Sunday, September 13, 2009
Why don’t they leave? Why don’t they just stop?
After meeting with a client the other day about some ongoing problems she is having with neighbors, an advocate asked me why, even though the woman is clean and sober, she continues to have difficulties staying out of trouble. This woman had been through a couple of extended inpatient treatment programs and is currently in the process of rebuilding her life after leaving her relationship for a second time. There are children involved and the woman had done a lot of work to be able to regain custody of her children after she ended her drug use. Remarkably, she is staying clean and sober and she appears determined to succeed in staying away from her abuser.
I told the advocate that the unfortunate issue for a lot of women who become clean and sober is that their economic circumstances force them to return to the same type of neighborhoods in which they previously engaged in drug use. Their priorities have changed. They want to be mothers. They want to be safe and they want to be sober. However, they may not have the resources, as single women with children, to move beyond a low income neighborhood. For this same reason, a woman with children may choose to return to her abuser or become involved with a new man. Financially, she just can’t do it on her own.
For many women who have grown up in homes where abuse was an ongoing occurrence, the idea of being able to move out and beyond her circumstances may seem to be an insurmountable task. There may be little evidence in her life that things can get better.
In a world where 85% of women who are in treatment for drugs/alcohol have been physically (including sexually) we may instead wonder what is her motivation for staying clean and sober. To have to live with the ongoing pain that comes from childhood abuse or ongoing domestic violence may result in self medication of that pain with any means possible. A number of women become addicted to pain or anxiety medications that were prescribed to them after seeking medical attention for injuries due to abuse.
There is a lot of stigma that surrounds women with children who abuse drugs. It is a common idea that a woman who uses drugs or alcohol either neglects or provides inadequate care for her children. This is not necessarily so, but the shame and guilt that surrounds a woman who self medicates can often be a trigger to ongoing use even after entering a recovery program. Judgment comes in many forms, but self judgment is the hardest. No matter what we may think, it is still harder to be her than we can ever imagine.
In severe cases, there may be a lot more going on than we can imagine. The long term effects of significant childhood and ongoing adult trauma can make it very difficult for a survivor to make decisions that increase safety and sobriety. Often there are human service workers or family members who become frustrated with clients who seem to be stuck, who seem defiant or manipulative, or resistant to treatment or court recommendations. The reasons for this perceived resistance have more to do with past trauma than being manipulative or defiant.
Neuroscience has found that under extreme stress the brain goes into flight or fight mode. For victims of long term or severe abuse the brain remains in that mode for a long period of time. The doing center of the brain (the amygdale) becomes flooded with adrenaline and cortisol and the thinking area of the brain (the frontal cortex) shuts down in order to allow the doing center to take action to be safe. Over the long term, it is like pressing on the gas and brake pedals at the same time. The abuse survivor is working completely from a place of self preservation. As human services workers who want to be able to help, we find this frustrating and forget that even though we are not the abuser the person still has no reason to trust us. In fact, it may be child service workers, therapist, police officers, parents, teachers, and others who let the victim down in the past and may have made her situation even worse. In addition, she may have found that the only thing that can calm down the intense emotions she is experiencing may be a drug.
This information is not to justify a survivor’s drug use. It is more of an explanation as to why trauma informed treatment programs are so necessary. Mental health and substance abuse treatment programs that do not address the issues via a trauma informed approached are less likely to meet the needs of their clients and help them maintain true recovery.
Most mental illnesses have roots in of trauma that triggered an ongoing reaction to the world that may seem maladaptive to the rest of us, but for the survivor it has become the only way to feel safe in the world. Anxiety and panic disorder, Post Traumatic Stress Disorder and substance abuse disorders have their roots in unresolved trauma. The person has lost their sense of safety in the world and remains hyper-vigilant against any further trauma. I heard a statement the other day that I am going to start carrying with me as a credo in promoting trauma informed treatment. “If we can start addressing the trauma that occurs in a child’s life, we may someday be able to reduce the DSM (Diagnostic and Statistical Manual used to diagnosis mental illness) to a pamphlet.”
Saturday, September 12, 2009
Special Places
I have been fortunate to have had many special places in my life. Places that took me away from whatever stress or drama there was in my life and allowing me to be fully present with myself.
