“He reached across the kitchen table, choked me and dragged me across the floor. It felt like he almost broke my spine. He screamed at me, said that I am fat and ugly and stupid and beat me in the face. I was so upset, I had to lock myself in the bedroom and couldn’t go to work, because I knew he would be there.”
This is a text message I received yesterday from a person in my immediate social environment. Until this point I was in the fortunate position of being to say that I never experienced major forms of abuse in any of my past relationships, and had never been confronted indirectly with it through friends or family members.
Domestic violence or living in an abusive relationship always occurred to me as something removed from my life, a fact I would deal with only as a research topic for university. Reading this text message and sensing the despair, sadness and helplessness of the abused, domestic violence suddenly assumed significance in my life. This has led me to dig deeper into the different forms and patterns of abuse as well as risk factors, consequences and possible ways to withdraw from interpersonal violence in relationships.
Individual Risk Factors
Factors such as being involved in stable and supportive social relationship,s and being financially and socially independent from your partner, seriously reduce the risk of experiencing domestic violence. On the other side, there are a number of facts increasing this risk:
Being female (approximately 85 % of the survivors of relationship violence are female, while there are a high number of unreported cases among men. Currently, there are also studies carried out concerning violence in relationships within the LGBTQ spectrum)
Living with a physical or mental disability (persons with disabilities also run at a high risk to suffer from abuse by health care providers or caregivers)
Personality characteristics (e.g. low self-esteem/insecurity, leading to emotional dependence)
Young age (women ages 20 to 24 are at the greatest risk of experiencing violence within a relationship)
Low educational qualification/unemployment, leading to financial dependency
Prior experience of physical or psychological abuse (spiral of violence)
Forms of violence
Violence in relationships not only occurs in the form of physical assault – it is only the most obvious of the potential forms of violence. Instead, violence manifests itself in different, more subtle, forms that often arise in combination with each other. Non physical violence is not to be classified as “less bad” or less painful. Although there are no immediate visible injuries; its effects are as significant as of the other forms of violence.
Psychological/emotional: insults disguised as jokes, intimidation, permanent control, emotional blackmailing, prohibitions, twisting of facts, intentional denial (e.g. “I have never said that”, “I’ve never done this”)
Social isolation, control/sabotage/prohibition of social contacts, confinement, disregard of privacy, spreading rumors/lies (e.g. “s/he is crazy/jealous)
>Economic: control of finances, refusal of money, forbidden ownership of a bank account, sabotage of education or work, constant calls to the workplace
Sexual violence: sexual pressure, coercion to sexual practices, unwanted touching
Physical violence: confinement, pushing, spitting, violence against pets and objects, punching, kicking, choking/li>
Patterns of violence
The Power and Control Wheel was invented by the Domestic Abuse Intervention Programs (DAIP) in 1984 to visualise the cyclic pattern of violence in abusive relationships, and to describe the different dimensions of relationship abuse. It is important to again state that men (and transgender) individuals can, and are, also subjects of abuse, but that male-female relationships are the certain toxic mythologies about manliness contribute to this arrangement’s prevalence.
The results of violence
There are a number of different psychosomatic and psychological consequences of domestic violence, caused by a permanent state of alarm. Beyond the immediate consequences of the physical assault by the abuser, survivors tend to suffer from heart and circulatory problems, headache, digestive problems, back problems, and a general weakening of the immune system.
Psychologically, and alongside the primary effect of a minimised self-esteem, abuse can cause insomnia and nightmares, and, if experienced regularly, increases the risk of mental illnesses such as Depression, Burnout Syndrome and Post Traumatic Stress Disorder.
How to break the cycle
If you suffer from any of the forms of domestic violence and are not sure how to break the cycle of abuse and subsequent apologies, please be sure to tell the ones close to you about your experiences. This is the first step to regain a healthy self-image which has been and still is damaged by the abuser. It also makes it harder for the abuser to portray the abused as exagerating or making it up, should the abused seek help from the police.
Do not feel overpowered by shame – domestic violence, and living in an abusive relationship is never primarily your fault. Doing nothing about the situation, whether your relationship or one involving a friend or aquaintance, would be your fault. Please reach out for support and remember that you don’t have to deal with the situation on your own – friends and family would love to help if you make the first step, so talk to them about the abuse. Another step could be to call a hotline (e.g. the U.S. National Domestic Violence Hotline at 1-800-799-7233 or TTY 1-800-787-3224), or to visit a crisis center to get expert help with crisis intervention and safety planning in a confidential and safe space.
Sources
National Network to End Domestic Violence: www. nnedv.org
According to statistics published by the Transgender Violence Tracking Portal (TVTP) in 2014, 10 % of acts of violence against homo- or transsexual people have been committed against transgender youth, with an assumingly high number of unreported cases. Acts of violence reported to the TVTP include
An 8-year-old boy beaten to death by his father
A 14-year-old strangled to death and stuffed under a bed
Two 16-year-olds shot to death
Three 18-year-olds stabbed to death, dismembered or shot
Two 18-year-olds murdered with no details being reported
An 18-year-old suffered two violent attacks by a mob and survived
The latest case of transphobic violence who also gained some attention of the media was that of 22 year old Bri Golec – a trans woman from Ohio who was reportedly stabbed to death by her father on Friday 13, 2015.
A 2014 study conducted by the American Foundation for Suicide Prevention and the UCLA School of Law reveals that the prevalence of suicide attempts among respondents to the National Transgender Discrimination Survey is 41%, which vastly exceeds the 4,6 % of the overall U.S. population who report a lifetime suicide attempt, and is also higher than the 10 to 12 % of gay, lesbian and bisexual adults who report ever attempting suicide. The study points out that transsexuals are confronted with discrimination on a daily basis, both the micro-level – in everyday interactions – as well as institutionalised on the macro-level:
57 % of the respondents experience rejection by family members
50 to 54 % are harassed or bullied at school
50 to 59 % are discriminated against at work
60 % are denied access to healthcare as doctors or health care providers refuse to treat them
They are more likely to experience sexual violence (At work: 64 to 65 %; at school: 63 to 78 %; by law enforcement officers: 60 to 70 %)
57 to 61% are disrespected or harassed by law enforcement officers
69 % experience homelessness
How can those outstandingly high numbers of discrimination, victimization, and violence towards transsexuals on all societal levels be explained? The answer to this question is complex and would be beyond the scope of this article. One among many possible reasons could be the flawed and stereotypical depiction, sensationalization and the devaluation of transsexuality in the media, which clearly reveals a general lack of understanding of what transsexuality really is.
