The PTSD Trap – Extras (sources, links, a bit of multimedia)

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Posted on: March 16, 2009 11:02 AM, by David Dobbs

Below are materials supplementing my story “The Post-Traumatic Stress Trap,” Scientific American, April 2009. (You can find the story here and my blog post introducing it here.) I’m starting with annotated sources, source materials, and a bit of multimedia. I hope to add a couple sidebars that didn’t fit in the main piece — though those may end up at the main blog, so you may want to keep an eye there or subscribe via RSS or Atom.

Main sources and documents in “The Post-Traumatic Stress Trap.”

These are organized by story section, roughly in the order the relevant material appears. Quoted passages are from the article, with source material following. 

- Introduction-

 
• Harvard psychology professor Richard J. McNally’s, “Progress and Controversy in the Study of Posttraumatic Stress Disorder [pdf download],” Annual Rev Psychology 2003:229-52, As the story notes, the PTSD debate has been going on a while now — since the PTSD diagnosis’ creation in the late 1970s — but was fanned into heat in 2003 by this long review essay by McNally.

“This critique, which was originally raised by military historians and a few psychologists, is now being pushed by a broad array of experts…” These have appeared in many venues, but are presented together most comprehensively in Gerald Rosen’s (ed) 2004 Posttraumatic Stress Disorder: Issues and Controversies (also in a Kindle edition and in a special 2007 issue of the Journal of Anxiety Disorders.

• The 1990 National Vietnam Veterans Readjustment Survey, which surveyed over 1,000 Vietnam veterans in 1988 and found that 15.2 percent of them had PTSD then and 30.9 percent had suffered it at some point since the war, is a key document in the PTSD debate. It established the canonical rate estimates — but came under fire almost immediately for not confirming cases and for rate estimates some historians and diagnosticians thought unrealistically high. Its findings are summarized nicely here by Jennifer Price at the VA’s National Center for PTSD.

• In “The Psychological Risks of Vietnam for U.S. Veterans: A Revisit with New Data and Methods in Science in August 2006, Columbia University epidemiologist Bruce Dohrenwend and others, hoping to resolve the debate about the NVVRS, presented a reanalysis of the original NVVRS data. They found that the 1988 rate was 9.1 percent and the lifetime rate 18.7 percent — 40 percent drops from the original. Both sides claimed these findings proved their case. The PTSD establishment said the study supported the construct’s basic integrity by confirming most cases and showing a dose-response relationship. Critics said it proved that this seminal 1990 study had overstated Vietnam veterans’ PTSD rates.

• McNally’s “Psychiatric Casualties of War,” presented alongside Dohrenwend’s study in Science, stressed how sharply Dohrenwend’s revision cut the canonical rates established by the NVVRS — and argued that applying standard clinical defintions of impairment would cut the rates even further. The letters section that follows these pieces online gives a good picture of the academic dispute that flared up afterwards.

It was that exchange that drew my attention to the controversy; as editor of Scientific American’s Mind Matters blog, I solicited “The Costs of War,”, a pair of commentaries on the controversy — one by McNally, one by William Schlenger and Charles Marmar — that ran in Mind Matters in the fall of 2007. (Apologies for the post’s present formatting; it did not fare well in sciam.com’s later website overhaul.)

The flap in Science also led to a special, hastily called symposium at the November 2006 annual meeting of the International Society for Traumatic Stress Studies (ISTSS), which featured presentations by Dohrenwend; Terry Keane, a leading PTSD researcher and clinician at the Boston VA; then-ISTSS president Dean Kilpatrick, who is is a PTSD researcher and clinician at the Medical University of South Carolina; and — via an 8-minute presentation delivered via DVD, as he was in Europe on a previous commitment — Richard McNally.

I am hoping to secure ISTSS’s permission to place here an audio recording of the entire symposium. McNally’s video presentation, however, is viewable below.

 

(It was this presentation that led Kilpatrick to “essentially call McNally a liar,” as I said in the piece. Specifically, after McNally’s presentation aired, Kilpatrick took the floor (it was his turn) and said, “What I would like to do is swear Rich McNally in under oath to tell the truth, the whole truth, and nothing but the truth. If that were done, I think you’d have seen an entirely different presentation.” Kilpatrick later said he meant not that McNally lied, but that he failed to present the entire story — an odd thing to ask, as one observer noted, of an 8-minute presentation)

 

- A Problematic Diagnosis -

 
The fourth Diagnostic Statistical Manual (DSM-IV) provides the present diagnostic definition and guidelines for PTSD. This is updated somewhat from the original construct presented in the 1978 DSM-III.

On the reliability of memory: Elizabeth Loftus’s “Creating False Memories,” from Scientific American, Sept 1997, describes how malleable memory can be, as does Daniel Schacter’s Seven Sins of Memory. McNally’s book Remembering Trauma gives a fuller, more trauma-specific account of memory’s foibles. The “1990 study at the West Haven VA Hospital” that explored malleability of memories in veterans of the 1990 Gulf War is by “Consistency of memory for combat-related traumatic events in veterans of Operation Desert Storm, ” by Southwick and others.

On PTSD’s endocrinology:Rachel Yehuda’s “Biology of posttraumatic stress disorder,” from 2001, is one of several studies that found evidence of neuroendocrinological pecularities in PTSD; a 2004 study by Lindsey et alia’s is one of several that did not. On the search for correlates of PTSD detectable through brain imaging, see Francati, Vermetten, and Bremner, “Functional neuroimaging studies in posttraumatic stress disorder: review of current methods and findings,” 2006.

On the ties between trauma and PTSD symptoms,: see the Bodkin, Pope, and Hudson study described in the article, “Is PTSD caused by traumatic stress,” which found zero correlation between PTSD diagnoses made by symptom clusters and those made by trauma histories.

“The most effective PTSD treatment is exposure-based cognitive behavioral therapy” – This is asserted by many experts and authorities, including a comprehensive review by a National Academy of Science committee, Treatment of Posttraumatic Stress Disorder: An Assessment of the Evidence (2007).

The symptom overlap between PTSD and traumatic brain injury is explored, among other places, in Hoge et alia’s “Mild Traumatic Brain Injury in U.S. Soldiers Returning from Iraq,” New England J of Medicine, 31 Jan 2008.

 

- Disabling Conditions -

 
“In civilian populations, two-thirds of PTSD patients respond to treatment.” from, e.g, “A Multidimensional Meta-Analysis of Psychotherapy for PTSD,” Am J Psychiatry 162 (Feb 2005) (Search for “Across all treatments”)

“…most veterans getting PTSD treatment from the VA report worsening symptoms until they reach 100 percent disability — at which point their use of VA mental health services drops 82 percent.” From VA Office of Inspector General, “Review of State Variances in VA Disability Compensation Payments” [large download] (Report VAOIG-05-00765-137), May 2005, p ix.