My first special place was an apple tree in the backyard of the small farm where my family lived when I was in grade school. It had the perfect branch onto which I could climb and lay back, read a book or look up through the leaves at the blue sky above. The sunlight would sparkle through the leaves and the breeze would lightly blow across my face. On early summer days I could smell the strawberries from the patch nearby. I remember watching clouds pass over head and the sensation of the earth spinning beneath me. Those were my first days connecting with nature.
We eventually moved into town and my special place was anywhere I could find on my bicycle. As it is with so many teenagers, adolescence was not kind to me and I struggled with a whirlwind of emotions and hormones as I came of age in a small town on the edge of Lake Superior. I would get on my bike and peddle as hard and as fast as I could along US Hwy 2. The highway ran along the southern edge of Chequamegon Bay past the old ore docks and the paper mill and further on to the Bad River Indian Reservation. There were times I did not want to turn back.
During the spring of my freshmen year at the University of Wisconsin in Superior, I left class late on a Friday morning and told a friend that I was heading out on my bicycle and that if I wasn’t back in a couple of hours that I had probably decided to go all the way to Iron River – 50 miles away – where my parents lived. And that is what I did. Riding along US 2 on an April day in 1975 I was passed by big rigs and felt their pull against my wheels. The sky was clear and I rode past dairy farms and pastures. I can still remember the rush I felt as I went mile after mile. When I reached Iron River I went into my Uncle Tiny’s bar and announced that I had just arrived by bicycle from Superior and that I really would appreciate a ride the last four miles to my parent’s home. I had reached my limit and knew the hilly terrain between town and their cabin would probably undo me.
When I arrived, my mother went white as a sheet and my father was uncharacteristically speechless. I didn’t realize until a few years later that all three of them, my uncle and my parents, were all remembering how my Uncle Elroy had died on that same highway two years earlier while riding his bicycle. What I had done had been thoughtless and ill conceived but I still remember the freedom I felt as I moved through the northern Wisconsin landscape.
Over the next few years my life changed drastically and my next special place was a rocking chair. This was the place where I would sit in the middle of the night while holding my son. I would rock quietly and hum while running my hand softly over his face and eyes. His eyes would close and then slowly open again in rhythm with the rocking of the chair and as I passed my hands over his face one last time he would drift off to sleep.
I lost myself in my twenties as my marriage ended and I was left on my own in Norfolk, VA. If there was a special place during those years it would have been O’Hara’s Bar on Ocean View Avenue. I only call it special in that there was little else in my life then. I will leave that story for another time and move on to a place that is still special in my heart.
Norfolk, Virginia has a spectacular botanical garden. It is placed near the airport and is surrounded by brackish inlets that eventually lead out through Little Creek Naval Station to the Chesapeake Bay. In late March and April the garden is full of blooming azaleas in a variety of sizes and colors, in May the rose garden is the site of many weddings and in June and July there are hydrangeas around every corner. Geese, ducks, heron, and a pair of bald eagles make their homes in the garden and spring brings a parade of goslings around every corner.
There are walking paths all through the garden and at any time of day you may find families with strollers or exercise enthusiasts out for a run. There are plenty of places to stop and sit, an herb garden, a duck pond with a fountain, a bench along the water, but my favorite spot was on a bench next to an old oak tree near the waterway where the paddle boat would take visitors out to the larger lake. This tremendous oak sits at the foot of an old stone bridge made from cobblestones from the streets of Norfolk and is estimated to be over 250 years old.
While sitting on the bench beneath the tree I could watch the sunlight dance on the water, feel the breeze across my face and sway in my seat with the movement of the willow tree across the water. There was little that could break the peace of the moments underneath my oak tree.
I am fortunate to have spent much time sitting under that tree with a number of people who have meant the most to me, my best friends, a goddaughter, and a lover. I could feel the energy of the tree surrounding us all, moving through us in a healing and loving way. I would always bow to the old oak as I left and thank it for the time and energy it had given, and for the peace of mind that I felt during the time sitting beneath its outstretched branches. I was blessed when I left Norfolk with a picture of that special spot as seen from across the water. From my living room couch I can see the bench, the bridge, the willow and the welcoming arms of the old oak tree and remember the moments alone and with others.
I continue to find and create special places in my life, alone or with others. These places create the map of my life and remind me of loved ones come and gone. I encourage everyone to find and remember their special places.