A short intro to transsexuality
The word “trans” in transgender is Latin, meaning “across”
Transsexuals experience a disparity between their individual gender identity and the gender assigned to them by society based on their biological sex
2 examples:
A person who is biologically female, but identifies as male and chooses to transition to male is called a trans man.
A person who is assigned the label “male” by society based on its biological features and who identifies as a women and chooses to transition to female is a trans woman.
Transgenders are to be addressed with the pronoun of the gender they identify as (e.g. a trans man is to be addressed with the pronoun “he”)
The “trans” specification is not necessary
Sexual orientation and gender orientation are often confused when it comes to transsexuality:
Gender orientation is who you identify as
Sexual orientation is who you are attracted to
A transsexual man can be attracted to females, males, both or feel no sexual attraction at all.
The same goes for transsexual women.
GENDER ORIENTATION DOES NOT AUTOMATICALLY DEFINE SEXUAL ORIENTATION!
Gender identity, sexual orientation and gender expression are non-fixed, they are instead fluid categories which have to be thought of independently from each other when it comes to transsexuality.
Gender identity describes how you identify your gender and how you see and understand yourself
Sexual orientation refers to who you feel attracted to
Gender expression is the way you express yourself outwardly. Often gender expression and cross dressing are confused when it comes to transsexuality. Transsexuality and cross dressing are not the same: cross dressing alludes to gender performance as a means of expressing yourself (e.g. through drag) which does not necessarily have to affect gender identification or orientation.
Transition to male or female does not only or necessarily mean undergoing plastic surgery to get a sex change. It includes many different steps – for example changing gender pronouns and opening up to friends and family are factors contributing to transition.
1. “The basis of sexual relationships are respect, equality and a respect for each other’s needs and boundaries.”
I am sure that most of the readers of this entry will agree with this statement. So far so good. But how can it be explained that every 107 seconds, a person in the USA is sexually assaulted, with an average of 293,066 victims (age 12 or older) of rape and sexual assault each year?
2. “The rapist is a masked stranger” is a socially constructed stereotype.
According to statistics of the Rape, Abuse & Incest National Network (RAINN), an anti-sexual assault organization based in Washington, the majority of rapes are committed by someone known to the victim. The vast majority of rapes aren’t committed by masked strangers hiding in bushes:
73% of sexual assaults were perpetrated by a non-stranger
38% of rapists are a friend or acquaintance
28% are an intimate partner
7% are a relative
More than 50% of all rape/sexual assault incidents were reported by victims to have occurred within 1 mile of their home or at their home
There are numerous approaches to explain those numbers. A rather new factor to be taken into account in the analysis of sexual violence is consent and its indispensability when it comes to sex.
Etymological: the modern noun consent derives from the Latin verb “cōnsentīre”, which is a combination of the prefix “com-“ (“with”) and the verb form “sentiō” (“to feel”)
As a more general understanding: “a voluntary agreement to engage in sexual activity”
Legal: “a freely given agreement to the conduct at issue by a competent person”
The U.S. legal definition of consent, as anchored in § 920 – Art. 120 of the U.S. Code of Federal Regulations, continues as follows:
“An expression of lack of consent through words or conduct means there is no consent. Lack of verbal or physical resistance or submission resulting from the use of force, threat of force, or placing another person in fear does not constitute consent. A current or previous dating or social or sexual relationship by itself or the manner of dress of the person involved with the accused in the conduct at issue shall not constitute consent.”
4. There is a discrepancy between the legal definition and social reality of consent
Although it is essential to state that a lack of verbally expressed consent to sexual interaction equals an absence of consent, social study has shown that in reality most of sexual interaction relies on non-verbal communication to initiate and reciprocate consent (Hall et al., 1988) as part of a social script. This script regulates sexual interaction and is formed by a number of cultural, interpersonal, and psychological factors operating on the societal micro- and macro-level as well as individual psychological processes. Sexual violence in this article is to be examined with regard to socially constructed gender differences.
5. Unspoken gender constructs cause problems
Consent cannot be analyzed without taking hegemonial power differences which are a result of the socially constructed gender binary into account. Studies in this context hint to differences between how men and women initiate and reciprocate sexual consent (cf. Hickman and Muehlenhard, 1999): The script of heterosexual sexuality dominant in Western culture requires the man to be the initiator of sexual interaction. He holds the active part, while the woman is still often viewed as the non-verbal, passive gate-keeper. Generally speaking this means that gender relations influence sexual consent as the ways in which men and women are socialized into gender roles influence their perceptions of sexual relationships as well as their expected gendered roles within those relationships.
The danger of harmful non-consensual interaction lies in the cultural understanding of men as the sexual initiators in heterosexual relationships: Studies show that a misperception of sexual intent occurs as a result of hierarchical gender differences – giving men the power of consent and forcing women into a passive, reserved position (cf. Berkowitz, 2002).
6. You need to speak out! Sensitize yourself!
If sexual scripts are mostly non-verbal, then encouraging direct communication of desires and boundaries – especially among women – would be an essential factor amongst others to help stop sexual abuse. A biased perception of consent influenced by societal gender inequality makes the sensitization of men an equally important part of consensual sexual conduct.
Men need to become more aware of possible inhibitions of women to express themselves. Among other factors, a fear of embarrassment might play a crucial role in the lack of communication, especially among younger and/or sexually inexperienced women. Also, disabilities or imposed societal norms such as compulsory heterosexuality might affect communication about sexual practices and/or consent.
Furthermore, it should be taken for granted that consent cannot be given under the heavy influence of alcohol or other drugs. Definite ways to tell if your partner does not consent to sexual activity, even if a “no” is not specifically articulated, are for example freezing up, saying you’re tired, or pulling away. There are numerous other subtle forms which might indicate a lack of consent, thus again pointing to the importance of direct communication. Remember: A person doesn’t have to yell “no,” scream, kick, or bite for it to be clear that they don’t want to engage in sexual activity. If you push someone into consent, it isn’t consent.
Image may be NSFW. Clik here to view.Disclaimer: The focus on heterosexuality in this article is the result of a lack of studies on consent in homosexual relationships. This text does not want to indicate that a lack of consent does not occur in same-sex relationships. Also, the intention of this text is not to imply that communication is the magic solution to stop sexual abuse. It is only one factor amongst many others that needs to improve when it comes to sexual violence. Furthermore, there are obviously not only women who are pressured into sexual activity by men. A large number of cases of sexually violated men goes unreported each year. Finally, there are of course many women who are able to express themselves when it comes to sexual interactions as well as many men who are sensitized when it comes to the wishes of their partner.
For more information on consent and what it is, what it isn’t, and how it functions in different relationships, watch this video.