“… although the risk of PTSD from a traumatic event drops as time passes, the number of Vietnam veterans applying for PTSD disability almost doubled between 1999 and 2004, driving total PTSD disability payments to over $4 billion annually.” from Veterans Compensation for Posttraumatic Stress Disorder, Institute of Medicine and National Research Council PTSD Compensation and Military Service, National Academics Press, 2005.

The innovative disability program used in Australia is described here.

- Two Ways to Carry a Rifle –

Finally, the conflicting studies of PTSD in US veterans of the Iraq and Afghanistan wars cited in the piece are Milliken et alia, “Longitudinal Assessment of Mental Health Problems Among Active and Reserve Component Soldiers Returning From the Iraq War,” JAMA 14 Nov 2007, which found rates of around 20%, and Smith et al, “New onset and persistent symptoms of post-traumatic stress disorder self reported after deployment and combat exposures: prospective population based US military cohort study,” BMJ 16 Feb 2008, which found rates of under 5%.

(NB: To simplify housekeeping, I’ve closed the comments on this post only. If you want to comment on the story, please do so at my post or at the story.)

Tinea Versicolor (often abbreviated as TV) (say “TIH-nee-uh VER-sih-kuh-ler”) or Pityriasis Versicolor is known as a fungal infection or mild yeast infection of the skin, which causes oval and scaly spots. The patches often combine to form larger patches of various colors (hence its name) — white, tan, brown, and occasionally reddish or pinkish.

Tinea Versicolor:  Do You Have The
Appearance Of Uneven Skin Color
Or Scaly Spots On Your Body? 

1. What is Tinea Versicolor?
2. What Causes Tinea Versicolor?
3. Symptoms of Tinea Versicolor.
4. Who Can Get Tinea Versicolor?
5. Tinea Versicolor Risk Factors.
6. How is Tinea Versicolor Diagnosed?
7. How is Tinea Versicolor Treated?
8. Doctor Recommended Medical Prescriptions for Tinea Versicolor.
9. Safe & Natural, Home Remedies / Treatments for Tinea Versicolor.
10. What Happens After Tinea Versicolor Has Been Treated?
11. Why Does Tinea Versicolor often comes back?
12. What Other Conditions Resemble Tinea Versicolor?
13. Reviews, Experiences & Testimonials of Different Treatments.
14. Leave Your Comments or Questions 

Spots commonly appear on the torso, back, and the upper chest. Occasionally it can appear on the face, neck, under and upper arms and lower legs. Tinea Versicolor may be darker than the rest of the skin in those with light skin or lighter in those with dark skin.

Slow growing yeast called Malassezia furfur or Pityrosporum orbiculare normally grow on the skin sparsely without causing a rash and we typically never realize it is there. It is thought that the yeast feeds on skin oils (lipids) as well as dead skin cells.

However, in some individuals it grows more actively for reasons unknown, thus causing the mild troublesome infection known as Tinea Versicolor. It is known to appear in warmer and humid environments causing it to grow in abundance.

• Oval or irregularly shaped, scaly spots with diameter of 1/4 inch to 1 inch
• Pale, dark tan, or pink in color, with a reddish undertone and sharp border
• An odd assortment of flat, scaling multi-hued creamy and brown patches
• Edges of the dime-sized patches may coalesce, merging into larger patches
• Fine scaling
• Itching that gets worse with sweating
• Spots darken and are more noticeable when patient is over heated, (such as in a hot shower or during/after exercise), after sun tanning or on people with darker skin
• Spots may subside or disappear during the winter season and intensify or reappear when the weather becomes warm and humid
• In light-skinned people, the lesions can appear darker than the surrounding skin, while in dark-skinned people, the reverse is seen. These discolorations have led to the term “sun fungus”

In the United States, it is estimated that 2% to 8% of the population has Tinea Versicolor. It can develop in people of all ages, races, and of either sex. However, Tinea Versicolor is most commonly found in adolescents and young adults. Factors known to trigger the yeast to change into its “disease-causing” form of Tinea Versicolor include:

• Oily skin
• Warm, humid climate
• Sweating frequent or excessively
• Being malnourished
• Using corticosteroids (cortisone)
• Taking medications that weaken the immune system
• Having an impaired immune system (which can occur during pregnancy or from some illnesses)
• Suppressed Immunity (HIV, cancer, diabetes, etc.)
• Cushing disease
• Genetics
• Certain antibiotics or birth control pills
• Families living in the same household mainly sharing bathing towels and bedding
• Tanning booths and public gym equipment

Remember, the vast majority of people who develop Tinea Versicolor are perfectly healthy.

Tinea Versicolor causes no permanent damage to the skin and has no serious complications. The only real effect of the infection is the “cosmetic” concern (unless you’re the one suffering from it in which case its a disaster).

If ignored the yeast can stimulate melanosomes (packages of the skin pigment melanin) to become larger. Once sunlight hits the area, pigment darkens the affected portions of the skin. Imagine each spot tanning and becoming more noticeable after being exposed to the sun. It becomes a nuisance to find a healthy solution to properly rid yourself of this infection before it gets out of control and the possibility of spreading it to your family members arises.

Microscope view of Tinea Versicolor has a spaghetti and meatball appearance.  Diagnosis is usually quite obvious to the trained eye of the dermatologist. However, when in doubt, a microscopic test called a KOH is performed. This consists of the doctor painlessly performing a light skin scraping with a small blade and in rare cases, a skin culture or biopsy. The scales are placed onto a glass slide, a droplet of liquid (potassium hydroxide) is placed onto the slide and then it is examined under the microscope. A positive test shows what we fondly call the “spaghetti and meatballs” sign under the microscope. Hyphae and spores from the yeast are both present and provide that creative appearance.

The infection is treated with skin creams, shampoos, solutions, or antifungal pills. But not everyone chooses the medical treatment method. Generally the creams can:

• Be inconvenient and messy
• May sting and smell bad
• May be just as expensive as pills
• Can take a long time to apply, especially if the rash covers a large area of your body

The reality is that while the rash may clear, medications don’t prevent the inevitable recurrences. Naturally if you attack fungus with drugs, you will also attack the human cells the fungus lives on. If the infection is severe and it covers a large area of your body, returns often, or does not get better with skin care, your doctor may want to prescribe antifungal pills. Antifungal pills cannot be taken by some people, especially those with liver or heart problems. It is important to remember that you have alternative options to costly prescriptions and that you review which treatment is right for you.

There are several medications that doctors would gladly prescribe to treat the infection of Tinea Versicolor; Ketoconazole (Nizoral), Fluconazole (Diflucan), Terbinafine (Lamisil), Ciclopirox (Ciclopirox olamine), Clotrimazole, Miconazole, Lotrimin, Spectazole (Econazole Nitrate), Mentax (Butenafine Hydrochloride) and Oxistat (Oxiconazole Nitrate), Loprox and Naftin (Naftifine Hydrochloride), Itraconazole (Sporanox) and Nizoral 2% just to name a few. Some require treatment for over 1-2 weeks.

