Decision making for children who suffer abusive head trauma invokes multiple ethical considerations. The degree to which parents are permitted to participate in decision making after the injury has occurred is controversial. In particular, in this issue of The Journal of Clinical Ethics, Grigorian and colleagues raise concerns about the potential for conflict of interest in end-of-life decision making if the parents are facing criminal charges that could be escalated if the child dies. There are additional concerns (...) about the parents’ capacity to make decisions that are best for the child, given that the injury occurred. We argue that there are important reasons not to exclude parents from the decision-making process and that, with appropriate safeguards in place, parents are integral to determining what is best for the child. (shrink)

Volume 19, Issue 10, October 2019, Page 114-115.

We argue that multiple levels of trauma were present in Egypt before, during and after the 2011 revolution. Individual, social and political trauma constitute a triangle of traumatisation which was strategically employed by the Egyptian counter-revolutionary forces – primarily the army and the leadership of the Muslim Brotherhood – to maintain their political and economic power over and above the social, economic and political interests of others. Through the destruction of physical bodies, the fragmentation and polarisation of social (...) relations and the violent closure of the newly emerged political public sphere, these actors actively repressed the potential for creative and revolutionary transformation. To better understand this multi-layered notion of trauma, we turn to Habermas’ ‘colonisation of the lifeworld’ thesis which offers a critical lens through which to examine the wider political and economic structures and context in which trauma occurred as well as its effects on the personal, social and po... (shrink)

IntroductionIn highly developed countries, as many as 16 percent of children are physically abused each year. Traumatic brain injury (TBI) is the most common injury in non-accidental trauma (NAT) and is responsible for 80 percent of fatal NAT cases, with most deaths occurring in children younger than three years old. Cases of abusers who refuse withdrawal of life-sustaining medical treatment (LSMT) to avoid criminal charges have previously been reported. Therefore, we hypothesized that NAT is associated with a lower risk (...) for withdrawal LSMT in pediatric TBI.MethodsThe pediatric Trauma Quality Improvement Program database was analyzed (2014 to 2016) for patients aged 16 and younger with TBI and Glasgow Coma Scale (GCS) of 8 and lower on admission. Patients with a head Abbreviated Injury Scale (AIS) of 2 or less or who died within 48 hours were excluded. A multivariable logistic regression model was used for analysis.ResultsOf 2,209 TBI patients, 92 (4.2 percent) had withdrawal of LSMT. Compared to those without withdrawal of LMST, those with LMST had statistically similar median age (three years of age versus seven years, p = 0.07) and a higher rate of NAT (33.7 percent versus 13.5 percent, p < 0.001). The most common specified perpetrator was a father/stepfather/ male partner (70 percent). After adjusting for covariates, factors associated with higher risk for withdrawal of LSMT included age of less than three years (OR 2.38, CI 1.34-4.23, p < 0.05) and NAT (OR 1.86, CI 1.02-3.41, p < 0.05).ConclusionNAT is associated with increased risk for withdrawal of LSMT in pediatric TBI. Age of less than three years is similarly associated with a higher risk for withdrawal of LSMT. Future research in this population is needed to determine what other factors predict withdrawal of LSMT and what resources, such as social workers and/or ethics consults, are utilized. (shrink)

Exploring the early development of an area of medical literature can inform contemporary medical debates. Different methods of inference include deduction, induction, abduction, and inference to the best explanation. I argue that early shaken baby research is best understood as using abduction to tentatively suggest that infants with unexplained intracranial and ocular bleeding have been assaulted. However, this tentative conclusion was quickly interpreted, by some at least, as a general rule that infants with these pathological signs were certainly cases of (...) abuse. Rather than focusing on inductive arguments, researchers today may be better off focusing on making a compelling inference to the best explanation. (shrink)

Academic scholarship has steadily reported unfavourable clinical findings on the sport of boxing, and national medical bodies have issued calls for restrictions on the sport. Yet, the positions taken on boxing by medical bodies have been subject to serious discussions. Beyond the medical and legal writings, there is also literature referring to the social and cultural features of boxing as ethically significant. However, what is missing in the bioethical literature is an understanding of the boxers themselves. This is apart from (...) their brain injuries, the debates about the degenerative brain disease known as chronic traumatic encephalopathy, and related issues about the disease. This article argues that the lives of boxers, their relationships, their careers, and their futures, also requires its own research, particularly in telling stories about their lives, and those lives and futures which boxing affects. The article uses two approaches. First, to imagine a more enduring “whole of life viewpoint” by using an extended future timeframe. Second, to consider perspectives of a person’s significant others. After reviewing the boxing literature, the article discusses social settings and then explores the hidden social relationships in life after boxing. With these longer time and close relationship viewpoints, three important themes emerge: family and kinship; age, stage and career; and the effects of boxing fatalities. These analyses are used in conjunction with relevant clinical findings. which complement the telling of stories to improve medical information, and engages professional and public empathy for people’s experience of illness and difficulties in coping. (shrink)

Betrayal trauma theory suggests that psychogenic amnesia is an adaptive response to childhood abuse. When a parent or other powerful figure violates a fundamental ethic of human relationships, victims may need to remain unaware of the trauma not to reduce suffering but rather to promote survival. Amnesia enables the child to maintain an attachment with a figure vital to survival, development, and thriving. Analysis of evolutionary pressures, mental modules, social cognitions, and developmental needs suggests that the degree to (...) which the most fundamental human ethics are violated can influence the nature, form, and processes of trauma and responses to trauma. (shrink)

Specialists on issues of sexual abuse in religious institutions unanimously stress that this kind of experience significantly affects the victims’ spirituality. Particularly devastating and distorting for their spirituality is sexual abuse committed by clergy. In order to explore this issue for the first time in Poland, the authors conducted a qualitative study in the form of semi-structured interviews with five women who had experienced sexual abuse by Catholic clergy and/or religious in adolescence and young adulthood. The interviews were analyzed using (...) the interpretative phenomenological analysis and narrative methodology. The results showed that four respondents experienced or had experienced religious struggles in three areas: interpersonal, intrapsychic, and relationship with God. These struggles are complex and intense enough to be referred to as “spiritual trauma”, “religious trauma”, or “spiritual violence”. The results of the study may be of importance for people helping or having any other kind of contact with victims of clergy sexual abuse. (shrink)