Rape is a social reality. The Rape, Abuse & Incest National Network (RAINN) claims with reference to data researched by the U.S. Department of Justice’s National Crime Victimization Survey (NCVS) that every 107 seconds, another American is sexually assaulted. Statistics from the CDC indicate that about 1/5 of all women in the US have been raped. This fact makes it very likely that you or someone in your immediate social environment – a family member or a close friend – has experienced sexual violence at least once during their life course.
I personally have met many people coming from different social backgrounds and age groups, with different genders and sexual orientations, who all share one common experience: they all have come in contact with sexual abuse, either directly in varying degrees of severity or indirectly through the accounts of others.
But how come that some persons who experience sexual violence struggle with coping with the events and have a hard time articulating what has happened, still being overwhelmed by an experience that –to the outsider– has happened years and years ago, while others seem to have stored the memories in a safe place and can talk about and evaluate the experience with detachment?
It is not the intention of this text to put survivors of sexual assault and rape under pressure to “finally get a grip” when they have a hard time dealing with what has happened to them. Instead, it aims to help understand what a traumatic experience really is and how it affects the brain in order to help survivors of sexual violence and those close to them to get a better understanding of how the traumatic memory works. Understanding how trauma works is, among many others, an important step towards healing.
This is the first text of a two-part series, defining the term “trauma” and giving an overview on its neurophysiological effects. It is a more medical approach to the topic; text number two will present a detailed insight in the psychological consequences of trauma.
Trigger warning: This text mentions factors contributing to the development of posttraumatic stress as well as some of its symptoms such as dissociation. It does not contain graphic descriptions of sexual abuse.
What is trauma?
Image may be NSFW. Clik here to view.Trauma is to be distinguished from a normal stressful event. It is experienced by those affected as something so dreadful and outside of their everyday reality that there are no coping strategies to process the happenings. The consequence is a discrepancy between what is happening and the person’s resources to handle the situation. The traumatic event is accompanied by feelings of terror, power-, helplessness and immense fear. The severity of the reaction to the trauma depends on its nature.
Focussing on the topic of rape, it is obvious that a car accident in which no one is killed has different long-term consequences for the person experiencing or witnessing the event than experiencing sexual violence. Concerning the traumatic effects of rape, the severity of the after-effect of the trauma depends on the age in which the person experienced the abuse as well as on the duration of the experience. Thus, a child experiencing sexual violence over an extended period of time is more likely to suffer from severe consequences of the trauma than an adult experiencing sexual violence once. Also there is a difference between experiencing rape in a country which offers the person affected the possibility to make use of medical, legal and therapeutic support in contrast to experiencing it in an extreme situation such as during times of war, which is a traumatic event on its own.
Risk and protective factors influence the consequences of experiencing a traumatic event
Nonetheless, it has to be stated that the ways in which a person copes with experiencing sexual assault or rape differ with regard to a number of different factors. In this context, social support becomes one of the most important factors when it comes to dealing with traumatic experiences. For example: A person who is strongly connected to its social environment and well-supported by friends and family members – both before and after experiencing sexual violence – might suffer less from the consequences of sexual violence than a person who experiences a lack of social support.
Besides social support, there are different other risk and protective factors that have an influence on how a traumatic experience as rape is processed. Those fall into three categories, which are pre (before), peri (at the time of the event) and post (after) traumatic factors.
Risk factors influencing the possibility to develop post-traumatic stress
Rape, as acute trauma, has both neurophysiological as well as psychological effects on the person experiencing it. To make this thesis more vivid, one can look at the animal kingdom, especially mammals: If a hedgehog encounters a predator – for example a marten – it will either fight, flight or freeze. The same counts for humans. This can be explained by the fact that the neurological region responsible for those basic impulses a hedgehog experiences when encountering a predator – the amygdala – developed early from an evolutionary point of view and can, therefore, be found in many mammals. This region is decoupled from the area of the forebrain – or the prefrontal cortex – which is responsible for understanding and thinking differentiated.
During a traumatic event, the amygdala automatically acts separately from the prefrontal cortex as a protective mechanism. Which one of the three possibilities a person chooses or has to choose when being threatened with or experiencing rape (or another trauma) – to fight back, escape the situation or to endure it – depends on a number of individual and contextual factors. Especially grievous trauma and learned helplessness can occur following prolonged and repeated trauma.
Nonetheless, it can be said that if a person cannot escape the situation and if the pain of the event – both physical and emotional – becomes unbearable, the amygdala region can cause dissociative behaviour in the person experiencing the abuse. Dissociation is another protective mechanism in which the brain separates the perception of self from the experience, and may lay in an internal mechanism meant to avoid overloading the brain with too much, too intense, experience at once.
There are many different neurotransmitters released during trauma, especially during rape. Rape (and some other forms of sexual abuse/abuse) has the added problem of bonding hormones like oxytocin, which are triggered by genital activity, which can have an affect on future bonding-behavior. Since we are conditioned by everything, and intense experience can condition far faster (in as little as one event), events that remind a person of traumatic events may start a processing of data the brain that had been previously filed away during disassociation.
Thus a high sensitivity towards related situations or stimulus is inherent in any type of trauma, regardless of whether we are talking about someone who was a soldier or has been raped. This can in turn lead to extreme reactions or distress when actors or events that are from or remind them of their trauma come into their present life.
Some of the hormones that are up-regulated during trauma are:
Epinephrine and norepinephrine (create a state of “hyperstress,” is the precursor for adrenaline)
Cortisol (providing energy in the form of glucose, and assisting immune functions)
Oxytocin (responsible for inhibiting memory consolidation, also for social attachment)
Vasopressin (prevents dehydration)
Endogenous Opioids (control pain and overwhelming emotions)
The dissociation causes a detachment between the body and the mind, leading a person to feel as if they are experiencing the abuse from outside, e.g. as if watching it happen like a spectator from a corner in the room.
Research indicates that high levels of norepinephrine, epinephrine, and endogenous opioids interfere with the storage of explicit memory, which is exemplified in our ability to reason and verbally repeat our experiences. Therefore, traumatic memories are stored in the implicit form as emotions and senses in the amygdala, making it hard to articulate the experience as the memory appears to be fragmented and composed of different incoherent sensory impressions.