Consequently, there are side effects to these drugs; some of these side-effects can be life-threatening.

Side effects of the above prescriptions include but are not limited to:

Nausea Vomiting Abdominal pain Fever Fatigue Loss of appetite Yellow skin (jaundice) Yellow eyes Itching Irritation of the skin Burning sensation Diarrhea Teratogenesis (disfiguring birth defects or malformations) QT interval prolongation (the heart’s electrical cycle)

Severe or lethal hepatotoxicity (implies chemical-driven liver damage) Small but real risk of developing congestive heart failure (CHF) Temporary change or loss of taste Chills Persistent sore throat Bruising Bleeding Vision changes Allergic reactions may include: rash, itching, swelling, severe dizziness, trouble breathing Blistering Hives Induce or exacerbate subacute cutaneous lupus erythematosus (a chronic autoimmune disease harming the heart, joints, skin, lungs, blood vessels, liver, kidneys and nervous system that can be fatal)

Keep in mind that Tinea Versicolor is easily treatable and preventable of future outbreaks in a safe and natural way without the risk of the above side effects. Is your health and well-being worth it?Most importantly, these medication don’t address the issue of reoccurring symptoms that occur when the Tinea Versicolor has already spread to your clothing and bed linens, waiting to reinfect you when you least suspect it.

 

Report Problems to the Food and Drug Administration

 

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.

There are many approach’s to home treatments of Tinea Versicolor. Although, like anything else, there are treatments that show better results than other’s and some that work better in conjunction with another treatment. It is important to be positive about being able to take care of Tinea Versicolor and be proactive in your approach.

Below you will find the top 3 home treatments (listed as good, better, and best) that we have found to rid yourself of this troublesome infection.

 

[ GOOD ]

Selenium Sulfide Introduction

Pronounced [ se-LEE-nee-um SUL-fide ]. Treats dandruff, fungus infections of the skin (tinea versicolor), and seborrhea of the scalp.

In the United States, the 2.5% strength is available only with your doctor’s prescription. The 1% strength is available without a prescription; however, your doctor may have special instructions on the proper use of this medicine for your medical problem.

Brand Name(s)

Head & Shoulders Intensive Treatment, Selseb, Selsun, Selsun Blue, Exsel Lotion Shampoo, Glo-SelSelenos, Rite Aid Dandruff, Dandrex, Versel Lotion, etc.

Selenium Sulfide Treatment

If applicable, use this topical treatment exactly as your doctor prescribed.

The most common home treatment is to apply over-the-counter dandruff shampoo containing 1% selenium sulfide (e.g., Selsun Blue) on the affected areas for 10 to 15 minutes before rinsing. This treatment should be done daily for 2-3 weeks, and once a week afterwards for preventative maintenance.

Other option: to be applied at night and washed off in the morning for a week.

Use this medication for the full prescribed length of time. Your symptoms may improve before the infection is completely cleared.

Users of this method should see their tinea versicolor rash start to fade relative quickly, although it may take several weeks for the skin to return completely to normal.

Precautions & Warnings Using Selenium Sulfide

 

Apply a small amount in an inconspicuous area to check for any allergic or other negative reactions.

If you are pregnant or breastfeeding, talk to your doctor before using selenium sulfide. The medicine may be absorbed into your body and may affect your baby.

Avoid getting this medication in your eyes, nose, or mouth. If it does get into any of these areas, rinse with water.

Do not use selenium sulfide topical on sunburned, windburned, dry, chapped, or broken skin.

Do not cover treated skin with a bandage or other dressing unless your doctor has told you to. A light cotton-gauze bandage may be used to protect clothing. Wear loose-fitting clothing made of cotton and other natural fibers until your infection is healed.

Possible Side Effects While Using Selenium Sulfide

Oily or dry hair or scalp

Skin irritation

Change in hair color

Hair loss

Stop using selenium sulfide and immediately call your doctor if you have unusual or severe blistering, itching, redness, peeling, dryness, irritation of the skin or any other negative side-effects.

Cons of Applying Selenium Sulfide

This treatment can be irritating

May lead to missing hard-to-reach spots on the mid-back

Can be expensive when you need to apply the selenium sulfide to a large area.

Selenium sulfide treatment may also temporarily stain your skin.

Where to Buy

» Well.CA Online Drugstore    » Amazon.com    » DrugStore.com

Retail Outlets: local pharmacy, Target, Walgreens, Walmart, CVS, Rite Aid, etc.

price: $6.00-$20.00/bottle

 

[ BETTER ]

Consistent use of the below products has shown in our tests to be an effective Tinea Versicolor treatment. We’ve found the soap to be the easier solution compared to the Lamasil cream.

DermaDoctor — ZNP Bar

Contains the active ingredient 2% Zinc Pyrithione, which can be used for both acute and for chronic Tinea Versicolor conditions.
price: $8.75/bar

DermaDoctor — AntiFungal Cream

Contains the active ingredient Miconazole Nitrate 2% which resolves and prevents symptoms of fungi, while providing unparalleled hydration, potent rejuvenating antioxidant protection and much-needed soothing relief.
price: $34.00

• Dermatologist Tested & Approved
• Allergy Tested
• Non-Irritating
• Fragrance Free
• Dye-Free
• Non-Comedogenic (i.e., does not block pores)
• Not Tested On Animals

 

[ BEST ]

Our tests have shown that this to be the most effective and least expensive Tinea Versicolor treatment on the market today. The Tinea Versicolor treatment prevents the Tinea Versicolor skin infection to come back which typically leads to a chronic condition lasting years of embarrasment!

Tinea-Versicolor.com

The site has a simple to follow e-book which is very easy to follow, providing a simple but safe Tinea Versicolor treatment to finally rid your body from this Tinea Versicolor skin infection forever. Incredibly, it only takes 3 household ingredients which most people typically have two of the ingredients already at home. The other ingredient can be easily found at either your local grocery store or comsumer retail outlet.

Tinea Versicolor does not leave permanent skin discoloration; however, it may take up to several months for the color to even out between skin areas that are affected and not affected.

The red or brown variety of rash clears up visually right away. It is, therefore, a good idea to have the condition treated as soon as any new spots appear so that any discoloration lasts as short a time as possible.

After the treatment is complete, the excessive amounts of yeast are gone. However, the “rash” is still visible. The “rash” that people perceive is actually skin discoloration. This persistent discoloration often leads people to think that the fungi are still present long after they have been eradicated.

It may take months for skin color to blend and look normal, but it always does. Just like having a significant tan line, it takes time for the skin tone to even out. You may help this by avoiding getting the area exposed to sunlight. By preventing a suntan, you will help to cut down on the exaggeration of the uneven discoloration.