Using extra familial child sexual abuse as an example of family trauma, the author interviewed 60 parents of sexually abused boys on multiple occasions to analyze the organization of gender, race, and class in parental coping processes. Despite access to alternative interpretations of CSA that challenge conventional notions of gender, parents in this study typically rely on traditional themes to make meaning of the CSA experience. The author organized the data analytically around gender strategies and found that parents used (...) race- and class-specific gender strategies in the aftermath of trauma. Most important, mother-blame is theorized as a form of gender reaffirmation. The author uses the term gender reaffirmation to illustrate the way social actors recuperate after a situation has been interpreted as detrimental, challenging, or stressful to heteronormative gender relations. Mother-blaming accounts encouraged race and class enactments of gender that had negative consequences for women and helped maintain men’s cultural power. (shrink)

I show how much psychiatric disability is informed by trauma, marginalization, sexist norms, social inequalities, concepts of irrationality and normalcy, oppositional mind-body dualism, and mainstream moral values. Drawing on feminist discussion of physical disability, I present a feminist theory of psychiatric disability that serves to liberate not only those who are psychiatrically disabled but also the mind and moral consciousness restricted in their ranges of rational possibilities.

I show how much psychiatric disability is informed by trauma, marginalization, sexist norms, social inequalities, concepts of irrationality and normalcy, oppositional mind-body dualism, and mainstream moral values. Drawing on feminist discussion of physical disability, I present a feminist theory of psychiatric disability that serves to liberate not only those who are psychiatrically disabled but also the mind and moral consciousness restricted in their ranges of rational possibilities.

This article first summarizes research regarding the relationship between sports that intentionally structure multiple types of brain trauma into their practice, such as rugby and boxing, and the range of negative health outcomes that flow from participation in such sports. The resultant brain injuries are described as ‘now’ and ‘later’ diseases, being those that affect the child immediately and then across their lifetime. After highlighting how these sports can permanently injure children, it examines this harm in relation to existing (...) British laws and policies concerning child abuse. The conclusion drawn is that neither children nor adults on their behalf are legally able to give informed consent for participation, and that impact sport organisations effectively groom children into sustaining and accepting brain trauma. Adults providing brain-traumatizing versions of these sports are thus described as being complicit in a form of child abuse that we term brain abuse. The contradictions in existing sports policy are highlighted, where policy describes that children are to be protected from harm, and yet the very practice of such sports creates harm by design. Implications of the argument are that children should be prohibited from partaking in impact sports. (shrink)

Objective: The aim of the current study was to investigate associations, unique and interactive, between mothers’ and children’s histories of childhood sexual abuse (CSA) and children’s psychiatric outcomes using an intergenerational perspective. Further, we were particularly interested in examining whether maternal reflective functioning about their own trauma (T-RF) was associated with lower likelihood of children’s abuse exposure (among children of CSA-exposed mothers). Method: One hundred and eleven children (Mage= 9.53 years; 43 sexual abuse victims) and their mothers (Mage= 37.99; (...) 63 sexual abuse victims) participated in this study. Mothers completed the Parent Development Interview (PDI), which yielded assessments of RF regarding their own experiences of abuse, and also reported on their children’s internalizing and externalizing symptoms. Results: Children of CSA-exposed mothers were more likely to have experienced CSA. A key result was that among CSA-exposed mothers, higher maternal T-RF regarding their own abuse was associated with lower likelihood of child CSA-exposure. Mothers’ and children’s CSA histories predicted children’s internalizing and externalizing symptoms, such that CSA exposure for mother or child was associated with greater symptomatology in children. Conclusions: The findings show that the presence of either maternal or child CSA is associated with more child psychological difficulties. Importantly in terms of identifying potential protective factors, maternal T-RF is associated with lower likelihood of CSA exposure in children of CSA-exposed mothers. We discuss these findings in the context of the need for treatments focusing on increasing Trauma - RF in mothers and children in the context of abuse to facilitate adaptation and reduce the intergenerational risk. (shrink)

Extending a strategy previously used by Clancy, Schacter, McNally, and Pitman , we administered a neutral and a trauma-related version of the Deese–Roediger–McDermott paradigm to a sample of women reporting recovered or repressed memories of childhood sexual abuse , women reporting having always remembered their abuse , and women reporting no history of abuse . We found that individuals reporting recovered memories of CSA are more prone than other participants to falsely recalling and recognizing neutral words that were never (...) presented. Moreover, our study is the first to show that this finding even held when trauma-related material was involved. Correlational analyses revealed that fantasy proneness, but not self-reported traumatic experiences and dissociative symptoms were related to false recall and false recognition. (shrink)

Proceeding from a phenomenological perspective, the present study investigated the experiences of seven homeless women who had lived through childhood trauma and subsequent substance abuse, with specific focus on the recovery process experienced by each. Applying the analytical protocol of Giorgi to the written accounts obtained from the participants, 15 constituent themes of the recovery process were identified. In order to illuminate the participants’ experiences with minimal influence of any possible researcher bias, the researcher refrained from labelling, judging or (...) diagnosing the women’s life circumstances. Consequently, no treatment paradigm was applied to help explain, predict or judge the behaviour of the participants during the course of this research. (shrink)

"Nietzsche Trauma and Overcoming " shows that Nietzsche suffered from Post-Traumatic Stress Disorder, and most probably was a victim of childhood sex abuse. I bring convincing evidence from his texts to support these claims, along with a discussion of corroborating psychological findings on these issues. I show that he teaches coping with pain and suffering, based on his life experience, with lessons from the school of war, the wisdom of reinterpretation, and artistic activity. His three themes of the Superman, (...) Eternal Recurrence, and the Will to Power, the heart of his philosophy and psychology, are understood in a new light, in relation to his personal suffering and overcoming. The book criticizes the attempts to diagnose Nietzsche as suffering from various psychiatric disorders, psychoanalyze him as a fatherless child grown old, and outing him as a closet homosexual. These approaches lead to a dead-end. Firstly, it is impossible to prove that someone is a paragon of mental health, not a covert homosexual, and unmoved by a parent’s death. Secondly, these speculations explain only a small part of Nietzsche’s personal statements, found in his writings. Thirdly, and most importantly, they do not change our understanding of his ideas and how they were arrived at; they do not increase our appreciation of him; and do not leave us with any lessons for life (the goal of any good writing according to Nietzsche). (shrink)