Thus, survivors of abuse become haunted by feelings and senses they know are related to the trauma, but have great difficulty identifying those. These sensory impressions (so called “triggers”) bring overwhelming emotions and sometimes flashbacks and panic attacks which cause the body to return to the emergency chemical response experienced during the traumatic event. If the stress created by the trauma continues to act, base-level psychobiological changes are induced:
Increased levels of catecholamines (causing chronic hyperstress)
Decreased levels of glucocorticoids (responsible for poor immune functioning)
Decreased alpha-2 Adrenergic receptors (causing less regulation of stress)
Increased endogenous opioid levels during traumatic memory triggers (which equals up to 8 mg of morphine)
Understanding how these processes work, and how your brain becomes conditioned by experience to trigger future reactions, can help you retrain your brain. In the same way counter-conditioning therapy uses the same stimulus with another reaction to slowly rewrite the associations, you can use your experience to recondition yourself. Hopefully, even if you aren’t afflicted, you can have empathy and understanding for those that are, and do your best to not make light of their feelings or experience.
On violence against transgender people: Stotzer, R. (2009). Violence against transgender people: A review of United States data. Aggression and Violent Behavior, 14, 170-179.
The Body Keeps The Score: Memory & the Evolving Psychobiology of Post Traumatic Stress by Dr. Bessel van der Kolk (MD, Harvard)
http://www.uvm.edu/~cdci/best/readings/readings2012/joyal-reading1.doc
Possibly most of the readers of this text will have come across the term “Post-Traumatic Stress Disorder” (PTSD) with regard to veterans returning home from war zones and having problems with reintegration. Still many people don’t realize that PTSD is also a normal reaction to traumatic events that happen outside of the military in everyday life – such as accidents, chronic illnesses or the death of a loved one. And although many people are familiar with the term, I noticed that most of the people using it are unsure about what it really means and the implications of the disorder on the lives of those affected.
For this reason, this text will deal with the psychological after-effects of trauma by taking a closer look at PTSD. Although its primary intention is to teach you about how it is diagnosed and its symptoms, it will also include statements of Mary [not her real name] – a friend of mine who was diagnosed with PTSD after experiencing sexual violence at the age of 16. The intention of doing so is to give you a more vivid picture of how PTSD feels in order to create a greater understanding and empathy towards those suffering from it.
Trigger warning: This text contains graphic descriptions of experiences and symptoms related to PTSD, including those from the dissociative spectrum. There are different triggers mentioned. There are no detailed descriptions of the act of rape as such or of self-harming behavior.
This is part two of a two-part series on trauma and its consequences. Part I gave a definition of the term „trauma“ and presented its neurophysiological effects.
In case you already forgot some of the main points, here are some of the things you could have learned in part I:
Trauma is to be distinguished from a normal stressful event.
The severity of the reaction to the trauma depends on its nature.
Traumatic events are for example natural disasters, torture and rape. Those don’t necessarily need to be experienced directly as traumatization can occur merely through being a witness of a traumatic happening.
There are different risk and protective factors that have an influence on how a traumatic experience is processed.
There are different neurotransmitters and forms of neural conditioning involved in trauma, possibly causing dissociation and leading to the storage of traumatic memories in the implicit form as emotions, associations, and senses.
What Happens After the Traumatic Experience?
So, something bad happened. Something really bad. Something so unexpected and far out of your comfort zone that it shakes you to the core. What happens next?
“I really didn’t realize what happened after it was over. I remember walking into the bathroom and looking in the mirror. Something was wrong, terribly wrong, but I couldn’t point my finger at what it exactly was. I was in physical pain and there was blood, but I couldn’t feel anything. I remember staring at myself for what seemed to be ages and it felt like I was looking right through myself. Everything felt strangely numb and dull. It wasn’t until the next day or so when I realized what had actually happened. When it hit me, I had a break-down, both mentally and physically. I was lying on the floor, screaming and crying. My world collapsed. ”
The state of numbness Mary describes here is an acute shock reaction caused by the increased endogenous opioid levels during and shortly after the traumatic situation. Survivors or witnesses of trauma often report feeling numb and apathetic directly after the event, which is a protective mechanism of the brain to help the body cope with the extreme level of stress and pain.
As mentioned in part one of this series, the blood opioid level can rise to what equals up to 8 mg/l of morphine during a traumatic event or a flashback memory. When this level comes back to normal after a few hours, as the body is not able to maintain this protective default setting over a long-term period, the shock reaction turns into an acute PTBS. Approximately 25% of all persons experiencing trauma develop this form of PTSD, depending on a number of different risk and protective factors, which were mentioned in the previous text.
In approximately every tenth case it is also possible to show symptoms of PTBS with a delayed onset – that is if symptoms of PTSD start to show at least 6 months after the event, often caused by external factors reminding the person affected of the trauma. The acute form of post-traumatic stress has the same severe symptoms as chronic PTSD (see below), lasts longer than one month and up to three months after the experience.
After that period of time and under the influence of different protective factors, such as strong social support, the probability for so-called “spontaneous remission” – that is a slow decrease of symptoms without seeking therapeutic support – rises to up to 50% within a year. A lack of social support, further contact to the perpetrator, and other secondary stress factors increase the probability to develop chronic PTSD, which is diagnosed if symptoms persist for longer than three months.
I was feeling desperate and helpless. I remember turning to my friends for support, because I somehow didn’t feel like myself anymore. Something inside of me was ‘broken’, if that makes sense. I didn’t get any help – they all either told me that it was my own fault, that I shouldn’t have been drinking that beer with him, that I shouldn’t have let him into my room. Or they said something along the lines of that ‘stuff like that’ happens to a lot of people and that I will get over it if I just don’t think about it anymore. Some said that I should just go and see a therapist then, but no one offered to go with me or help me in any other way. I felt overwhelmed and alone. That was when I started to feel guilty. Maybe they are right? If I hadn’t gone on that holiday, if I hadn’t drunk that beer, if I were a really good person this wouldn’t have happened to me. I must be a bad person. I am worthless, I deserved it and I will never be the same again. This was the beginning of a destructive mind spiral, which is very hard to exit. During times when I am feeling low, I still catch myself falling back into this train of thought.”
In addition to the storing of the memory as implicit knowledge in the amygdala, evaluative processes play a central role when it comes to developing and maintaining symptoms of PTSD. How the traumatic event and its consequences are assessed is crucial in this regard. A traumatic experience inevitably changes the way the person affected thinks about his/herself, the world, and his/her future. In which direction this change of thinking goes decides whether and how much the person affected suffers from symptoms of PTSD. When Mary thinks that she must be a bad person, because otherwise the rape wouldn’t have happened to her, feelings of anger, shame, guilt and fear are setting in, reinforcing the symptoms of PTSD in the long term.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) specifies clear criteria that must met in order to be diagnosed with PTSD. Published by the American Psychiatric Association, it provides standard criteria and common language for the classification of mental disorders. For the diagnosis of PTSD, a standardized questionnaire, called “The Posttraumatic Stress Disorder Checklist” (PCL), is used.