Sunscreen is important. You need to wear an SPF 30 daily to prevent the dark spots from getting any darker in the sun, even if the yeast is gone. Normalizing the variation in skin tone may take a few months. This is a great reason to follow through with your preventative maintenance treatment.

Unfortunately, you can be easily re-exposed to the fungus of Tinea Versicolor without realizing it! Almost all information about Tinea Versicolor, either via the web or as prescribed by your Doctor, is focused solely on treating your skin condition either medically or holistically with pills, soaps, lotions and creams. After your condition has improved you’re under the false impression that the Tinea Versicolor is finally eradicated; however, this is not your last step in battling Tinea Versicolor.

The number one reason why Tinea Versicolor becomes a chronic condition is because vigorous yeast (or fungi) is able to attach themselves to clothing, bedding, bathing towels, etc. for months at a time, patiently waiting to attach themselves upon you when you rest these fabrics on your delicate skin.

It’s absolutely critical to wash all bedding, towels and clothing (e.g., women: especially your bras) to prevent recurrence. It is advised not to wear the same bra day after day (or shirt) prior to being washed. It is important to note that common household detergents, cleaners and hot water alone will not kill the yeast or fungus.

To prevent recurrence of Tinea Versicolor, it is important that treatment be aimed at eradicating the unsightly condition rather attempting to control the chronic condition which can plague you for many years.

Conditions that look like Tinea Versicolor but are really quite different include:

Pityriasis alba: A mild form of eczema seen in children that produces mild, patchy lightening of the face, shoulders, or torso.

Vitiligo: This condition results in a permanent loss of pigment. Vitiligo is likely to affect the skin around the eyes and lips, or the knuckles and joints. Spots are porcelain-white and, unlike those of tinea versicolor, are permanent.

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COGNITIVE DISTORTIONS

We all tend to think in extremes…and when traumatic events happen we think that way even more. Here are some common cognitive distortions. Take a look and see if any of them are getting in your way.

·      All-or-nothing thinking: You see things in black and white categories. If your performance falls short of perfect, you see yourself as a total failure.

 

·      Overgeneralization: You see a single negative event as a never-ending pattern of defeat.

 

·      Mental filter: You pick out a single negative detail and dwell on it exclusively so that your vision of all reality becomes darkened, like the drop of ink that discolors the entire beaker of water.

 

·     Disqualifying the positive: You reject positive experiences by insisting they “don’t count” for some reason or other. You maintain a negative belief that is contradicted by your everyday experiences.

 

·     Jumping to conclusions: You make a negative interpretation even though there are no definite facts that convincingly support your conclusion.

 

·     Mind reading: You arbitrarily conclude that someone is reacting negatively to you and don’t bother to check it out.

 

·     The Fortune Teller Error: You anticipate that things will turn out badly and feel convinced that your prediction is an already-established fact.

 

·     Magnification (catastrophizing) or minimization: You exaggerate the importance of things (such as your goof-up or someone else’s achievement), or you inappropriately shrink things until they appear tiny (your own desirable qualities or the other fellow’s imperfections). This is also called the “binocular trick.”

 

·     Emotional reasoning: You assume that your negative emotions necessarily reflect the way things really are: “I feel it, therefore it must be true.”

 

·     Should statements: You try to motivate yourself with shoulds and shouldn’ts, as if you had to be whipped and punished before you could be expected to do anything. “Musts” and “oughts” are also offenders. The emotional consequence is guilt. When you direct should statements toward others, you feel anger, frustration, and resentment.

 

·     Labeling and mislabeling: This is an extreme form of overgeneralization. Instead of describing your error, you attach a negative label to yourself: “I’m a loser.” When someone else’s behavior rubs you the wrong way, you attach a negative label to him, “He’s a damn louse.” Mislabeling involves describing an event with language that is highly colored and emotionally loaded.

 

·     Personalization: You see yourself as the cause of some negative external event for which, in fact, you were not primarily responsible.

 

From: Burns, David D., MD. 1989. The Feeling Good Handbook. New York: William Morrow and Company, Inc.

Genes for schizophrenia uncovered

Many genes are thought to play a role in schizophrenia
Three separate research projects have pinpointed genetic flaws linked to schizophrenia.

One of these, reported in the journal Nature, could mean a fifteen-fold increase in risk.

However, one of the researchers warned that schizophrenia is so complex genes alone will only ever partially explain the illness at best.

Mental health charities said genetic studies should be matched by work to reduce the known risk factors.

It’s very dangerous to say never, but to me, there are so many genes involved, that the idea of predicting whether someone will develop schizophrenia doesn’t seem to me very likely

Scientists have suggested that an individual’s risk of schizophrenia is roughly half dictated by their genetic make-up, and half by other factors during their lives.

However, on both sides of this equation, much has still to be revealed about the precise causes.

The three large-scale projects have taken a step towards unravelling the genetic picture of schizophrenia.

Two separate international groups, both testing thousands of people with schizophrenia and healthy volunteers, identified the same two rare genetic variants which appeared to contribute strongly to the chances of developing the disease.

However, although one of them increased the risk 12 times, and the other 15 times, they are carried by relatively few people, and so cannot play a part in a large proportion of schizophrenia cases.

The third group, led by Professor Michael O’Donovan, from the University of Cardiff Medical School, and published in the journal Nature Genetics, revealed more common genetic variations, held by many larger numbers of people, but which offer a much smaller contribution to their risk of schizophrenia.

Professor O’Donovan said that while the research was an important step – and could eventually lead to greater understanding, or even better treatment, for schizophrenia, scientists were still far from having a complete picture of how various genetic flaws might work together or separately to produce schizophrenia symptoms.

He said: “It’s very dangerous to say never, but to me, there are so many genes involved, that the idea of predicting whether someone will develop schizophrenia doesn’t seem to me very likely.”

He said it was possible that further study would uncover many different genetic “routes” to schizophrenia symptoms.

Jane Harris, from the mental health charity Rethink, welcomed the advance, but urged people to focus on aspects they could change to reduce the risk of schizophrenia.

She said: “There is lots you can do – it’s half nature, and half nurture, and we have good evidence for many of these things.

“We know, for example, that obstetric complications, or cannabis use, have been linked with an increased risk of schizophrenia.

“Genetics is just a really grey area, and there is a danger people will think you can predict it, or even pretty much eliminate it.”

Marjorie Wallace, from Sane, said that research was important, as it could eventually shed more light on those at greater risk.

But she added: “However, these findings should be treated with caution, as they may be adding to the confusion in a world where scientific studies into the genetic cause or causes of schizophrenia have to date yielded many false positives and led down many cul-de-sacs.”