Sexting has been defined as sending, receiving, or forwarding sexually explicit messages, images, or photos to others through digital platforms, and can assume more consensual or more abusive and violent forms. This study aims to explore the prevalence of abusive sexting in Portuguese adolescents and the psychological characteristics of sexting abusers in terms of emotional and behavioral problems, potential markers of psychopathy, childhood trauma and maltreatment, and different forms of aggression. A cross-sectional study was conducted with 4,281 (...) participants, aged 12–20 years, of whom 204 engaged in abusive sexting behaviors and 182 self-identified as being a non-consensual sexting victim. Abusive sexting was more common among boys and middle adolescents, and abusive sexting victims were more likely to be children of single-parent families. Engaging in abusive sexting and being a victim of abusive sexting were also related to behavioral and emotional problems, callousness, experiences of neglect and abuse in childhood, and various forms of aggression. Implications for future research and intervention are discussed. (shrink)

In the face of violent crime, mothers are often the most vocal in fighting for justice. When those mothers are also active in a Christian Church, they are well versed in the motifs of sacrifice and forgiveness. From a feminist perspective, these motifs have been severely criticised for weighing more heavily on women than men, given Christianity’s long history of teaching the submission of women and the dominance of men, and, further, have been instrumental in keeping women in abusive (...) relationships. This paper will ask whether: when faced with the traumatic loss of a daughter or son due to the violent actions of another, are the motifs of sacrifice and forgiveness equally problematic or do they help mothers through their grief? Is forgiveness another form of sacrifice required of Christian mothers in the aftermath of violent crime? Does a mother’s fight for justice require that she does not forgive the perpetrator? How do mothers navigate their Christian faith and these varied motifs in recovering from the traumatic grief that they experience following sudden bereavement? This paper will explore these questions by engaging with the accounts of, for example, Julie Nicholson, the Anglican Priest, whose daughter was killed in the 7/7 bombings in London in 2005; Doreen Lawrence, whose son, Stephen, was murdered in a racist attack in London in 1993; Sybrina Fulton and Lucy McBath, whose sons, Trayvon Martin and Jordan Davis, were fatally shot in separate incidents in Florida in 2012; and mothers affected by the Grenfell Tower fire in London in 2017. (shrink)

It has been reported that, on average, most adults recall first memories formed around age 3.5. In general, most first memories are positive. However, whether these first memories tend to be visual or verbal and whether the period for childhood amnesia (CA) is greater for visual or verbal or for positive versus negative memories has not been determined. Because negative, stressful experiences disrupt memory and can injure memory centers such as the hippocampus and amygdala, and since adults who were traumatized (...) or abused during childhood (TA) reportedly suffer memory disturbances, it was hypothesized that those with a history of early trauma might suffer from a lengthier childhood amnesia and form their first recallable memories at a later age as compared to the general population (GP). Because the right hemisphere matures earlier than the language-dominant left hemisphere, and is dominant for visual and emotional memory, as well as the stress reponse, it was hypothesized that first recallable memories would be visual rather than verbal. Lastly, since stress can injure the brain and disrupt memory, it was hypothesized that the traumatized group would demonstrate memory and intellectual disturbances associated with right hemisphere injury as based on WAIS-R, Wechsler Memory Scale, and facial-memory testing. All hypotheses were supported. Positive and visual memories are formed before negative and verbal memories. TA CA offset, on average, is at age 6.1 versus 3.5 for GPs. TA PIQ (performance IQ), short-term visual memory, and facial memory were significantly reduced. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Trauma, Recognition, and the Place of LanguageJuliet Mitchell (bio)Definitions of trauma abound within the psychoanalytic discipline. My own definition is going to be simple. A trauma, whether physical or psychical, must create a breach in a protective covering of such severity that it cannot be coped with by the usual mechanisms by which we deal with pain or loss. The severity of the breach is such (...) that even if the incident is expected, the experience cannot be foretold. We cannot thus make use of anxiety as a preparatory signal. The death of a sick relative, the amputation of a diseased limb may be consciously known about in advance, but if they are to be described as traumatic then the foreknowledge was useless. In trauma we are untimely ripped.Whether it is as childhood seduction, infantile abuse, shell shock, or war violence, or as a preoccupation with the place of neoteny and the trials of human birth, trauma is continually posited as the hypothetical “origin” of psychic states. However, although “trauma” is crucial to psychoanalytic theory, trauma in itself is not really the focus of its analysis. Freud proposed a “biological bedrock” on which psychic states were formed, but this bedrock was not the object of psychoanalytic inquiry. I suggest that what emerges as a motif in the many retheorizings of psychoanalysis time and again, as another “bedrock,” is trauma. One might call it an “experiential bedrock.” As with biology, it is crucial—but as the area of another mode of inquiry. Psychoanalysis is equipped to contribute to the understanding of the reaction to trauma, not to the trauma itself.In a colloquial context we tend to look from the perspective of the observer and label a range of difficult or tragic occurrences “traumatic.” Instead, I want to define trauma from the perspective of the person who experiences it. This means both that the same event will not always be traumatic for different people, and that the experience of different events, if they are experienced as trauma, will be the same whatever the event and whoever the sufferer. It was essentially for this reason that Freud eventually disagreed with the rich findings of Otto Rank, who proposed the trauma of birth as the origin of mankind’s neurosis. Trauma is the great equalizer. What differentiates us, since we were all born? Furthermore, what appears to be the trauma from the observer’s perspective may, from the viewpoint of the psychic response of the recipient, only be the catalyst that brings to the surface an experience which, were it not for this later event, might not in itself have been traumatic (or vice versa). Even so extreme an experience as the Holocaust may not breach the defenses of a particular individual. The catalytic event in the present triggers an earlier occurrence which becomes traumatic only by virtue of its retrospectively endowed meaning.Probably all animate matter can be traumatized; it would seem likely that the response to the breach in the human defensive system takes place at a generalizable psychosocial level. Recognition and language are interactional social processes; without another person neither a psyche nor language is possible. Object relations analysts, notably D. W. Winnicott, whom Max Hernandez addresses in his paper in this issue, have devoted their work to aspects of the psyche, Lacanians to language. To me the fields are interdependent and gain from being looked at together, both in their practice and in the theories that can [End Page 121] be applied to them. When we have a physical trauma it is common for an immediate aftereffect to be some uncertainty about words; even the ability to spell correctly can temporarily disappear. There are undoubtedly physiological explanations for this. But I shall argue that there are psychological parallels. Every patient whom I would regard as having had some relevant form of trauma had a specific relationship to language, and it is this that concerns me. In addition, Max Hernandez describes the breach in the defenses caused by the anal rape of a patient when he was a young boy. But neither the patient’s symptom nor his complaint on coming to a therapist for treatment pertains to... (shrink)

