1 Posttraumatic Stress Secondary Transmission

Posttraumatic Stress Disorder and Secondary Transmission Susan C. Richardson Liberty University

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Abstract Those people within the Christian Church who have been called of God to be Lay Counselors or People Helpers are being faced with an ever widening ministry to those affected by Post Traumatic Stress Syndrome. Not only are those who return from military service plagued by this disorder but anyone who suffers a traumatic incident or abuse will possibly develop it. Most disconcerting to the writer of this work is the fact that PTSD seems to be passed down, in many instances, to the immediate members of the sufferers household. Knowing the symptoms of PTSD, the family issues, a basic understanding of treatments and when to refer a client is imperative to ministering to those who present themselves for help in the local church. We are admonished in Galatians 6:1-2 that we should help those who are overtaken and restore them, bearing one anothers burdens. Brethren, if a man be overtaken in a fault, ye which are spiritual, restore such an one in the spirit of meekness; considering thyself, lest thou also be tempted. Bear ye one another's burdens, and so fulfill the law of Christ.(KJV)

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Posttraumatic Stress Disorder and Secondary Transmission Posttraumatic Stress Disorder (PTSD) has long been associated with the aftereffects of war and natural disasters. This disorder was brought to mainstream attention with the return of soldiers from the Vietnam War. (Putnam, 2009) Many of these returning soldiers experienced recurrent nightmares, suddenly feeling or acting as if the event were recurring, restricted range of affect, and hypervigilance (Davidson & Foa, 1993). It is now recognized that PTSD is not limited to wartime but may arise from a variety of traumatic events that can occur throughout the life cycle of men, women, and children. It is estimated that 4 out of 10 Americans have experienced major trauma, and the disorder may be present in 9% of the U.S. population (Breslau & Davis, 1987). Secondary Traumatization PTSD criteria provide a common language for diagnoses and assessment of trauma victims, including those with war related trauma, Holocaust survivors and others. Many of these survivors established post-war families and it is here that we began to witness the possibility of trauma transmission. (Williams-Keeler, McCarrey, Baranowsky, Young & Johnson-Douglas, 1998) Parental communication regarding the past is often characterized by obsessive re-telling or all-consuming silence. This communication, along with strong family ties, is implicated in the theoretical literature on trauma transmission. Terms such as vicarious, empathic, and secondary traumatization have been used to describe intergenerational trauma transmission. (WilliamsKeeler, McCarrey, Baranowsky, Young & Johnson-Douglas, 1998) As an example, Holocaust survivors suffered directly from the injustices of the Nazi regime. The next generation was not directly exposed to the cruel fate of their parents, yet, there

4 Posttraumatic Stress Secondary Transmission is substantial evidence that many of the offspring suffered from a secondary exposure to the trauma which their parents faced. (Williams-Keeler, McCarrey, Baranowsky, Young & JohnsonDouglas, 1998) "Various researchers have suggested that since many Holocaust survivors suffer from PTSD, their offspring will also suffer from a syndrome of similar dimensions with diminished proportions. (Solomon, 1990) Those who closely interact with or who have a strong emotional connection to a trauma victim may experience similar symptoms, even if the traumatic experiences are not discussed, because of exposure to the emotional and physical reactions of the victims. This is evident when they share in the experiences of their family members during flashbacks, nightmares, and intrusive thoughts. It is easy for them to form their own traumatic images of war. (Nelson & Wright, 1996) In addition to the symptoms that occur when one member of a household experiences PTSD, a number of interpersonal problems are likely. Confusion often characterizes the households of PTSD veterans. The triggering of veteran's PTSD symptoms causes much uncertainty for family members. Veterans often feel completely controlled by this PTSD "monster" and fear the effects it will have on them and their families. (Nelson & Wright, 1996) Family members often face fear and blame themselves when PTSD symptoms occur. Four specific areas of interpersonal problems associated with PTSD include: coping with the veteran's PTSD symptoms, unmet needs of female partners, violence, and emotional abuse. (Nelson & Wright, 1996) Vicarious traumatization which involves internal changes in core beliefs, identity, needs and wants, relationships, and view of others as a result of repeated exposure to traumatic material can also take place. (Krause, 2009)