Professor Michael O’Donovan
Cardiff University School of Medicine

Very Nervous

The following is from

The Brain That Changes Itself: Stories of Personal Triumph from the Frontiers of Brain Science (James H. Silberman Books) by Norman Doidge

 

 

THE BRAIN THAT CHANGES ITSELF
by Norman Doidge, M. D.

 

 

 

“Normally, when we make a mistake, three things happen. First, we get a “mistake feeling,” that nagging sense that something is wrong. Second, we become anxious, and that anxiety drives us to correct the mistake. Third, when we have corrected the mistake, an automatic gearshift in our brain allows us to move on to the next thought or activity. Then both the “mistake feeling” and the anxiety disappear.But the brain of the obsessive-compulsive does not move on or “turn the page.” Even though he has corrected his spelling mistake, washed the germs off his hands, or apologized for forgetting his friend’s birthday, he continues to obsess. His automatic gearshift does not work, and the mistake feeling and its pursuant anxiety build in intensity.

 

We now know, from brain scans, that three parts of the brain are involve in obsessions.

We detect mistakes with our orbital frontal cortex, part of the frontal lobe, on the underside of the brain, just behind our eyes. Scans show that the more obsessive a person is, the more activated the orbital frontal cortex is.

Once the orbital frontal cortex has fired the “mistake feeling,” it sends a signal to the cingulate gyrus, located in the deepest part of the cortex. The cingulate triggers the dreadful anxiety that something bad is going to happen unless we correct the mistake and sends signals to both the gut and the heart, causing the physical sensations we associate with dread.

The “automatic gearshift,” the caudate nucleus, sits deep in the center of the brain and allows our thoughts to flow from one to the next unless, as happens in OCD, the caudate becomes extremely “sticky.”

Brain scans of OCD patients show that all three brain areas are hyperactive. The orbital frontal cortex and the cingulate turn on and stay on as though locked in the “on position” together — one reason that Schwartz calls OCD “brain lock.” because the caudate doesn’t “shift the gear” automatically, the orbital frontal cortex and the cingulate continue to fire off their signals, increasing the mistake feeling and the anxiety. Because the person has already corrected the mistake, these are, of course, false alarms. The malfunctioning caudate is probably overactive because it is stuck and is still being inundated with signals from the orbital frontal cortex.

–p.170

**
“Pain and body image are closely related. We always experience pain as projected into the body. When you throw your back out, you say, “My back is killing me!” and not, “My pain system is killing me.” But as phantoms show, we don’t need a body part or even pain receptors to feel pain. We need only a body image, produced by our brain maps. People with actual limbs don’t usually realize this, because the body images of our limbs are perfectly projected onto our actual limbs, making it impossible to distinguish our body image from our body. “You own body is a phantom,” say Ramachandran, “one that your brain has constructed purely for convenience.”

p. 188

**
“According to Ramachandran, pain, like the body image, is created by the brain and projected onto the body. This assertion is contrary to common sense and the traditional neurological view of pain that says that when we are hurt, our pain receptors send a one-way signal to the brain’s pain center and that the intensity of pain perceived is proportional to th seriousness of the injury. We assume that pain always files an accurate damage report. This traditional view dates back to the philosopher Descartes, who saw the brain as a passive recipient of pain. But that view was overturned in 1965, when neuroscientists Ronald Melzack (a Canadian who studied phantom limbs and pin) and Patrick Wall (an Englishman who studied pain and plasticity) wrote the most important article in the history of pain. Wall and Melzack’s theory asserted that the pain system is spread throughout the brain and spinal cord, and far from being a passive recipient of pain, the brain always controls the pain signals we feel.

Their “gate control theory of pain” proposed a series of controls, or “gates,” between the site of injury and the brain. When pain messages are sent from damaged tissue through the nervous system, they pass through several “gates,” starting in the spinal cord, before they get to the brain. But these messages travel only if the brain gives them “permission,” after determining they are important enough to be let through. If permission is granted, a gate will open and increase the feeling of pain by allowing certain neurons to turn on and transmit their signals. The brain can also close a gate and block the pain signal by releasing endorphins, the narcotics made by the body to quell pain.

***
Wall and Melzack showed that the neurons in our pain system are far more plastic than we ever imagined, that important pain maps in the spinal cord can change following injury, and that a chronic injury can make the cells in the pain system fire more easily — a plastic alteration — making a person hypersensitive to pain. Maps can also enlarge their receptive field, coming to represent more of the body’s surface, increasing pain sensitivity. As the maps change, pain signals in one map can”spill” into adjacent pain maps, and we may develop “referred pain,” when we are hurt in one body part but feel the pain in another. Sometimes a single pain signal reverberates throughout the brain, so that pain persists even after its original stimulus has stopped.

**
Extending the gate theory, Ramachandran developed his next idea: that pain is a complex system under the plastic brain’s control. He summed this up as follows: “pain is an opinion on the organism’s state of health rather than a mere reflexive response to injury.” The brain gather evidence from many sources before triggering pain. He has also said that “pain is an illusion” and that “our mind is a virtual reality machine,” which experiences the world indirectly and processes it at one remove, constructing a model in our head. So pain, like the body image, is a construct of our brain.”

 

 

 

 

Organizational Coping Patterns

by Rick Brenner

If your organization doesn’t cope well with adversity, it might be caught in one of several ineffective coping patterns. To help it to be more effective, begin by understanding how different organizations cope.  In this essay, I adapt a well-known model of coping styles for individuals to describe organizational coping. You can use this model to recognize how to enhance or change the coping strategies of your organization.

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Organizations deal with adversity by coping in characteristic ways.  Although every organization is unique, you can understand its coping patterns in terms of three basic elements.  The description that follows is based on a model of personal coping behavior first developed by Virginia Satir [Satir 1976, Satir 1988] and elaborated by others.  I found Weinberg [Weinberg 1994] and McLendon and Weinberg [McLendon 1996] especially helpful.

The fundamental idea of Satir’s model, as applied to organizations, is that organizational coping patterns take reality into account in different ways.  We can represent reality as a combination of three elemental factors: the Self, the Other and the Context.  In organizational terms, the Self represents the internal world of the organization itself.  The Other represents people or organizations external to the organization, but close to the organization.  Finally, the Context represents the world beyond that — everything else.

Once you’ve identified a pattern that your organization uses repeatedly, you have all the tools you need to modify that pattern.  If one or more elements of reality is under-represented or over-represented, you can work to bring things back into balance.

Here’s an example.  Let’s suppose that we’re trying to understand how a project team came to a certain state of stress, and we’re looking at the flow of its communications with Marketing. Applying Satir’s model, Self would be the Project Team, Other would be Marketing, and all other factors are part of Context.  In this example, the CEO and the Finance organization, as well as the Federal Communications Commission and the Law of Gravity, are part of Context.