Understanding sexual abuse es un libro que sorprenderá al lector por varias razones. En primer lugar, es un testimonio de la vida real del autor como víctima de abuso sexual en su niñez por una de las personas más cercanas a su familia. En segundo lugar, no es el típico libro sensacionalista que busca llamar la atención ni generar lástima ni victimizarse ni buscar fondos para alguna ONG de prevención de abuso sexual; más bien, el autor, con mucha apertura interior, (...) humildad, valentía, así como con un elevado profesionalismo, describe lo profundo que pueden ser las heridas de este tipo de abuso y lo crudo e injusto que es este crimen. En tercer lugar, la manera como el autor se aproxima al tratamiento de un trauma como el abuso sexual, permite que el lector se identifique plenamente con el autor, si ha sido abusado sexualmente, o si no, que aun así pueda tomar muchos elementos para sanar traumas de su propia vida, a pesar de no tratarse de abuso sexual, y sobre cómo acompañar a otras personas que han sufrido este tipo de abuso; he aquí la riqueza de este libro. (shrink)

Children may be abused physically, sexually, emotionally and by omission or commission in any permutation under these headings. This is discussed in terms of the separate and overlapping responsibilities of parents, guardians, the community in which they live and the network of professional services developed to care for, protect and educate children. An attempt is made to place these issues within an ethical framework, with regard to the legislature of England and Wales. It is argued that professionals working within this (...) field have an obligation either to keep up to date in respect of a large and growing body of research and practice knowledge or to consult 'experts' within the field when making complex and far-reaching decisions on behalf of abused children and their families. A representative, inevitably incomplete, bibliography is discussed and appended and there is brief reference to the role of expert witnesses concerning children involved in civil legal proceedings. (shrink)

In many cases of family trauma, victims are left with the burden of rebuilding relationships that have been damaged. This paper illustrates that inappropriate pressure to forgive can harm victims of abuse. This pressure can come from a combination of assumptions. Firstly, often forgiveness is conflated with reconciliation, and those who put pressure on victims to forgive do so to avoid uncomfortable blame or estrangement. Secondly, anger is often inappropriately understood as a morally blameworthy emotion to hold. I draw (...) on Amia Srinivasan’s (2018) work on affective injustice to address this assumption and argue that pressure to forgo anger, forgive, and reconcile stems from a mistaken interpretation of these concepts and is ultimately harmful. I demonstrate this by using examples where victims have found their voices stifled by the mistaken coding of anger as morally blameworthy and forgiveness as morally required. (shrink)

Child trauma plays an important role in the etiology of Bordeline Personality Disorder. Of all traumas, sexual trauma is the most common, severe and most associated with receiving a BPD diagnosis when adult. Etiologic models posit sexual abuse as a prognostic factor in BPD. Here we apply machine learning using Multiple Kernel Regression to the Magnetic Resonance Structural Images of 20 BPD and 13 healthy control to see whether their brain predicts five sources of traumas: sex abuse, emotion (...) neglect, emotional abuse, physical neglect, physical abuse. We also applied the same analysis to predict symptom severity in five domains: affective, cognitive, impulsivity, interpersonal for BPD patients only. Results indicate that CTQ sexual trauma is predicted by a set of areas including the amygdala, the Heschl area, the Caudate, the Putamen, and portions of the Cerebellum in BPD patients only. Importantly, interpersonal problems only in BPD patients were predicted by a set of areas including temporal lobe and cerebellar regions. Notably, sexual trauma and interpersonal problems were not predicted by structural features in matched healthy controls. This finding may help elucidate the brain circuit affected by traumatic experiences and connected with interpersonal problems BPD suffer from. (shrink)