This checklist was developed by Weathers et al. in 1993 and is a 17-item scale based on the DSM-IV criteria that assesses the domain of PTSD symptoms. There are three different versions of the PCL available: the PCL-C (for civilians), the PCL-S (for addressing a specific stressful experience), and the PCL-M (for military). You can see a version of the PCL-C here.
Although the criteria for being diagnosed with PTSD have been relatively stable over the past 20 years, some slight alterations have been made in the fifth revision of the DSM (DSM-5), which was released in May 2013. It moved PTSD from the class of anxiety disorders into a new class of “trauma and stressor-related disorders”. Also it includes slight changes to the diagnostic criteria for PTSD, such as the division of the previously three clusters of symptoms in DSM-IV into four clusters in DSM-5. The four new symptom clusters now are intrusion, avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity. Also other symptoms were revised to clarify symptom expression, a clinical subtype “with dissociative symptoms” was added to include individuals who meet the criteria for PTSD and experience additional depersonalization and derealization symptoms, and separate diagnostic criteria were included for children ages 6 years or younger.
How Does It Feel To Suffer From Posttraumatic Stress?
When asked about her PTSD, it becomes clear that Mary suffers or used to suffer from a large number of symptoms specified in four clusters in the DSM-5.
1. Intrusion
The DSM-5 states that you need to persistently re-experience the traumatic event in one of several ways:
Thoughts or perception
Images
Dreams
Illusions or hallucinations
Dissociative flashback episodes
Intense psychological distress or reactivity to cues that symbolize some aspect of the event
Intrusive symptoms include what people commonly describe as “flashbacks”. Flashbacks are not to be thought as to be only visual, but multi-sensory. This means that the person affected by a traumatic experience will re-live aspects of the trauma it if they are confronted with certain stimuli (“triggers”). If for example confronted with a certain smell that reminds the person affected of the traumatic experience, intrusive memories will be triggered. This includes experiencing physiological reactions such as sweating, trembling, difficulty breathing, nausea or gastrointestinal complaints.
“In the first years after the abuse I didn’t know what made me relive the experience over and over again. I had never heard of ‘triggers’ or anything like that at the time. I didn’t know that I was suffering from PTSD. All I knew was that I there were certain situations and people that made me extremely anxious and that caused different very intense fragments of the rape to suddenly pop up without a warning. I could walk home along a dark street at night and I would suddenly start to panic, convinced that someone was following me. I would start running and lock myself in my bedroom crying, because I was convinced that someone was in my flat. The same would happen when I was in a room and suddenly the lights went off. I would start trembling and sweating and feel sick. My heart would beat so fast, I was convinced that I would have a heart attack.
Over time it became worse and worse until I couldn’t even walk through my own flat with the lights off. At that time I was triggered by so many different things that my life started to feel like a nightmare. I was afraid of everything. I thought that I was slowly going crazy. Also I felt extremely ashamed that anyone would find out what was going on, that I wasn’t “normal”, because I didn’t feel supported by my social environment and I thought no one would understand me. I started wearing a mask and tried not to show that something was wrong with me. It wasn’t until therapy that I learned to recognize and categorize my triggers. There I also learned that darkness is one of them as it was dark in the room the abuse happened in. Now that I know, I am able to control it. A big part of that is to allow yourself to feel afraid in certain situations and not to force yourself to do anything because you feel that you ‘have to do’ certain things. Being afraid is okay and something you can admit. If I now for example feel uncomfortable walking home alone in the evening, I will simply ask a friend to accompany me. In the past I wouldn’t have done that, because I didn’t know what was going on. I was forcing myself to be ‘like everyone else’.”
It is important to know your triggers to regain control over what is happening to you. If the person affected also falls into the dissociative subtype of the disorder, he/she might experience dissociations while confronted with triggers and/or lose touch with reality while experiencing a flashback, meaning that he/she wouldn’t be able to distinguish the present from the past.
“One of my triggers is the mixture of the smell of alcohol and cheap perfume. I remember being on the train a couple of years ago and someone in the same wagon smelling that way. I remember feeling like I would throw up, if I didn’t get out of there as soon as possible. I was sweating and trembling. I got out at the next stop and sat on a bench. That was the point when I started to zone out – I was in some kind of trance. The next thing I remember is looking at my watch: 60 minutes had passed and I didn’t even notice it. Another situation I can now categorize as dissociative was when I was having sex with a partner and very suddenly a practice happened that also occurred during the rape. I remember feeling totally numb and apathetic and started to lose touch with my surroundings, while at the same time being extremely anxious and feeling sick. I somehow felt like it was back in that room the abuse happened in, like it was that year again and that I was 16 years old again. In therapy I learned how to get myself out of that dissociative state of mind – for me, this is for example by saying out loud the year and the city that I am in and telling myself that it is okay. I still find it very difficult to stop it once it has started. It is also extremely exhausting every time it happens, both physically and mentally, so I try to avoid those situations by letting partners know as soon as possible what is okay when it comes to sexual practices and what is not in order not to put myself in danger. I also learned that trust is very important when it comes to my sexual relationships as to reduce the risk of being triggered by sexual practices.”
2. Avoidance
Avoidance includes staying away from stimuli that are associated with the trauma. According to the diagnostic guideline of the DSM-5, one or both of the following criteria must be met in this symptom cluster.
Avoidance of thoughts, feelings, or conversations associated with the event
Avoidance of people, places, or activities that may trigger recollections of the event
“As I said: so many different things would trigger me that I started to feel that I lost control over my life. I wanted to regain control without anybody noticing what was going on. One way of doing so was to avoid certain people. There are different people I associate with that period of my life, especially one person who was directly involved with the traumatic event, that I still have a problematic relationship with and try to avoid as much as possible.”
3. Negative Alterations in Cognitions and Mood
As stated in the DSM-5, you will experience two or more of the following symptoms of negative alterations in cognitions and mood when suffering from PTSD. Concerning the inability to experience positive emotions, coupled with social retreat and a high probability of substance abuse (see below), the individual suicide risk increases. According to the National Center for PTSD, considerable debate exists about the reason for the heightened risk of suicide in trauma survivors. Whereas some studies suggest that suicide risk is higher among those who experienced trauma due to the symptoms of PTSD, others claim that suicide risk is higher in these individuals because of related psychiatric conditions. However, a study analyzing data from the National Comorbidity Survey, a nationally representative sample, showed that PTSD alone out of six anxiety diagnoses was significantly associated with suicidal ideation or attempts.
