/. Accessed January 24, 2017. Shonkoff JP, et al. JAMA. 2009;301():2252-2259. Dong M, et al. Circulation. 2004;110(13);1761-1766. RISK FACTORS FOR ADULT HEART DISEASE ARE EMBEDDED IN ACES 3.5 Odds Ratio 3 2.5 2 1.5 1 0.5 0 1 2 3 4 5 6 7 8 ACEs ACES AND BEHAVIORAL HEALTH Dube SR, et al. JAMA. 2001;286(24):3089-3096. Dube SR, et al. Pediatrics. 2003;111(3):564-572. Felitti VJ. Prax Kinderpsychol Kinderpsychiatr. 2003;52(8):547-559. Anda RF, et al. Am J Prev Med. 2007;32(5):389-394.
YOU MUST GO ON; I CAN T GO ON; I LL GO ON. SAMUEL BECKETT THE UNAMABLE 33
v PROCESS OF CHANGE META-VISCERAL AWARENESS FEEL PAUSE TOLERATE REGULATE INTEGRATE OSCILLATE (ITERATIVE PROCESS OF CONVERGENT LOOPS) REACTIVE PAUSE PROACTIVE State of New Jersey Department of Children and Families. Taming Trauma New Jersey Statewide Training. www.nj.gov/dcf/home/trauma.html. Accessed July 21, 2017. HONOR
cheryl It is Unbelievable but it is not Unlivable. The Active Side of Infinity Carlos Castaneda