5 Posttraumatic Stress Secondary Transmission Solomon (1990) reported that second generation Israeli soldiers exposed to combat situations exhibited PTSD symptoms remarkably similar to Holocaust survivors. This included "intrusive symptoms, hyperalertness, cognitive impairment, and guilt feelings ... all symptoms ... highly reminiscent of the nightmares and flashbacks so prevalent among Holocaust survivors" (p. 1742). The importance of the research by Solomon et al. (1988) and Solomon (1990) is twofold. First, it provides support for Rosenheck and Nathan's (1985) conceptualization of "secondary transmission." In their paper, secondary transmission was used to suggest the transmission of trauma between Vietnam Veterans suffering from PTSD and their offspring. Second, there is some evidence for the hypothesis that children of survivors will exhibit PTSD significantly more often than matched controls. (Williams-Keeler, McCarrey, Baranowsky, Young & JohnsonDouglas, 1998) Children Trauma and Parental PTSD According to Ogawa (2008), psychological trauma in children can be defined as the mental result of one sudden, external blow or a series of blows rendering the young person temporarily helpless and breaking past ordinary coping and defensive operations. According to the nature of the event childhood trauma can be divided into two categories: Type I, which involves a single, sudden, unexpected, relatively time limited, and public (i.e., affecting children from more than a single family) stressor, such as a natural disaster or school shooting; and Type II trauma, which refers to a stressor resulting from a long-standing ordeal, such as repeated abuse (Ogawa, 2004). PTSD in a parent can and often does result in Type II trauma of the children and spouse. Brown, Brack & Mullis (2008) relate that traumatic events give rise to various symptoms and consequences that differ among affected children. Trauma produces profound and prolonged changes in physiological arousal, emotion, cognition, and memory that may disconnect these

6 Posttraumatic Stress Secondary Transmission normally integrated functions from one another. These changes always affect school functioning. (Schiraldi, 2009). Unfortunately, many of the descriptors of the male child abuser often fit the veteran PTSD sufferer who is also normally in his or her mid-20s, depressed and unable to cope with stress, becomes enraged easily, and has experienced violence. (Krause, 2009) According to Lambie (2005), most abuse of children occurs at the hands of parents, with a minimum four out of five victims found to be abused by at least one parent. Mothers acting alone were most commonly found responsible for physical abuse, nonrelatives and fathers acting alone were most commonly found responsible in sexual abuse cases. Finally, most physical abuse fatalities are caused by enraged or extremely stressed fathers or other male caretakers. The average abuse parent is in his or her mid-20s, lives near or below the poverty level, often has not finished high school, is depressed and unable to cope with stress, and has experienced violence firsthand. (Lambie, 2005) As was shown, untreated PTSD in our veteran population can possibly lead to secondary transmission of symptoms to a generation of children reared by the PTSD sufferer. This perpetuates transgenerational trauma. Wylie (2010) relates that it is also glaringly obvious to mental health professionals that child abuse and childhood PTSD significantly increases the risk for mental and emotional disorders and associated risks for alcoholism, drug abuse, and smoking. Transgenerational trauma can also be passed down with the abused acting out the abuse and so becoming an abuser themselves. Childhood adversity is also a major risk factor for many of society's most prevalent biomedical illnesses and causes of death including heart and lung disease, diabetes, liver and kidney disease, some cancers, sexually transmitted diseases (including HIV), and autoimmune diseases. Being abused or neglected as a child increased the

7 Posttraumatic Stress Secondary Transmission likelihood of being arrested as a juvenile by 59 percent, as an adult by 28 percent, and for committing a violent crime by 30 percent. In light of all this, it has been asserted that child abuse is the largest single public health issue in America. (Wylie, 2010) Not every trauma victim experiences the same responses. Our internal interpretation of events is the reason why two people may respond very differently to the same stressful situation. Anderson (2003) recognizes the fact that one does not have volitional control over our emotions but believes that they are primarily a product of our thoughts. He believes it is not the circumstances of life that determines how we feel. How we feel is primarily determined by how we interpret the events of life (i.e., what we choose to think and believe) and secondarily by how we choose to behave (p.84). This correlates to the passage, Proverbs 23:7 For as he thinketh in his heart, so is he: (KJV) If these statements are true, it is imperative that children, as well as adults, be taught and encouraged to communicate their thoughts so that the caregiver may help them interpret their situation in a positive manner. Indicators for PTSD Savitsky, Illingworth and Dulaney (2009) stresses that when providing services to those who have deployed to combat zones, it is important to look for signs of distress, such as "nightmares or other forms of sleep disorder; hypervigilance, jitteriness or overexcitement; and avoidance or social withdrawal" (Center for the Study of Traumatic Stress, n.d.-a). Traumatic events that contribute to the development of PTSD include sexual trauma, seeing dead bodies, being injured, killing others, seeing others killed, and having friends killed (Hoge et al., 2004). Comprehensive assessments of clients, both men and women, should include questions regarding military service and trauma prior to military service. Christian Counselors need to remember that they and their clientswrestle not against flesh and blood, but against principalities, against