This paper examines the deployment of the concept of psychological trauma in the field of sexual assault service provision, a field in which a feminist understanding of sexual violence has achieved a position of ‘truth’. Using a Foucauldian methodological approach, the investigation centred on service provision in New South Wales, Australia, and analysis focused on the everyday practices of workers illuminated through documents collected from the field, in particular the interview texts produced from interviews with thirty sexual assault practitioners. (...) The paper focuses on the adult survivor of child sexual assault who emerged in the study as the most traumatised category of victim. I lay out how ‘trauma’, specifically the concept of ‘complex trauma’, operates as the conceptual (emotional, relational, neurobiological) link between past abuse and current problems, redefining them not as ‘problems’ but as the symptoms or effects of untreated childhood trauma. I argue that in the local field this deployment is simultaneously enabling and problematic. The production of a subject position of ongoing ontological vulnerability has the effect of repositioning the ‘adult survivor’ outside the socio-political context of their current lives and as such appears misaligned with a feminist ‘regime’ centred on enabling practices and structural gender inequality. However, I demonstrate how this same knowledge of the neurobiological, relational and emotional effects of trauma on the survivor self is used by practitioners as part of their established feminist practices of enabling victims to regain a sense of power and control, of interrupting blame and working for victims at a broader systemic level. The research adds to feminist research and commentary that has drawn critical attention to uptake of trauma in sexual assault work by showing the specificity of how trauma operates in a specific location, and illustrating both the potential and the problematic aspects of trauma as a feminist knowledge practice. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Providing Care to a Potential Aggressor: An Ethical DilemmaHandreen Mohammed SaeedFollowing the abrupt fall of almost a third of its territory in 2014 to armed militias, Iraq fell into civil war turmoil. As a direct result of the armed conflicts, hundreds of thousands of Iraqis were displaced or subjected to atrocious human rights violations with physical, sexual, and psychosocial abuse. While the scenes on the TV provided only a (...) glimpse of what was happening on the ground, the true stories circulating about people’s suffering left me personally in absolute shock. Among those who suffered the most from the offences were marginalized religious and ethnic minority groups, who were viewed and treated as infidels by the aggressor militants. Those marginalized communities not only endured displacement due to the armed conflicts but they were also mass-exterminated, sexually abused, and underwent massive destruction of their towns and villages.In 2016, I was working for Ministry of Health as a primary care physician in a small town in Iraqi Kurdistan, which hosted tens of thousands of internally displaced people (IDPs) from one of those marginalized minority communities. I had the opportunity to hear their tragic stories firsthand as they fled for their lives in 2014. Working in those communities as a primary care physician allowed me to truly understand their feelings and emotions and reflect on their experiences while providing healthcare services. This experience sparked an interest in humanitarian work, in which I could be close to areas of need and involved in providing physical health first-aid and also psychological and social first-aid; all crucial in addressing the future health consequences experienced by people going through humanitarian crises. In the same year, 2016, I joined an international medical organization and started working in remote and low-resource settings in northern Iraq as a humanitarian physician. Our projects included a variety of primary care, psychosocial, and urgent care services targeting refugees, IDPs, and vulnerable host communities in areas near conflict zones. The projects were designed and implemented with the hope that the most vulnerable populations have access to our services.In October 2016, the Iraqi authorities launched a massive military operation known as the “Battle of Mosul” to regain control of Mosul, the second-largest city in Iraq. As an emergency medical humanitarian organization, we had to be near the battlefield and respond to the unfolding humanitarian crisis on a daily basis. As the official security forces backed by the international alliance started to advance, tens of thousands of people, including some militants and their families, fled Mosul and headed towards areas controlled by the Kurdistan Regional Government’s forces in the north, where our organization was operational. Some of them sought refuge in one of our medical facilities in northern Iraq, which was operated by local staff, [End Page 172] including members from some of the minority communities that had suffered the most from the militants’ aggression in 2014. The patients entering our facilities were mainly older adults, women, and children, but we were also visited by a small group of potential militants who were either injured, malnourished, or just seeking help and refuge. As a neutral, impartial, independent, humanitarian organization compliant with medical ethics, we were committed to providing healthcare services to anybody in need without discrimination or judgment.As we responded to the humanitarian crisis unfolding before our eyes, some of our staff members came forward and raised valid questions about the ethics of treating patients potentially involved in serious human rights violations. With tears in her eyes, one nurse approached me and stated, “Seeing these people reminds me of all the girls and women who went missing from my village and are now being sold as sex slaves in Syria”. The staff expressed serious concerns about their ability to provide care to patients who may have been involved in mass killing, torture, and the destruction of their own towns, as well as sexual abuse against their family members, friends, and people in their communities. Due to the psychological and physical trauma caused by the militants’ conquest, the staff was reluctant to provide medical care to these patients, as seeing and hearing them brought back... (shrink)

A psychology-informed view of human rights has been taken into account by many scholars while examining the short-term and long-term effects of human rights violations on individuals and communities. In Trauma and Human Rights: Integrating Approaches to Address Human Suffering, for instance, the authors discuss the trauma-informed approach in the context of human rights violations, namely domestic violence, racial and other forms of discrimination, etc. In the paper on Trauma among children and legal implications, the authors advance (...) a trauma-informed approach to human rights. The approach considers the experiences of trauma associated with physical abuse, sexual abuse, neglect, psychological/emotional abuse, community violence, natural disasters, serious accidents, parental death/grief, medical procedures and conditions, and terrorism. In the case of violations including rape and torture, the paper Torture by means of Rape concerns the psychological suffering of victims of rape, abuse, and torture in light of the Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment. As for the jurisprudence of international human rights bodies, the advancement of a psychology-informed view of human rights is noticeable. Take the example of the Report of the Special Rapporteur on torture and other cruel, inhuman, or degrading treatment or punishment on Biopsychosocial factors conducive to torture and ill-treatment. The Report explores the root causes of the current worldwide complacency concerning torture and ill-treatment and recommends the urgent and proactive incorporation of science-based conclusions into ongoing, policy-based global governance reform processes. Further, the report provides that the root cause of the systemic governance failure is attributed to the generic biopsychosocial factors that have shaped human decision-making throughout history, irrespective of national, cultural, religious, or other distinctive influences. Since the two fields are creating a landscape of new concepts and perspectives, one may study this interface broadly under three headings; (a) Psychology in Human Rights. (b) Rights-Based Approach to Psychological Science and Research. (c) Psychology and Human Rights in Law and Policy. (shrink)

Self-harm, or self-mutilation, is generally viewed in academic literature as a pathological act, usually born out of trauma and/or a psychological and personality defect. Individuals who engage in self-harm are usually seen as damaged, destructive, and pathological. While self-harm is not a desirable act, this paper argues through the narratives of those who engage in such acts that self-harm may be better construed as a meaningful, embodied emotional practice, bound up in social understandings of psychological pain and how best (...) to attend to such pain. In particular, this paper suggests that those who engage in self-harm practices are performing embodied, socially situated acts of healing, survival, and self-creation in a physical attempt to retell complex, fragmented stories of abuse, existential angst, trauma, and loss of self. While these individuals may be more or less successful in such attempts, this paper suggests that understandings of self-harm would benefit from more nuanced approaches to individuals’ embodied expressions of pain that take into account the difficult nature of psychological suffering and the effects of trauma. (shrink)