Inability to remember an important aspect of the trauma
Persistent and exaggerated negative beliefs about oneself, others, or the world
Persistent, distorted cognitions about the cause or consequences of the event(s)
Persistent negative emotional state
Markedly diminished interest or participation in significant activities
Feelings of detachment or estrangement from others
Persistent inability to experience positive emotions
“I was unable to recollect what exactly had happened during the abuse for many years. In therapy I learned to recollect the memory which previously appeared to be somehow distorted and splintered. I would remember a smell or a certain sensation, but there were only fragments and never a coherent picture. Making the impression of being ‘normal’ became more and more difficult for me and I started to feel more and more disconnected from others. I felt like an actor in a play I didn’t choose to be a part of. I wasn’t sad all the time, but I never felt authentic. I forced myself to participate in social interactions, but it became harder and harder. I was also still convinced of the fact that no one liked me anyway, that I was a bad person, and that I had no real friends, because I wouldn’t deserve to have real friends. I just wanted to stay in bed all day. I started to think about suicide, because that was not the life I found worth living.”
4. Alterations In Arousal And Reactivity
The DSM-5 states that two or more of the following symptoms must be experienced in this cluster when suffering from PTSD.
Irritable behavior and angry outbursts
Reckless or self-destructive behavior
Hypervigilance
Exaggerated startle response
Concentration problems
Sleep disturbance
When it comes to self-destructive behaviour, it has to be said that people suffering from the effect of post-traumatic stress, especially those who go without treatment or are undertreated, have a high probability to develop an alcohol or drug addiction in the context of self-medication. The National Center for PTSD reports that “up to three quarters of those who have survived abusive or violent trauma report drinking problems”. In a study conducted by Sonne et al., men with PTSD reported an earlier age of onset of alcohol dependence, greater alcohol use intensity and craving, and more severe legal problems due to alcohol use. In the same study, women had higher rates of positive test results for cocaine use at treatment entry than did men. Furthermore, PTSD more often preceded alcohol dependence in women than men. There is also a high probability of comorbidity – that is to develop other psychological disorders when being diagnosed with PTSD, such as depression and/or borderline personality disorder.
“It felt like the more I tried to push the memory of what had happened away, the more it came back to me and forced itself upon me. It wouldn’t let me sleep at night or I would wake up in panic and tears after having nightmares about what had happened, convinced that the perpetrator was in my flat. During one of my worst phases, this would happen every night and I wouldn’t get more than two or three hours of sleep for months. In the morning I would feel totally knocked up, but at the same time extremely nervous and jumpy, like something bad was about to happen. I would jump up if a car door was slammed on the street. When I tried to concentrate, I couldn’t keep a coherent thought and everything I read would immediately slip away. It was agonizing. I started drinking and smoking weed as a measure of self-medication. Concerning anger issues, I know that I can get extremely angry if I have the impression that I am not taken seriously, because it reminds me of the time directly after the abuse when my friends failed to show me support. I also used to be – and at times still am – self-destructive with regard to substance abuse, reckless and self-harming behavior. This is personally the worst part of PTSD for me, because I feel like it doesn’t only negatively affect me, but also has a negative effect on people close to me that I don’t want to hurt. There were many times when I wished I would have acted differently, felt incredibly sorry and regretted my actions. Improving myself and not hurting those around me is a big part of my healing process and something I still work on every day.”
Sonne SC, Back SE, Diaz Zuniga C, Randall CL, Brady KT. Gender differences in individuals with comorbid alcohol dependence and post-traumatic stress disorder. Am J Addict. 2003 Oct-Dec. 12(5):412-23.
The National Center for Biotechnology Information. Appendix E: DSM-IV-TR Criteria for Posttraumatic Stress Disorder: http://www.ncbi.nlm.nih.gov/books/NBK83241/
We are bombarded with hundreds of thousands of models attempting to define masculinity each day. Clearly, in the media there is a glorification of a small number of particular body types above all others. Also, the men that seem to be the “coolest” and most successful tend to be portrayed in mainstream pop culture as the most aggressive, dominant, and tough. Just like women, men are pressured to adapt to distinctive physical and behavioral standards in order to be socially accepted.
There are clear ideas prevalent in Western societies about physical features and stereotypical character traits a man has to have to be “a real man”. Unfortunately, an authentic concept of manliness which lies outside of gender-stereotypical attributions seems hard to grasp. What is manliness? At which cost is “a real man” produced? Is there any grief that comes with his production? To answer those questions, I let some men in my social environment speak for themselves. Although my survey is in no way representative due to its small size and its focus on a certain geographical region, age and level of education, the answers made me aware of some aspects which are useful for a deconstructive view on masculinity.
Gender Stereotypes
Even in 2015 there are many people who are convinced of the fact that there are character traits which are specifically – and to some people even exclusively – “male” or “female”. Still, there is a general societal acceptance of the belief that women are for example more emotional, soft, empathetic, and reactive in their actions than men. Men on the other side are considered to be rational, logical, and aggressive in their behavior and decision-making.
Some of the men I asked reproduced or indirectly referred to the stereotypes listed above:
“Being a man means to have a more logical and ‘colder’ overall approach to life.” Adam, 26
“Being assertive, not ducking down, not being whiny.” Georg, 65
“Responsibility.” Oliver, 23
On the other hand there also seemed to be a general sense of awareness among most of the men surveyed that masculinity is something that in some sense needs to be “produced” as it does not come to you naturally – one explanation for this awareness could lie in the composition of the sample which comprised mostly men with an academic education based in the humanities and/or gay/bisexual/queer men. Thus it became clear that a majority of those I asked are aware of the fact that the character traits listed above are mere stereotypes and that there is no such thing as a fixed and natural “male” or “female” personality:
“There is not much left of manliness if you subtract societal role expectations. Manliness is a concept that doesn’t play a role in my thinking. But most people would associate it with aggression, competitiveness, technical knowledge, and heterosexuality, I guess.” Neo, 28
“It means being authentic. I freely adopt ‚male‘ as well as ‚female‘ traits to form my own gender identity. Saying anything else would just be stereotypical or a quotation of insignificant statistical tendencies.” Björn, 31
“I experience masculinity as something artificial. Something that is imposed on you through societal norms.” Matthias, 28
Gender as an Interactive System
If being a man does not come to you naturally, but is something that needs to be performed, how can masculinity be achieved? According to Raewyn Connell, gender is constructed in interaction – it is an interactive system based on power and exclusion. Instead of speaking of gender identities, she sees gender as a system of multiple patterns of social practices and behaviors which need to be learned – for example through gendered socialization and repeated. Social settings in which masculinity is reproduced are for example football teams or armies, fostering an athletic form of masculinity and placing a focus on strength and physical power. Others are, amongst others, companies and governments, favoring the production of knowledge- and technology-oriented patterns of masculinity. For this reason there is no such thing as the “one and only” masculinity, instead there are multiple forms of “manliness” which often have a hierarchical relationship or compete against each.