8 Posttraumatic Stress Secondary Transmission powers, against the rulers of the darkness of this world, against spiritual wickedness in high places Ephesians 6:12. (KJV) Prayer must be in the forefront of any treatment plan. Individualized Treatment Treatment for PTSD must be as individual as the person experiencing the symptoms. Nelson & Wright (1996) say that the issues that most obviously need attention include decision making, problem-solving skills, and learning healthy coping skills. However, more serious problems may need addressed. Some of these, like isolation, guilt, low self-esteem, and hostility can be dealt with through individual sessions. Others, such as depression and anxiety, may require psychiatric intervention as well. of the common therapies in use today include Grief Resolution, Scripted Exposure and Eye Movement Desensitisation and Reprocessing. These therapies, as well as many more, are important for the Lay Counselor to be familiar with. There are now several therapies available for the treatment of posttraumatic stress disorder (PTSD) that are primarily cognitive, include cognitive components, are based on cognitively oriented theory, or propose to change faulty cognitions or fear networks. These treatments have undergone or are currently undergoing trials for efficacy and/or comparison to each other. (Falsetti & Resnick, 2000) Guilt Resolution follows a course similar to other intense feelings common to PTSD. This course includes denial of responsibility, processing of the harm done and our responsibility as well as clarifying faulty thinking, and resolution where appropriate sorrow and amends are made with the focus on appropriate growth and change. Before guilt can be resolved it is beneficial for the therapist to help the client to determine his percentage of responsibility and reframe his thinking. (Schiraldi, 2009 p.196) Without a person accepting personal responsibility for their own actions, and only their own actions, guilt cannot be resolved and in the spiritual

9 Posttraumatic Stress Secondary Transmission realm, repentance toward salvation is also impossible. David gives an example of this in Psalm 51:2-4. Here he says: Wash me throughly from mine iniquity, and cleanse me from my sin. For I acknowledge my transgressions: and my sin is ever before me. Against thee, thee only, have I sinned, and done this evil in thy sight:(KJV) Another promising therapy for desensitization of traumatic memories is Scripted Exposure. Musruck and Pringle (2003) relate that scripted exposure involves keeping a written record of thoughts, feelings, behaviors and ideas. They also site Spiegel (1999) in describing how ventilation of negative emotion, even to an unknown reader helps patients to 'acknowledge, bear and put into perspective their distress'. By encouraging people to put traumatic emotions into words, writing offers a therapeutic release. Musruck and Pringle (2003) also relate that Pennebaker (1997) suggests that the process of writing about traumatic experiences can be a major contribution towards understanding the experiences. Eye Movement Desensitisation and Reprocessing is a therapy that was developed in the late 1980s and involves sessions during which specific eye movements are carried out in conjunction with traumatic thoughts and memories being brought to the forefront of a person's consciousness and reprocessed (Shapiro, 1991 (Musruck & Pringle, 2003) EMDR has been extensively tested on thousands of patients, from Vietnam War veterans to disaster victims, including survivors of earthquakes in Mexico and Turkey, the Oklahoma City bombing and the Columbine High School shootings. (Musruck & Pringle, 2003) Conclusion In conclusion, loving the victim of PTSD and their damaged family is the greatest gift the church can provide for them. Education and preparation is necessary to understand the scope and outreach necessary to provide for the needs of this group of individuals. Providing care for the

10 Posttraumatic Stress Secondary Transmission sufferer of PTSD can and may have generational and eternal benefits. God requires His followers to accept and care for those who are helpless to defend and uplift themselves. Praying and fasting as the scripture prescribes in Matthew 17:21 will avail much in seeking relief from the demons that torment those contending with PTSD. Exhibiting Gods love through prayer, acceptance, boundary setting and honesty will form the basis for reestablishing safety and trust in both others and with God. Christians must be made aware that to accept one of these tormented souls and their little ones is to accept Christ and the One who sent Him.

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