When we put appropriate weight on each of these three elements, we have the best chance of coping well with reality.  When coping and communication are effective, the organization’s internal representation of reality coincides with — is congruent to — reality itself.  In the same way, the organization’s representation of itself to the outside world coincides well with — is congruent to — the internal reality of the organization.  An organization that’s coping with reality from this position is said to be in a Congruent stance.  When an organization’s views disregard one or more of these three elements, unfavorable outcomes are more likely.  This is called incongruent coping.

                                                             The Blaming Configuration

 

Satir represents these possibilities using a simple graphical notation.  To the right is an example of her notation as applied to the incongruent coping stance called blaming.  In blaming, Self and Context are taken into account, but the Other (the one blamed) isn’t.  In the graphic, I’ve chosen to represent with the dark color an element that’s taken into account.  Elements that are disregarded or not taken into account are represented with the light color.

Typically, when we blame, we disregard or deliberately hide the true worth of the person or thing blamed.  For example, when we blame Congress for writing such complex laws, and when we really get worked up about it, we tend to ignore the good things Congress has done, and continues to do. It may well be true that Congress has written some bad laws — but it’s just as certainly true that it has produced some good ones.  It would be unwise to eliminate Congress just because it has made some mistakes.

Yet, in project work, when a colleague has made a drastic error that costs the project dearly, we sometimes blame the project’s failure on that one person.  And, sometimes, such people are terminated, demoted, or moved to other assignments, even when we need their unique capabilities.  Although this is sometimes the right thing to do, it’s also true that the blaming position can lead to the unnecessary loss of capability that the organization really needs.  And it can bring unjustified harm to any person’s career.  An organization that’s conversant with Satir’s model of coping stances has the best chance to notice itself adopting a blaming pattern in a situation like this one.  Once it has noticed the pattern, it can begin to formulate alternate choices, and perhaps find a way to deal with the problem while avoiding undue harm to the person who erred, and to itself.

In the rest of this essay, I’ll list all eight patterns of organizational coping.  To help convey the characteristic behavior of each pattern, each description contains a brief summary of how an organization that has adopted that pattern would respond in a typical emergency project situation:

The scene is a hastily-called meeting of executives, managers, and project managers.  The agenda for this meeting is a review of the status of a key project, upon which the future of the organization depends.  The meeting is being held because the project’s manager, in response to new information about three problematic tasks, has re-estimated the delivery date, and now expects a significant slip, which would have serious negative consequences for the organization and its customers.

Each of the eight characteristic organizational patterns suggests a characteristic atmosphere for such a meeting.  That’s why this scenario is so useful for conveying the character of each pattern. And, of course, we’ve all attended such meetings, so we have our own experiences to compare to. Comparing the different responses within this one vignette helps clarify the distinctions among the eight patterns. 

Each description concludes with a brief discussion of what might be needed to change that coping pattern to the Congruent pattern.  You might be able to use these insights to help guide your organization to behave more congruently in similar situations.

The eight organizational coping patterns are:

 

 

 

Congruent

When an organization copes on the basis of understanding its own value, its own flaws, and its own limitations, it has the best chance of achieving its potential — and great things.

Placating

A Placating organization shows undue concern for possible negative consequences. The group can be so driven by avoidance of discomfort right now, that it’s willing to exchange it for far greater — even inevitable — discomfort in the future. When the group placates, it collectively avoids confronting issues or people, preferring instead to take full responsibility itself for any disappointing outcomes.

Blaming

When an organization copes by Blaming, it seeks people or things to hold responsible for any problem, not to learn from its mistakes, or to prevent them in the future, but to preserve its view of its own infallibility — and the fallibility of others.

Loving/Hating

In coping by Loving/Hating, the organization is driven by its relationship with other organizations, people or ideas. Whether finally to destroy that organization, person or idea; or to attach itself thereto in permanent adoration and ethereal bliss, it ignores almost everything and everyone else external to the focal relationship.

Narcissistic

When an organization is coping in the Narcissistic pattern, it’s driven by its love of itself and disregard for everything else. No other organization, no person, nothing external to itself is of any worth or value, except perhaps as support or utility to itself. The Narcissistic organization is prepared to use, abuse or exploit anyone, any idea, or any other organization, including its organizational parent, to further its own ends.

Infatuated

The Infatuated organizational coping pattern displays complete devotion to a particular person, idea or organization. It remains dedicated in the face of almost any contradictory data, which can lead it to decisions that expose itself to inordinate risk or even to organizational disaster.

Irrelevant

Irrelevant coping in an organization is coping by flight. In the face of adversity, the organization copes by avoiding not only the adversity, but any recognition of it.

Super-reasonable

Super-reasonable organizational coping emphasizes Context, usually through a devotion to “objectivity” and at the expense of human considerations or considerations of relationship. Super-reasonable coping can lead an organization to adopt self-destructive strategies because they make sense for the “bottom line,” or because they emphasize some specific organizational priorities, even if they’re self-destructive.

 

Flexibility of Coping Stances:

 

When an organization copes with a situation, it assumes a coping stance, which might be any one of the eight possible stances, or it might be a combination of two or more.  To perhaps a greater extent than personal coping, organizational coping can more easily involve combinations, because so many people are involved.  For instance, some of the people in the organization might prefer Blaming, while others might prefer Placating.  What emerges for the organization is the result of everyone’s contributions.

The incongruent coping patterns of organizations are thus distinct from what might be perceived as organizational behavior disorders, in that they’re transient.  Coping styles can vary with time and certainly with situation.  Like people, the coping behavior of an organization in any specific situation might not fit any neat categorization scheme.  Nevertheless, patterns of coping can emerge. An organization might favor one or two incongruent coping stances, on the whole and most of the time, but it still has the potential for Congruence at any time.  An organization that behaves congruently most of the time can still occasionally adopt a blaming or placating stance once in a while. Variation is the only constant.

Learning to Use the Model

 

 

 

 

Learning to use the model is difficult, especially when we try to apply it to an organization in which we play a key role, in part because of our own role in the incongruence.  It might be easier to begin by studying incongruent coping of organizations in which you play a minor role, or no role at all.  One very effective approach might be to study a historical situation from the perspective of this model. Historical examples are especially useful, because we often have access to detailed background information that’s difficult to obtain in real-life personal experiences.  For example, the Munich Pact of 1938, under which Germany acquired the Sudetenland from Czechoslovakia, could be an example of organizational placating by Great Britain.  By exploring historical examples, you can become familiar with the model and its application to organizations.

Once you have this familiarity, try tracking specific situations within your own organization.  And when the time is right, try to move your organization towards congruence.

 

At the University of Seattle psychologist John Gottman (click to find his book at Amazon. com) has been researching the ingredients that make for successful marriage and successful therapy of couples who are wanting to make their relationships more fulfilling.

Gottman challenges many of the myths we hear in our day to day lives:

He reminds us that research does not support the idea that neurotic conflicts bring failure in marriage.