In this context, Connell sees gender as a system of hegemony/subordination, cooperation and marginalization/empowerment. With regard to gender stereotypes, masculinity is not to be understood as the sum of specific character traits, but as “configurations of practice which are accomplished in social action”. Masculinity – and gender as such – is dynamic in the sense that it undergoes historical development and is thus subject to change – and although this is where we can find potential for subversion in Connells approach, the change of constructions of masculinity and femininity over time does not automatically have to be for the better in the sense of greater equality.
For Connell, demands and limitations evolve around male dominated societies – this includes that men need to adapt to certain behavioural patterns and fulfil certain expectations in order to fit into the pattern of conduct which is considered superior within the social and cultural hierarchy of masculinity. By many, men are still put under the pressure to be solely active, courageous, outspoken, rational and so on, while at the same time denying them other equally important character traits which stereotypically considered “female” and therefore weak.
“Manliness for me is a stereotypical societal projection of traits or certain expectations. Even aside from old-fashioned or outdated structures, you are still expected to be strong, to show leadership skills and so on. People are irritated if you don’t fulfill these expectations.” Philipp, 27
In her work “Gender and Power” and with reference to Antonio Gramsci, Connell calls this form of dominant masculinity hegemonic. Hegemonic masculinity is marked by cultural authority over other forms of masculinity which are produced in distinction from it and are consequently marginalized. Also women are central in many of the processes constructing masculinities.
“During a festival a woman walked by our tent. A friend of mine shouted at her: ‘Nice tits!’ Afterwards he looked at me like he wanted my approval. [sighs] I didn’t say anything, because I didn’t want to start an argument at this moment, but I just thought: ‘Why do you have to be like this?!’ It was embarrassing, rude, and inappropriate.” Dorian, 31
Some women may have masculinities (tomboys) and there is also a hegemonic femininity, but neither have the same cultural authority as hegemonic masculinity. This fact relates to the unequal opportunities of men and women. There are different strategies of hegemonic masculinity that women adapt to and there are reactionary forms of femininity that developed in reaction to dominant masculinity. Most often, the hegemonic – the most powerful – version of masculinity is heterosexual, whereas marginalized – rejected – forms of masculinity are frequently associated with being gay and frowned upon.
As mentioned above: there is not only one masculinity, but rather different patterns of masculinity, forming around different sets of skills and knowledge and competing for hegemony. This fact pressures many into feeling the need to live up to a standard which is an unattainable illusion, a mere cultural ideal.
“One part of being a man for me is constant comparison, an ongoing competition with other men concerning looks, strength, etc. This happens unconsciously and is something that is hard to stop.” Alexander, 23
The nature of hegemonic masculinity is dynamic, meaning that it can be challenged by other forms of masculinity that in time gain or lose their hegemonic power. Through its aggressive and dominant character and its enforcement though methods of brutalization and hardening, it aims at maintaining its privileged status.
“Hegemonic masculinity – I don’t find that concept easy to define. I guess for me it is a distinctive way to talk that does not allow for any other opinions except your own. It is for example saying: ‘This is my opinion and you have to accept it. Even if some part of me knows that you are right – I won’t change my opinion, no matter what!’” Max, 31
Pressure, Competition, Showmanship
If masculinity is nothing but a cultural construct, a behavioral pattern, how can authentic masculinity ever be achieved, especially if there is no basis for authenticity given? Clearly, a man who conforms to the hegemonic standards of society cannot be produced without losing something of himself.
The nature of hegemonic masculinity is aggressive, ruthless and bases itself on domination. Internalizing this behavioral pattern not only includes creating an image of yourself for everyone else to see reflecting those attributes, but also creating a certain self-concept – a mode of how you want to perceive the world around you. Thus, hegemonic masculinity always comes at a cost. If a man needs to conform to the social expectation of being unemotional, not vulnerable and always rational, and if he again and again needs to reassure himself and others of this fact through his actions and statements, this automatically means that he will lose a part of himself in this process. The reduction of your own complexity of character is one price you have to pay: being strong and in control and thick-skinned means not being able to be soft and passive and sensitive.
For some this loss is deep-felt and painful as they perceive societal expectations of how “a real man has to be” as harmful. They can distance themselves to a certain extent from the restrictive power of societal pressure to adapt to certain behavioral and physical expectations by means of articulation and/or by finding other forms of societal gratification through the adaption of alternate patterns of masculinity – which don’t have to be marginalized.
Others – in varying degrees consciously – seem to decide to conform to patters of hegemonic masculinity in order to find stability and to orientate themselves to the standards and role expectations that come with hegemonic masculinity, and this have the potential to reduce the complexity of social reality and the possibilities for action.
“Masculinity is one attempt among many to find your own place in life.” Christian, 29
Yet others seem to be unaware of the harmful consequences of hegemonic patterns of masculinity for themselves and others around them, and have internalized hegemonic social-role expectations. In the course of this internalization the loss of parts of themselves becomes unconscious. Thorough self-reflection could be one measure to prevent falling into patterns of “toxic” hegemonic masculinity.
In 2015, women hold an increasing number of top leadership positions. The number of women in Congress is at an all-time high. They generally seem to have the same chances as men in all areas of society. So is there still any problem with sexism at all? I argue: Yes, sexist attitudes and behavior is still very present these days and more dangerous than ever.
Sexism doesn’t come across as open hostility towards women, but is more subtle and hidden nowadays, often acted out under the guise of chivalry.
Objective indicators, such as the Gender Empowerment Measure (GEM) or the Gender Inequality Index (GII), reveal that in none of the over 150 evaluated countries, gender equality has been achieved. Although there are cross-country differences, women in all countries researched are underrepresented in positions connected to power and status, and generally have a lower quality of life. Also, I argue that there is no such thing as the one and only sexism, but instead there are different forms of sexist behaviors and attitudes differing in their underlying beliefs. Illustrations by Ricardo Prager.
Modern Sexism / Neosexism
Is marked by the denial that any form of discrimination against women still exists and therefore rejects measures aiming to reduce gender inequality. Modern Sexism and Neosexism try to ideologically justify existing inequality as the result of fair odds.
