Wednesday, May 21, 2014

Written on May 21, 2014
Hijacked :: Hope for Healing
Even though CSA puts one at risk for a long list of psychological challenges, many children are so resilient that they never develop PSTD or any psychiatric condition. Support during times of trauma may provide a buffer to the effects of severe stress response: "When rescued from extremely neglectful and abusive environments, some profoundly developmentally delayed maltreated children were capable of accelerated rates of catch-up growth, including remission of severe psychopathology and normalization of cognitive function.” Loving families, cognitive behavioral therapy, and medications may all help to lessen the effects and symptoms of PTSD, depression, and the like.[1] Apart from these more obvious mitigation activities, there may be additional actions one can take to help her hurting brain. Just as martial-arts is known to combat anger and reduce aggression, less obvious forms of treatment may offer solutions. There are several actions one can take to promote mental health. Thomas R. Insel is an American neuroscientist and psychiatrist who has led the National Institute of Mental Health since 2002. He says the following:
“Over the past two decades, neuroscience research has transformed our understanding of the brain. Three insights have been fundamental. First, we now recognize the brain as a dynamic organ, capable of remarkable changes in how cells are connected and even in the number of cells available throughout life. Second, we recognize considerable individual variation in the relationship between brain anatomy and function. Classic maps of the cortex with specific areas for motor and sensory fields are still useful but only as a broad generalization that varies greatly across individuals. And finally, we now appreciate a stunning level of modularity in the brain, with circuits dedicated to highly specific functions, such as verbs versus nouns or animate versus inanimate objects.”
The high complexity of the brain provides much hope.

If there’s a Will, is there a Way?

Genetics predispose us to develop in a particular way, but it is our experiences, positive and negative, that greatly influence how those predispositions are uniquely expressed. It turns out that both are required for ideal development of the human brain.[2] Nature vs. nurture is a term that was long ago coined due to an ongoing popular debate. Researchers have long argued the importance of one’s inherent qualities (nature) compared to one’s personal experiences (nurture) in causing unique physical and behavioral characteristics. In other words, if we take the top-down approach to break down the elements that feed into a particular outcome or expression, we’ll find that both a person’s predispositions (genetics) and environment (circumstances) both play a role, and virtually all features within a person can be explained as such. Whether predisposition or environment is the greater influence is the argument that often arises. For example, in the book Quiet, Susan Cain argues that we can stretch our personalities but only so much. While such characteristics can be altered to a degree thanks to free will and environmental differences, they are inherent within us and cannot altogether be changed. Cain summarizes research that suggests something important: “we can stretch our personalities, but only up to a point.” Perhaps what is more important is the interaction between genetics and experience.

Nancy Talbot of the University of Rochester Medical Center and her colleagues examined the relationship between specific dimensions of CSA and personality traits in adulthood. Their findings suggest that there are associations between personality traits and CSA characteristics in psychiatric patients. More specifically, women who experienced intercourse by a parent may be more introverted and less open to experience than women whose sexual abuse history does not include parental incest.[3]

Reduction in gray matter volume in certain areas of the brain may present a preference for alternative facial perceptions. The team of Harvard researchers has thought that this may explain why some patients have learned to see unclear expressions as signs of anger. Cain explains that the amygdalae of introverts tend to be more sensitive to unfamiliar faces, emotions, art, and even various types of stimuli such as caffeine. These additional facts make it difficult to determine the exact origin of personality traits such as high sensitivity. Regardless of the basis for possessing various personality traits, do we have a say in the person we become? In reference to past sexual abuse, Carl Jung once said, “I am not what happened to me; I am what I choose to become.” We cannot control that which is outside of ourselves—abuse, neglect, maltreatment, betrayal—but perhaps we can choose who we become.

In a study involving college undergraduates, psychology professor Dolores AlbarracĂ­n and her colleagues had students write either the words “Will I” or “I will” 20 times. Students who wrote “Will I” performed better on an anagram task versus the students who wrote “I will.” Contrary to what we may expect, the declarative form of thinking (I will) didn’t win. In other words, this will I-type thinking “may elicit more intrinsically motivated reasons for action, resulting in goal-directed behavior.”[4] A possible explanation for these results lies within choice. “Will I” allows one to respond with yes or no, meaning if action is taken, it arises as a result of increased internal motivation and a desire to complete the task at hand.