He cautions that having common interests can mean smooth or rough sailing depending on how you treat one another when you are sharing time together.

He has found that in happy marriages couples are not keeping tabs on one another and thus the quid pro quo theory of blissful matrimony is bogus.

He warns that avoiding conflict is not an asset in a marriage, depending on the personality of the individuals involved.

He recognizes that affairs to not generally break up marriages but that failing relationship intimacy leads to affairs. (I am sure he would agree that this is not always the case.)

He especially goes after the myths about men having poor relationship skills and a need to “spread their seed:” a sort of

And finally he asserts that while men and women have differences due to gender, this does not necessitate that they live on different planets.

So what does he look for and work for in helping his couples improve their lives?

First, he is concerned about the pattern of relationship repair. He has noticed in his observation of couples that those who succeed find ways to engineer “personal space walks” to fix what is failing or has injured their marital ship.  He says that “In the strongest marriages, husband and wife share a deep sense of meaning…don’t just ‘get along’–they also support each other’s hopes and aspirations and build a sense of purpose into their lives together.” (source: The Seven Principles for Making Marriage Work)

He has noticed that couples who are successful avoid “harsh startups.”  This is about how spouses bring up issues, approach each other in problem solving.  Contempt can be found in a soft but cunning voice or in a loud abrasive and accusatory challenge.  It is the negativity and hostility factor that makes for the difference.

He goes on to identify The Four Horsemen of the Marital Apocolypse:

1. Relating by criticizing rather than complaining.  Complaints address issues and problems while criticism addresses global characteristics and escalate the conflict.

2. Contempt, demonstrated by frequent sarcasm and cynicism, of expression is a marriage killer.  He says, “Contempt is fueld by long-simmering negative thoughts about the partner.”  The cousin of contempt, he says, is belligerence: aggressive anger that contains a threat or provocation.

3. Defensiveness, he says, maintains these first two characteristics of marital failure.  By focusing on the partner’s faults or avoiding responsibility for relationship sabotage, the power struggle then escalates and solutions do not develop.

4. Finally, he posits that Stonewalling or tuning out is the ultimate killer, often arriving later on the marital scene, as hope begins to falter or is lost in the negative spiral of unsuccessful problem solutions.

He recognizes that a spouse will begin to stonewall as a protection agaisnt feeling overwhelmed or flooded by angry and painful emotions.

All of these factors are conveyed and expressed through body language that reveals an alarmed somatic reaction to the marital stress: increased adrenaline, fight or flight reactions, mounting blood pressure, and other significant hormonal changes:  Selye’s stress cycle.

These problems, as they become chronic in a failing marriage, make it much more difficult for repair attempts to succeed. He observes that “The more repair attempts fail, the more these couples keep trying.”  As the marriage continues bad memories begin to replace the dreams, high hopes and expectations that held the marriage together in the first place.  History gets rewritten, he says, and distorted memories begin to intensify.

Gottman’s Principles for Rebuilding Marital Relationship Include:

1. Enhancing Love Maps: Sharing and Getting to Know Your Partner Again
2. Nurturing Fondness and Admiration: Fanning the Flames of Appreciation
3. Turning Toward Instead of Away From Each Other: Learning How to Have Stress Reducing Conversations
4. Letting Your Partner Influence You: Practicing Emotional Intelligence and Yielding
5. Solving Solvable Problems and Being Tolerant of One Another’s Faults
6. Overcoming Gridlock by

• Finding Common Ground
• Defining Areas of Flexibility 
• Establishing Temporary Compromises 
• Addressing Short-Term Needs or Wishes

He encourages the development and maintenance of family rituals:  having meals together; attending reunions and religious services; having family outings; establishing repetitive events that express the unique interests or goals of members of the family, such as attending sports events or hiking.

Photobooks, memory books, and or photo collections can also cement marital and family relationships and help form a symbolic and expressive symbolic expression of a couples’ life journey.

The Tarasoff Statute is precedent-setting and specifies that the therapist or counsellor has a duty to warn “where the patient has communicated a serious threat of physical violence against a reasonably identifiable victim or victims.” In these situations, the therapist’s duty is to make a “reasonable effort to communicate the threat to the victim or victims and to a law enforcement agency.” Failure to act may also result in potential civil liabilities. 

A new California statute (AB733) became effective January 1, 2007 and  clarifies further Tarasoff Mandated Reporting:  The court expanded the definition of Civil Code 43.92 to include family members as persons covered within the statute:

The intent of the statute is clear. A therapist has a duty to warn if, and only if, the threat which the therapist has learned – whether from the patient or a family member – actually leads him or her to believe the patient poses a risk of grave bodily injury to another person. “The expanded duty from now on applies to credible threats received from the patient, or the patient’s family, however, the court made clear that its decision did not go beyond “family members.”

Myths and Facts About Domestic Violence

Myth # 1: Battering is rare.

FACT: Domestic violence is extremely common. The F.B.I. estimates that a woman is battered every fifteen seconds in the United States.

Myth #2: Domestic violence occurs only in poor, poorly educated, minority or “dysfunctional” families. It could never happen to anyone I know.

FACT: There are doctors, ministers, psychologists, and professionals who beat their wives. Battering happens in rich, white, educated and respectable families. About half of the couples in this country experience violence at some time in their relationship.

Myth #3: Battering is about couples getting into a brawl on Saturday night, beating each other up, and totally disrupting the neighborhood.

FACT: In domestic assaults, one partner is beating, intimidating, and terrorizing the other. It’s not “mutual combat” or two people in a fist fight. Its one person dominating and controlling the other.

Myth #4: The problem is not really woman abuse. It is spouse abuse. Women are just as violent as men.

FACT: In over 95% of domestic assaults, the man is the perpetrator. This fact makes many of us uncomfortable, but is no less true because of that discomfort. To end domestic we must scrutinize why it is usually men who are violent in partnerships. We must examine the historic and legal permission that men have been given to be violent in general, and to be violent towards their wives and children specifically. There are rare cases where a woman batters a man. Battering does occur in lesbian and gay male relationships. Survivors of abuse in such relationships should hear that because their situation is rare – or because they are in a societally unaccepted relationship – that does not make it less valid or serious. The National Domestic Violence Hotline believes that violence is unacceptable in intimate relationships and provides services to any person who has been victimized.

Myth #5: When there is violence in the family, all members of the family are participating in the dynamic, and therefore all must change for the violence to stop.

FACT: Only the perpetrator has the ability to stop the violence. Many women who are battered make numerous attempts to change their behavior in the hope that this will stop the abuse. This does not work. Changes in family members’ behavior will not cause or influence the batterer to be nonviolent.

Myth # 6: Batterers are crazy.

FACT: An extremely small percentage of batterers are mentally ill. The vast majority seem totally normal, and are often charming, persuasive, and rational. The major difference between them and others is that they use force and intimidation to control their partners. Battering is a behavioral choice.