A psychology-informed view of human rights has been taken into account by many scholars while examining the short-term and long-term effects of human rights violations on individuals and communities. In Trauma and Human Rights: Integrating Approaches to Address Human Suffering, for instance, the authors discuss the trauma-informed approach in the context of human rights violations, namely domestic violence, racial and other forms of discrimination, etc. In the paper on Trauma among children and legal implications, the authors advance (...) a trauma-informed approach to human rights. The approach considers the experiences of trauma associated with physical abuse, sexual abuse, neglect, psychological/emotional abuse, community violence, natural disasters, serious accidents, parental death/grief, medical procedures and conditions, and terrorism. In the case of violations including rape and torture, the paper Torture by means of Rape concerns the psychological suffering of victims of rape, abuse, and torture in light of the Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment. -/- As for the jurisprudence of international human rights bodies, the advancement of a psychology-informed view of human rights is noticeable. Take the example of the Report of the Special Rapporteur on torture and other cruel, inhuman, or degrading treatment or punishment on Biopsychosocial factors conducive to torture and ill-treatment. The Report explores the root causes of the current worldwide complacency concerning torture and ill-treatment and recommends the urgent and proactive incorporation of science-based conclusions into ongoing, policy-based global governance reform processes. Further, the report provides that the root cause of the systemic governance failure is attributed to the generic biopsychosocial factors that have shaped human decision-making throughout history, irrespective of national, cultural, religious, or other distinctive influences. -/- Since the two fields are creating a landscape of new concepts and perspectives, one may study this interface broadly under three headings; -/- (a) Psychology in Human Rights. (b) Rights-Based Approach to Psychological Science and Research. (c) Psychology and Human Rights in Law and Policy. (shrink)

The aim of this study was to examine preliminary evidence of the validity of the Trauma Reflective Functioning Scale and to investigate reflective functioning and attachment in pregnant women with histories of trauma, with a particular focus on the capacity to mentalize regarding trauma and its implications for adaptation to pregnancy and couple functioning. The Adult Attachment Interview was used to assess attachment, unresolved trauma and mentalization (measured as reflective function; RF) regarding relationships with attachment figures (...) (RF-G) and trauma (RF-T) in 100 pregnant women with histories of abuse and neglect. The majority (63%) of women had insecure attachment states of mind and approximately half were unresolved regarding trauma. Furthermore, the majority of women manifested deficits specific to RF-T. Their RF-T was significantly lower than their RF-G; the findings indicate that women with histories of childhood abuse and neglect do not manifest a generic inhibition of reflectiveness, but a collapse of mentalization specific to trauma. Low RF-T, indicative of difficulty in considering traumatic experiences in mental state terms, was associated with difficulty in investment in the pregnancy and lack of positive feelings about the baby and motherhood. In addition, low RF-T was also associated with difficulties in intimate relationships. Results of a regression analysis with RF indicated that RF-T was the best predictor of investment in pregnancy and couple functioning. In sum, the study provides preliminary evidence that RF-T can be reliably measured and is a valid construct that has potential usefulness for research and clinical practice. It highlights the importance of mentalization specifically about trauma and suggests that it is not the experience of trauma per se, but the absence of mentalization regarding trauma that is associated with difficulties in close relationships and in making the transition to parenthood. (shrink)

As a distortion of God's created designs, sexual abuse carries a unique devastation-factor. Abuse that is sexual in nature damages a spectrum of internal and external aspects of personhood. In particular, the core realities of: self-identity, community, and spiritual communion with God can be deeply fractured through SA. In light of the significance of the image of God, movement toward healing includes strengthening personal agency, processing profound boundary ruptures, and managing disillusionment with God. Due to the multi-faceted trauma of (...) sexual abuse spiritual formation programs must not only plan for the unique profile of abuse victims, but also need to incorporate a fuller understanding and praxis of the realities of embodiment, ritual, and theocentric metaphor into their transformational goals. Analysis includes first-person experience, anthropological science, and theological reflection. (shrink)