In the same way, “must,” “have to,” and “should” ways of thinking aren’t nearly as beneficial as acknowledging the choice. For example, say I’m unhappy with my current job, so I begin to search for other available positions, yet after searching, I find nothing else worth pursuing. So I make the choice to remain in my current position. I am much more likely to be content in my job if I give myself the option as opposed to feeling imprisoned. Likewise, healing—even general change—isn’t required.

One may acknowledge that difficulties in her past clearly have affected the person she’s become; she may also appreciate those differences. For example, the introversion that may have initially evolved as the result of trust issues may actually prove to be a desirable acquired “skill.” Perhaps the abilities to self-reflect and slow down are advantageous. Maybe the scanning of one’s surroundings that once seemed to be an embarrassing nervous act now helps to protect oneself and children. At the very least, hopefully one can acknowledge the endurance she’s attained as a result of her pain, yet if the will exists to change, there must be a way. 

Change Blossoms from the Ground of Self-acceptance

Carl Jung once said, “We cannot change anything until we accept it. Condemnation does not liberate, it oppresses.” We begin by learning to accept our sinned against selves, acknowledging that what happened was outside of ourselves. More importantly, it’s important to note that CSA is a harm that affects not only the brain and the body but also the spirit and the lies we believe. Actively engaging in the war against unforgiveness and lies is an absolute must is one hopes to heal. These spiritual matters must be addressed. Wholeness is moving towards God in addition to knowing and accepting all I am. It means rejecting values and behavior which are inconsistent with the goal! 

Recognize Self-worth

According to World Health Organization (WHO), “in young people, depression and low self-esteem are linked with smoking, binge drinking, eating disorders and unsafe sex, putting them at risk of a range of diseases including sexually transmitted diseases […]” An individual’s emotional resilience, her ability to manage her thoughts and feelings, is associated with self-esteem. And it's all in the attitude. According to WHO, “Many studies since the 1950s support the idea that medically ill patients with negative attitudes have worse outcomes than those with more positive attitudes.” More recent studies show that those who are optimistic have lower death rates from conditions like heart disease. [5] 

Develop a Sense of Belonging

Family, friends, culture, country, and even the world—belonging is a universal desire. Motivation, happiness, and even health are linked to our sense of being a part of a greater community. There are plenty of opportunities to feel out of place.

(1) Anger, bitterness, unforgiveness, and /or lies are flourishing. Someone or a group of people have sinned against you and you carry this with you today. You may not even be consciously aware of your thinking process, but you’re convinced that others will repeat this. Let’s say someone decided against being your friend in the past because she felt like she couldn’t relate to your past. A past invalidation may stick with you if unforgiveness is harbored. You may believe that others feel this very same way about you without ever hearing the same words come out of their mouths. And perhaps the people you’re around are feeling the very same way you do. They’re cautious, maybe just as afraid to approach you. Maybe someone has also hurt them in the past, leaving them to assume that you’ll do the same. (2) Miscommunication is taking place. Someone or a group of people currently appear to not understand, validate, and/or care to hear about you or your past. Maybe the people you’re around are thinking and feeling nothing but wonderful things towards you, but they don’t know how to communicate this to you in a way that you’ll understand. Even small things can make us feel out of place. Jokes aren’t shared. Smiles aren’t returned. Interests aren’t common. (3) Unfortunately, a difficult situation is taking place. Someone or a group of people currently do not understand, validate, and/or care to hear about you or your past. People are sinners and are currently sinning against you, which is obviously unfortunate. One must be careful to see that the current situation doesn’t also lead to (1) and/or (2). As Christians, we must understand the spiritual war that is taking place. There are many reasons why Satan and his demons want us to feel as if we don’t belong.

(1) Isolation makes it easier for Satan and demons to attack and feed us lies. The lone sheep is sought after over the herd. Weak, secluded individuals are easier to deceive because they’re already deceived if they’re isolated. At the same time there’s less influx of truth due to a lack of friendships or community in general. (2) Isolation is a selfish act. Proverbs 18:1 reads, “Whoever isolates himself seeks his own desire; he breaks out against all sound judgment.” Isolation is selfish because it is based out of fear. Isolation is a protective, unhealthy self-preserving action. (3) Feelings of not belonging with other Christians point to feelings of belonging to the world by default. If we feel we belong to the world, we will act as if we belong to the world, but we must remember what John 15:19 says: “If you belonged to the world, it would love you as its own. As it is, you do not belong to the world, but I have chosen you out of the world. That is why the world hates you.” (4) Feelings of not belonging point to a lack of union with Jesus and the church. If we don’t belong anywhere, we don't belong in the body. We must remember what 1 Corinthians 12:12 says: “For just as the body is one and has many members, and all the members of the body, though many, are one body, so it is with Christ.” When we see all the reasons why Satan doesn't want us to belong, we’re more apt to consider that feelings of not belonging are often based on lies. Once the lies are acknowledged, there are several truths for the Christian to mediate on to create more feelings of belonging.