Myth # 7: Domestic violence is usually a one-time event, an isolated incident.

FACT: Battering is a pattern, a reign of force and terror. Once violence begins in a relationship, it gets worse and more frequent over a period of time. Battering is not just one physical attack. It is number of tactics (intimidation, threats, economic deprivation, psychological and sexual abuse) used repeatedly. Physical violence is one of those tactics. Experts have compared methods used by batterers to those used by terrorists to brainwash hostages.

Myth #8: Battered women always stay in violent relationships.

FACT: Many battered women leave their abusers permanently, and despite many obstacles, succeed in building a life free of violence. Almost all battered women leave at once. The perpetrator dramatically escalates his violence when a woman leaves (or tries to), because it is necessary for him to reassert control and ownership. Battered women are often very active (and far from helpless) on their own behalf. Their efforts often fail because the batterer continues to assault, and institutions fail to offer protection.

Myth #9: The community places responsibility for violence where it belongs – on the criminal.

FACT: Most people blame the victim of battering for the crime, some without realizing it. They expect the woman to stop the violence, and repeatedly analyze her motivations for not leaving, rather than scrutinizing why the batterer keeps beating her, and why the community allows it.

Myth #10: Drinking causes battering.

FACT: Assailants use drinking as one of many excuses for violence, and as a way of putting responsibility for violence, and as a way of putting responsibility for their violence elsewhere. There is a 50% or higher correlation between substance abuse and domestic violence, but no causal relationship. Stopping the assailant’s drinking will not end his violence. Both problems must be addressed.

Myth #11: Stress causes domestic assault.

FACT: Many people who are under extreme stress do not assault their partners. Assailants who are stressed at work do not attack their co-workers or bosses.

Myth #12: Men who batter do so because they cannot control themselves or because they have “poor impulse control.”

FACT: Men who batter are usually not violent towards anyone but their wives/partner or their children. They can control themselves sufficiently to pick a safe target. Men often beat women in parts of their bodies where bruises will not show. Sixty percent of battered women are beaten while they are pregnant, often in the stomach. Many assaults last for hours. Many are planned.

Myth # 13: Rapists are strangers.

FACT: One out of ever seven married women is raped by her husband. At least 60%, and possibly all, physically battered women are sexually abused by their partners. This abuse includes, but is not limited to: forced sex in front of children, forced sex with animals or in groups and prostitution.

Myth #14: If a battered woman wanted to leave, she could just call the police.

FACT: Police have traditionally been reluctant to respond to domestic assaults, or to intervene in what they think of as a private matter. Police have usually temporarily separated the couple, leaving the woman vulnerable to further violence.

Myth #15: If a battered woman really wanted to leave, she could easily get help from her religious leader.

FACT: Some priests, clergy, and rabbis have been extremely supportive of battered women. Others ignore the abuse, are unsupportive, or actively support the assailant’s control of his partner.

Myth #16: Men who batter are often good fathers, and should have joint custody of their children.

FACT: At least 70% of men who batter their wives, sexually or physically, abuse their children. All children suffer from witnessing their father assault their mother.

Myth #17: If a battered woman really wanted to leave, she could just pack up and go somewhere else.

FACT: Battered women considering leaving their assailants are faced with the very real possibility of severe physical damage or even death. Assailants deliberately isolate their partners, and deprive them of jobs, of opportunities for acquiring education and job skills. This combined with unequal opportunities for women in general and lack of affordable child care, make it excruciatingly difficult for women to leave.

——————————————————————————–

Reproduced with permission. The Domestic Violence Project, Inc., SAFE HOUSE (Shelter Available for Emergency) P.O. Box 7052, Ann Arbor, Michigan 48107.

CREATE YOUR OWN SAFETY PLAN!

You can create a less threatening environment for yourself and your children and regain control of your life by preparing for dangerous situations in advance.

IF YOU ARE LIVING WITH YOUR ABUSER:

Call the police (dial 911) if danger is escalating.

Tell a neighbor, co-worker, friend or family member about your situation, and ask them to call the police if you or your children are in danger.

Teach your children how to dial 911 and rehearse what they need to say.

If you have access to a cell phone, keep it handy at all times and know your location so you can call the Police if you are threatened.

Keep the Domestic Violence Hotline number available should you need assistance or guidance other than Emergency Police protection or intervention.

Educate yourself about the Protection Order and other legal options.

Educate yourself about shelters and resources available for battered women. Know what’s available before an emergency arises!

During an argument, stay out of the rooms where you know there are weapons such as guns, knives, tools, etc. Police may remove firearms when responding to domestic violence calls if the firearm is in view.

When the police arrive, stay calm and describe the incident as clearly as possible.

Keep an extra car and house key in a separate and secret place outside the home.

Plan where you will go if you have to leave in a hurry. For example: a shelter, a friend’s home, or a family member’s residence or maybe to the Police Station.

Be sure to have copies of all important documents, e.g. birth certificates, marriage license, passports, alien cards, tax returns, bank statements, bank checks and savings accounts, medical insurance information, legal documents, and keep in a safe place outside the home.

Keep an “Escape Bag” with a little money, clothing, toys for the children, snacks, important telephone numbers, and anything else you may need. Critical items such as eyeglasses, contact lenses, medication, appointment calendar, and updated pictures of your children might also be helpful. Put it in place where it cannot be found by the abuser–perhaps with a friend, neighbor or your workplace.

IF YOU ARE NOT LIVING WITH YOUR ABUSER:

Call the police (911) if you don’t feel safe.

Change the locks to your residence if the abuser has a key.

If you have a Protective Order, keep a copy with you at all times and call the police if the abuser violates the Order. Give a copy of your Protective Order to schools, daycare providers, a supportive neighbor, family or friend, and your workplace. Be sure they know to call the police if the abuser violates the order.

Get an answering machine with caller I.D. to screen your telephone calls.

Ask a work colleague or guard to escort you to your car, bus, or train after work.

Inform daycare centers, sitters and schools as to who has permission to pick up your children.

During exchange of children for visitation, arrange to meet in a public place such as a police station, a library, inside a shopping mall (but not in a parking lot), or at a family member’s home. It’s generally not a good idea to have visitation in your home without some other means of security available.

Do not allow the abuser into the home if he doesn’t live there. Tell your children not to open the door to anyone.

If you are receiving harassing telephone calls, dial *57. This will activate the telephone company’s CALL TRACE SERVICE. If the abuser leaves threatening messages on your machine, keep the tape.

Keep a journal documenting any harassment, incidents of abuse or threats. Include photographs of injuries and any damage to your property. Maintain a list of witnesses, if any.

If your abuser is in jail, keep informed of his status. If he is on probation, be sure you know the probation officer’s name and telephone number.