Parental substance use is a major risk factor for child development, heightening the risk of drug problems in adolescence and young adulthood, and exposing offspring to several types of traumatic event. First, prenatal drug exposure can be considered a form of trauma itself, with subtle but long-lasting sequalae at the neuro-behavioural level. Second, parents’ addiction often entails a childrearing environment characterised by poor parenting skills, disadvantaged contexts and adverse childhood experiences, leading to dysfunctional outcomes. Young adults born from/raised by (...) parents with drug problems and who develop a Substance Used Disorder (SUD) themselves might display a particularly severe condition in terms of cognitive deficits and impaired personality function. This preliminary study aims to investigate the role of early exposure to drugs as a traumatic event, capable of affecting the psychological status of young drug addicts. In particular, it intends to examine the neuropsychological functioning and personality profile of young adults with severe SUDs who were exposed to drugs early in their family context. The research involved 3 groups each consisting of 15 young adults (aged 18-24): a group of inpatients diagnosed with SUDs and exposed to drugs early, a comparison group of non-exposed inpatients and a group of non-exposed youth without SUDs. A neuropsychological battery (Esame Neuropsicologico Breve-2), an assessment procedure for personality disorders (Shedler-Westen Assessment Procedure-200) and the Symptom CheckList-90-Revised were administered. According to present preliminary results, young drug addicts exposed to drugs during their developmental age were characterised by elevated rates of neuropsychological impairments, especially at the expense of attentive and executive functions; personality disorders were also common but did not differentiate them from non-exposed young people with SUDs. Alternative multi-focused prevention and intervention programs are needed for children of drug-misusing parents, addressing executive functions and adopting a trauma-focused approach. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Falling From the Sky: Trauma in Perec’s W and Caruth’s Unclaimed ExperienceEleanor Kaufman (bio)1 Fear of FallingIt is not surprising to find a link between trauma and falling in an entire strain of postwar literature. It is arguably the case that, in the wake of the Spanish Civil War and World War II, a new and more aerial form of spatial perception came into prominence, one in (...) which something or someone might reasonably be expected to fall out of the sky. Such a form of perception, vertical rather than horizontal in its orientation, is often experienced as an uneasiness directed at falling in both its physical and its metaphysical senses. That is, there is both a literal fear of falling from a height and a spiritual angst about falling, generally through no agency of one’s own, from one station in life to another.Within the postwar French tradition, 1 the conjunction of these two forms of falling is nowhere better articulated than in Georges Perec’s semi-autobiographical novel W or the Memory of Childhood. W alternates chapter by chapter between two different forms of writing: one a fantastical narrative about the faraway island of W, in which a robust society of athletes devote their lives to an Olympic ideal of sport, and which is organized by a system that first appears like a rational utopia but by the novel’s end devolves into a terrifying concentrationary universe; the other a non-narrative, truncated, and elliptical set of references to Perec’s own Jewish wartime childhood (Perec’s father died fighting for France in 1940; his mother died after being deported to Auschwitz in early 1943; in 1942, his mother placed the young Perec, aged six, on a Red Cross convoy headed toward the French Free Zone). In the autobiographical section of W, Perec gives several versions of his departure from his mother. In what follows are two of these versions, followed by Perec’s subsequent analysis of this memory.Of particular interest is the way that images of falling or suspension, here in the form of the parachute, punctuate this memory and take on their meaning precisely at the later [End Page 44] moment when Perec finds himself parachuting from the sky.The only surviving memory of my mother is the day she took me to the Gare de Lyon, which is where I left for Villard-de-Lans in a Red Cross convoy: though I have no broken bones, I wear my arm in a sling. My mother buys me a comic entitled Charlie and the Parachute: on the illustrated cover, the parachute’s rigging lines are no other than Charlie’s trouser braces.[26]My mother took me to the Gare de Lyon. I was six. She entrusted me to a Red Cross convoy leaving for Grenoble, in the free zone. She bought me a magazine, an issue of Charlie, with a cover showing Charlie Chaplin, with his walking stick, his hat, his shoes and his little mustache, doing a parachute jump. The parachute is attached to Charlie by his trouser braces.[54]A triple trait runs through this memory: parachute, sling, truss: it involves suspension, support, prosthesis almost. In order to be, you had to be propped. Sixteen years later, in 1958, when the haphazard fate of military service made me into a short-lived parachutist, I was able to read, at the very instant of jumping, one of the decoded texts of that memory: I was thrown into the void; all the threads were broken; I was falling, alone and without support. The parachute opened. The canopy unfurled, a fragile and firm suspense before the controlled descent.[55, translation modified]These two memories of Perec’s departure from his mother, as well as the third decoded reading dating from 1958, might be viewed together as the story of a trauma that, with characteristic belatedness, is only readable after the fact. Moreover, the motif of falling, in this instance figured by the recurrence of the parachute, provides the key to deciphering the memory of the trauma. The last—and lasting—memory of the mother is that of her buying Perec... (shrink)

Understanding Animal Abuse and How to Intervene with Children and Young People offers a positive, compassion-based and trauma-informed approach to understanding and intervening in animal abuse. It provides an accessible cross-disciplinary synthesis of current international evidence on animal abuse, and a toolkit for professionals working with people and/or animals to help them understand, prevent, and intervene in cases of animal abuse. With contributions from experts in the field, this essential text offers ten user-friendly chapters with questions for reflection and (...) key summary points. It offers a definition of animal abuse, synthesises the latest research on children, young people and animal abuse, and explores the link between animal abuse and other forms of abuse, and legal perspectives on animal abuse. The second half of the book presents a practical toolkit for professionals, offering guidance and strategies for prevention of and intervention in cases of animal abuse. It provides multidisciplinary perspectives on interventions; from teachers' and social workers roles in detection and intervention of childhood animal abuse, to the roles of enforcement agencies and veterinarians in legal cases of adult animal abuse. Together with a final chapter proposing new directions for research, policy, and practice, this guide is for all who work with children, young people and/or animals, including psychologists, social workers, veterinarians, education professionals, and animal welfare educators. It is also key reading for those involved in legal and policy issues relating to animal welfare. (shrink)

Ecce Homo, Nietzsche's autobiography, is distinguished it the rest of his oeuvre and discloses, in no uncertain terms, by its profound candor in bringing to question a topic of vital importance that has remained a central concern of the cultural zeitgeist especially as a reaction to various events of the 21st century: trauma. Trauma [τραῦμα], a Grecian term that traditionally refers to "a wound," underpins much of Nietzsche's writing, and is present in observations of his own lived experience, (...) those of notable décadents such as Socrates and Wagner, and even his discussions of ethics and morality. Nietzsche's willingness to engage with his personal trauma—what he might refer as a Dionysian affirmation of being—is precisely what allows him to stand head and shoulders above other thinkers in terms of unadulterated authenticity. The relationship between trauma and authenticity is, if nothing else, a well-documented if not understated occurrence both in texts of antiquity as well as contemporary scholarship, therefore understanding trauma as a precondition for the authentic individuation of ek-sisting beings is a concern of uncommon consequence. In order to understand trauma in this regard, it becomes necessary to examine it within the context of its manifestations, in this instance the life and works of Nietzsche, as well as on its own terms as a phenomenon. (shrink)

This paper asks questions about 'trauma' and its cultural representation specifically, trauma's representation in the cinema. In this respect, it compares and contrasts the work of Robert Bresson, in particular his 1967 masterpiece, Mouchette , with contemporary Hollywood film. James Mangold's 1999 'Oscar-winning' Girl, Interrupted offers an interesting example for cultural comparison. In both Mouchette and Girl, Interrupted the subject matter includes, amongst other traumatic experiences, rape, childhood abuse and suicide. The paper ponders the question of whether such (...) aspects of trauma can ever be authentically represented on film; or, whether, on the contrary, through the deployment of cultural stereotypes, cinematic representation tends rather to reproduce the very forms of structural power which are, in the first place, trauma's primary cause. Bresson emerges from this analysis in a favourable light for, whereas Mangold stereotypes victims of trauma and represents traumatic experience itself as inevitable and over-determined, Bresson always retains for the victim a sense of critical agency. By contrasting key scenes from both films, the paper suggests that contemporary popular cinema (the 'Hollywood-ized' form), working in tandem with institutions of social control, such as psychiatry, does not subvert but, in fact, reproduces patterns of structural power. This argument has particular significance for the cultural representation of women. The paper is theoretically framed by Simone Weil's reflections on both 'representation' and 'structural power'. (shrink)