(1) Focus on knowing others’ stories. F. Scott Fitzgerald once said, “That is part of the beauty of all literature. You discover that your longings are universal longings, that you're not lonely and isolated from anyone. You belong.” If we take the time to get to know others’ stories, we’ll be less apt to think of ourselves so much. We’ll probably find that even if the details of someone’s life are different, they feel or think similar things. At the very least we can count on having our faith (and the struggles that come along with it) in common with other Christians. (2) Share your story. If we share our stories, they don’t have as much power over us, especially if they seem extreme, difficult, and “too much” for other people. Be vulnerable. Such stories are encouraging to others. This will broaden others' perspectives and help us to feel we have something to offer others—a testimony of God’s grace and love. And who knows, there are probably people in the room who have also gone through difficult things and are perhaps afraid to share them. (3) Release past bitterness and anger. We do this by focusing on Jesus and the forgiveness we have. We ask God to cleanse us of past wrongs and help us to discern which specific community we should be involved in. (4) Focus on belonging to God. He purchased us through Jesus. If we belong to the beautiful, perfect, loving, just God of the universe, how can we not belong with other Christians (who also belong to the God of the universe)? (5) Think of eternal belonging. We don’t belong in this world. We are in the world, but we are no longer of the world. There are going to be things about the world that we don’t like, including the sins of our own and other Christians. We’re all on the same (imperfect) journey towards wholeness. We belong with God and will one day be 100% reunited with Him. 

Consider Practical Actions to Promote Cognitive Health

According to Centers for Disease Control and Prevention and the Alzheimer’s Association, the majority of experts agree that healthy cognitive functioning includes health in the following areas: language, thought, memory, the ability to plan and carry out tasks, judgment, attention, perception, remembered skills (e.g. driving), and ability to live a purpose. The following may be associated with an improvement in cognitive health: “engaging in art or creative projects, reading, keeping physically active, playing games or doing puzzles, working, or spending time with family and friends."[6]

WHO defines mental health as “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.” Mental and physical health influence each other over time. The research of WHO has uncovered two primary pathways by which this occurs: (1) physiological systems and (2) health behavior such as sleep.[7] 

Consider Practical Actions to Promote Integration

The Music and Neuroimaging Laboratory (Beth Israel Deaconess Medical Center and Harvard Medical School) hopes to understand how the adult brain adapts in response to changes in the environment. Through ongoing research, another piece of the Music and Neuroimaging Laboratory's mission is to investigate the use of music and musical stimuli as an interventional tool for educational and therapeutic purposes. Gottfried Schlaug, the director of the lab, and his colleague state the following in their research regarding music making and brain plasticity:
Plasticity is a fundamental organizational feature of human brain function. Traditionally, the brain was thought to be hardwired following a critical period in development. However, it is now accepted that the brain has a remarkable capacity to modify its structural and functional organization throughout the life span, in response to changes in environmental input.[8]
Since playing music requires a multitude of sensory input and motor experience, it is thought that playing music can be used as an intervention for neurological disorders. Schlaug found that the musicians he studied have larger anterior corpus callosums compared to non-musicians. (This same area is smaller than controls in CSA survivors, leading to less integration of the two halves of the brain as well as shifts in mood and personality.) Musicians who started training early (before or at 7 years of age) had even larger corpus callosums than those that started later. These results suggest that music playing may promote interhemispheric communication. Enhanced cognitive development, skill transfer, and improved language skills include some of the implications for children. Other research suggests enhanced mathematical performance, even overall higher IQs.

In adults, Schlaug’s findings indicate that training can even lead to structural modifications post-development. Moreover, training may not be limited to practicing music. For example, differences in posterior hippocampi volume have been observed in tax drivers compared to non-taxi drivers.[9] In another study, fMRI was used to examine the brain of music academy students “before and after 2 semesters of intensive aural skills training […] This was also the first study to show that functional plasticity is possible in the adult hippocampus.”[10] The implications for CSA survivors may be increased integration of the brain hemispheres as well as lower risks of dissociative disorders and memory impairments.