This article examines sexual ‘misery memoirs’, focusing on author/reader and genre/market relationships in the context of models of trauma and child sexual abuse. It shows that the success of sexual ‘misery memoirs’ is inextricably bound up with the popular dissemination of a feminist-psychoanalytic model of traumatic memory that has taken place since the 1970s. It also argues that, as the ‘truth’ of recovered and traumatic memories has been fundamental to its success, anxieties about false memory and hoax ‘misery memoirs’ (...) have posed a challenge to the genre and established a market for ‘retractor’ narratives. (shrink)

This article explores the relationship between hermeneutical injustice in religious settings and religious trauma and spiritual violence. In it I characterize a form of hermeneutical injustice that arises when experiences are obscured from collective understanding by normatively laden concepts, and I argue that this form of HI often plays a central role in cases of religious trauma and spiritual violence, even those involving children. In section I, I introduce the reader to the phenomena of religious trauma and (...) spiritual violence. In section II, I describe the role normatively laden concepts play in shaping our social experience. I then elucidate how they can contribute to HI. In section III, I provide a brief overview of the history of some significant identity prejudices in the history of Christianity and argue that children can properly be understood as victims of HI within some religious communities. I then return in section IV to the examples of religious trauma and spiritual violence offered throughout the article and demonstrate that HI plays an important causal role in each of them. HIs sometimes constitute spiritual and religious harms; at other times they create an epistemic environment conducive to spiritual abuse. (shrink)

The nature of children's early environment has profound long-term consequences. We are beginning to understand the underlying molecular programming of the stress-response system, which may mediate the destructive long-term effects of cruelty to children, explain the evolutionary stability of cruelty, and provide opportunities for its reversal of early trauma.

Owing to its grappling with a motley of intricate socioeconomic, as well as medico-legal, crises, Haiti has found itself bereft of some of its people, many of whom have had to leave the Caribbean country in search of improved lives elsewhere. Receiving some of the Haitian refugees fleeing abject poverty, unemployment, and other harms and barriers has been the United States, one of Haiti's northern neighbors and a country that has played an outcome-determinative, if not outsized, role in steering the (...) country toward its presently hobbled state. Drawing on the U.S.’s recent treatment of Haitian refugees, this paper argues that U.S. reception of Haitian immigrants rubs salt in the wound of a long history of dehumanizing and oppressive abuses endured by Haitians. Furthermore, and more importantly, this paper posits that U.S. failure to wholly embrace its legal obligation to accept Haitian refugees under international law needs to be understood in the light of the specific horrors inflicted by science, in pre-independence Haiti, on non-consenting, Afro-Haitian experimental subjects. And by extension, such a contextually-nuanced understanding is crucial in shaping the delivery of healthcare services to Haitian refugees fortunate enough to remain in the U.S. —as an awareness and appreciation of the socio-historical context of patients' lived experiences, i.e., their complete social history, can furnish important clues vis-à-vis the presence and etiologies of disease, influence the foci of physical exams, and generally pave the way for the provision of cost-efficient and evidence-based care. (shrink)

In his pioneering study of Grande Dame Guignol (also referred to as hag horror or psycho-biddy), a female-centric 1960s subgenre of horror film, Peter Shelley explains that the grande dame, a stock character in this form of cinematic expression, “may pine for a lost youth and glory, or she may be trapped by idealized memories of childhood, with a trauma that haunts her past” (8). Indeed, a typical Grande Dame Guignol female protagonist/antagonist (as these two roles often merge) usually (...) deals with various kinds of traumatic experiences: loss of a child, domestic violence, childhood abuse, family conflicts or sudden end of career in the fickle artistic industry, etc. Unable to cope with her problems, but also incapable of facing the inevitable process of aging and dying, she gradually yields to mental and physical illnesses that further strengthen the trauma and lead to her social exclusion, making her life even more unbearable. Unsurprisingly, scholars such as Charles Derry choose to name psycho-biddies horrors of personality, drawing attention to the insightful psychological portrayal of their characters. Thus, it would be relevant and illuminating to discuss films such as Die! Die! My Darling! (1965) and Whoever Slew Auntie Roo? (1971) as narratives of trauma. This will be the main concern of my article. (shrink)

While many with schizophrenia experience deficits in metacognition it is unclear whether those deficits are related to other features of illness. To explore this issue, the current study classified participants with schizophrenia as possessing a deficit in both awareness of their own emotions and those of others , aware of their own emotions but unaware of the emotions of others and aware of their own emotions and of other’s emotions . Groups were compared on assessments of neurocognitive function, symptoms, and (...) history of sexual trauma. ANCOVA controlling for education found that the group unaware of their own emotions and those of others demonstrated poorer verbal memory, processing speed, executive function, less emotional discomfort and higher levels of disorganization symptoms relative to the other groups. The group aware of their own emotions but not those of others had a significantly higher report of childhood sexual abuse. (shrink)

This review identifies some of the many layers that surround and potentially obscure the emotionally charged topic of recovered accounts of childhood abuse. Consideration of the, admittedly often indirect, evidence provides suggestive support for many of the components of both recovered and fabricated memories of abuse. With respect to recovered memories the available evidence suggests that: although the prior accessibility of a memory may be difficult to determine, recovered memory reports can sometimes be corroborated with respect to their correspondence to (...) actual abuse; although individuals often retain memory for trauma, there is evidence for fluctuations in the accessibility of traumatic experiences, particularly for situations that are extremely difficult to talk about; there are compelling mechanisms available to account for both the decreases and the subsequent increases in accessibility of traumatic memories that could lead to recovered memory reports. With respect to fabricated memories the available evidence suggests that: people are highly capable of fabricating vivid recollections that can be confused with reality; once fabricated, there seems to be no limit to the preposterous false memories that some individuals are capable of accepting particularly when in the presence of a persuasive individual in a position of authority. Although future research is needed to provide more direct evidence for the above claims, at present readers are urged to consider the strong likelihood that both recovered and fabricated memories correspond to real phenomena. (shrink)