It’s possible that Eye Movement Desensitization and Reprocessing (EMDR) therapy may be especially helpful in promoting greater hemispheric integration. The therapy uses bilateral stimulation to promote concentration, relaxation, and adaptation. According to emdr.com, “One of the procedural elements is "dual stimulation" using either bilateral eye movements, tones or taps. During the reprocessing phases the client attends momentarily to past memories, present triggers, or anticipated future experiences while simultaneously focusing on a set of external stimulus. During that time, clients generally experience the emergence of insight, changes in memories, or new associations. The clinician assists the client to focus on appropriate material before initiation of each subsequent set.”[11]

Dr. Uri Bergman is the medical director of the EMDR International Associations. According to Dr. Bergman, “[…] EMDR stimulation (DAS/BLS) may facilitate the activation of the ventrolateral and central-lateral thalamic nuclei, thereby facilitating the repair and integration of somatosensory, memorial, cognitive, and synchronized hemispheric functions.”[12] Left and right hemisphere integration has the potential to improve via activities that stimulate both sides of the brain and require cooperation. According to Teicher, “Cognitive-behavioral psychotherapy, which emphasizes correction illogical, self-defeating perceptions, may work by strengthening left-hemisphere control over right-hemisphere emotions and impulses.” Furthermore, playing a musical instrument, reading,[13] and EMDR therapy (bilateral stimulation through sight, sound, or touch) all appear to help promote integration. EMDR in particular seems to help by soothing the patient’s limbic response to the stress of the memories.[14] 

Conclusion

We do not have the option in this lifetime of removing the cancer altogether. The effects of sexual abuse are very real, and we know more today than ever the nature of those effects. The damage occurs on a very fundamental level, meaning the anatomy and physiology of an abuse survivor undeniably differs from that of someone who suffered little to no disturbance during her upbringing. Praise God that one day all will be made new and no longer will we feel these effects of sin.

The acceptance of Jesus is the ultimate antidote. Perhaps the efforts to heal in this life can only be termed acute treatments. Our search for a cure in this sense can be compared to treatments for cancer. Pain, time, money, and energy will undoubtedly be expended with the knowledge that the cancer may not be cured. And if and when healing comes, a scar remains. Part of the solution does lie within one’s ability to view that scar tissue as thick and durable—something that develops perseverance and builds character—rather than an unsightly wound. At the same time, we ought to continue to pursue healing, knowing that it will one day be made complete. Moreover, "to confront madness as a potentially transformative experience takes courage." Use the pain for your own good, and for the good of others. 

Additional Resources

The Chemistry of Joy WorkbookMy Father's Shadow.

[1] De Bellis MD, Spratt EG, Hooper SR (2011): Neurodevelopmental Biology Associated with Childhood Sexual Abuse. Journal of Child Sexual Abuse, 20(5):548-587.
[2] Shonkoff JP, Phillips DA (2000): From neurons to neighborhoods: The science of early childhood development. Washington, DC: National Academy Press.
 [3] Talbot NL, Duberstein PR, King DA, Cox C, Giles DE (2000): Personality traits of women with a history of childhood sexual abuse. Comprehensive Psychiatry, 41(2):130-6.
[4] Sanay I, AlbarracĂ­n D, and Noguchi K (2010): Motivating Goal-Directed Behavior through Introspective Self-Talk. Psychological Science, 21(4):499-504.
[5], [7] World Health Organization (2005): Promoting Mental Health: A Report of the World Health Organization, Department of Mental Health and Substance Abuse in collaboration with the Victorian Health Promotion Foundation and The University of Melbourne. World Health Organization.
[6] Centers for Disease Control and Prevention and the Alzheimer’s Association (2007): The Healthy Brain Initiative: A National Public Health Road Map to Maintaining Cognitive Health. Alzheimer’s Association.
[8], [10] Schlaug G and Wan CY (2010): Music Making as a Tool for Promoting Brain Plasticity across the Life Span. Neuroscientist, 16(5):566-577.
[9] Maguire EA, Gadian DG, Johnsrude IS, Good CD, Ashburner J, Frackowiak RS (2000): Navigation-related structural change in the hippocampi of taxi drivers. Proceedings of the National Academy of Sciences, 97:4398–403.
[11], [14] Teicher MH (2000): Wounds That Time Won’t Heal: The Neurobiology of Child Abuse. Cerebrum: The Dana Forum on Brain Science, 2(4).
[12] Bergman U (2008): The Neurobiology of EMDR: Exploring the Thalamus and Neural Integration. Journal of EMDR Practice and Research, 2(4).
[13] St George M, Kutas M, Martinez A, Sereno MI (1999): Semantic integration in reading: engagement of right hemisphere during discourse processing. Brain, 122:1317-1325.

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