There is a conflict between egalitarian values and negative emotions towards women, which manifests itself in three main components:
Denial of ongoing discrimination.
Resistance against perceived privileging of women.
Rejection of demands for equality.
Hostile Sexism
Expresses itself in openly negative views on women. Among others, it is marked by the belief that men deserve a higher status than women as well as by a fear of losing job opportunities etc.
Hostile sexists believe that women aim to have power and control over men, either through feminist ideology and/or by using erotic capital. Therefore, Hostile Sexism is directed mostly towards non-traditional types of women such as feminists and/or career women.
Is a subtle form of sexism that comes in the disguise of chivalry. From the subjective point of view of the benevolent sexist, his behavior is the outcome of a positive attitude towards women. It suggests being able to compensate the negative consequences that come with Hostile Sexism by creating the illusion that there is no gender inequality at all, and that the relations between men and women can be seen as fair and just. It promotes gender-specific roles, dictating clear codes of conduct for men and women.
Three main facets of Benevolent Sexism can be distinguished:
Protective paternalism: the conviction that men need to protect women and need to support them financially.
Complementary gender-specific distinction: the belief that women are “the better sex”; marked by positive, but gender-conformal attributions. Women are described as more caring, loving and diplomatic than men.
Heterosexual intimacy: comprises a romantically transfigured image of a woman as a partner without whom no man can lead a fulfilling life. This concept idealizes heterosexual relationships and makes them seem as the most desirable aim while at the same time often putting women in the position of an accessory a successful man needs to have in order to lead a fulfilling life.
At first glance the three components don’t seem to be problematic: generally, to offer someone assistance and protection are positive gestures which don’t necessarily need to be motivated by sexism. But benevolent behavior becomes sexist if it is directed towards one gender only and/or if the same kind of paternalistic behavior is not wanted if it comes from women.
Similarly, positive attributions and compliments become questionable if they are one-sided and directed towards women only. Research shows that those who cling to stereotypically female character attributions (emotional, soft, warm) exclude women from having character traits that are stereotypically characterized as masculine (logical thinking, rationality), thus leading to the fact that although women are characterized as wonderful, they are at the same time seen as weak and in need of protection.
Ambivalent Sexism
Is the combination of both Hostile as well as Benevolent Sexism and bases on the interdependence between structural power (which is mostly held by men and describes the control over the distribution of economic and social resources), and dyadic power (which is held by men and women alike and describes the control over the need for intimacy, sexuality and closeness). Ambivalent Sexism is the result of the internalization of sexist attitudes and is practiced by both men and women. It leads to the “gratification” of gender-conformal behavior with Benevolent Sexism and the sanctioning of non-conformal behavior with Hostile Sexism. The result is the stabilization of patriarchal structures as well as the fostering of gender inequality.
Briefly, it can be said that although the conditions for women in terms of a shift towards chances for greater equality considerably improved over the last decades, women nowadays are still structurally disadvantaged and victims of everyday discrimination. One possibility to uphold structural discrimination and to protect the privileges of a distinct group (men) is to spread legitimizing ideologies and prejudices about a second, structurally disadvantaged group (women). Sexism now expresses itself differently: instead of having to face openly hostile attitudes, women now have to deal with hidden forms of discrimination which are often hard to criticize as they come across with subtlety.
Sources:
Becker, Julia. (2014). Subtile Erscheinungsformen von Sexismus. http://www.bpb.de/apuz/178674/subtile-erscheinungsformen-von-sexismus?p=all
Eckes, Thomas/Six-Materna, Iris. Leugnung von Diskriminierung: Eine Skala zur Erfassung des Modernen Sexismus, in: Zeitschrift für Sozialpsychologie, 29 (1998), 224–238.
Glick, Peter/Fiske, Susan T. The Ambivalent Sexism Inventory: Differentiating Hostile and Benevolent Sexism, in: Journal of Personality and Social Psychology, 70 (1996), S. 491–512.
Guttentag, Marcia/Secord, Paul F. (1983). Too Many Women?
Swim, Janet K. et al. Sexism and Racism: Old-fashioned and Modern Prejudices, in: Journal of Personality and Social Psychology, 68 (1995), 199–214.
Sexual assault is one of the most under-reported crimes in the U.S. While the U.S. Department of Justice’s National Crime Victimization Survey estimates an average of 293,066 victims of rape and sexual assault each year, the actual number of unreported cases is expected to be much higher. The anti-sexual assault organization RAINN estimates that approximately 68% of sexual assaults are never reported to the police.
This means that the vast majority of people experiencing sexualized violence will remain silent over what has happened to them.
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Photo: Project Unbreakable
Which factors contribute to this situation and why do the majority of rape survivors not speak out regarding what has happened to them? Why do most of the survivors of rape feel that they have to face their troubles overcoming their traumatic experiences alone and without taking legal actions?
I argue that this situation is caused by the fact that sexualized violence is dealt with as a trivial offense, which is rationalized, excused, or justified by the public at large. This does not mean that the individuals necessarily condone rape culture or think that sexualized violence is a good thing, but it means that many people tend to normalize rape and make excuses for it. Rape survivors are blamed for their victimization – and consequently are responsible for dealing and living with the consequences of their experiences on their own.
To put it into more scientific language: as an outcome of rape culture, sexualized violence is normalized due to internalized societal myths about what defines a “real rape”, exonerating the perpetrators of a sexual offence and diverting the guilt to the survivors. In this connection, Bohner states that “rape myths may contribute to the prevalence of rape” as they serve as cognitive neutralizers, allowing perpetrators to avoid social prohibitions. As well as having a neutralizing function serving to defend the rapist’s actions, myths also have an impact on the perception of victims of sexualized violence, thus leading to victim blame and sexist attitudes.
Here is a list of some of the most common myths entangling sexual violence.
The “real victim” stereotype: “women ‘ask for it’ by their dress or actions”
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Photo: Project Unbreakable
If survivors of sexualized violence want to be taken seriously, they need to be considered “respectable” – according to heteronormative standards. This stereotype raises the question of who is entitled to feel hurt in the first place, questioning victims who do not conform certain unstated standards. It includes utterances such as:
“Only young, white women without disabilities get raped” or “sexualized violence cannot be directed towards men*, trans- or inter-persons”.
Survivors of sexualized violence are often confronted with questions about their general sexual behavior, their drinking habits, and are quickly judged by their style of clothing and so on. The line of argument behind this myth is something like the following:
“If the person assaulted had a promiscuous lifestyle, has been drinking, doing drugs and wore a short skirt, they must have been asking for it. If they are violated, it is their fault for having been sexual or acting irresponsibly by drinking or dressing the way they did in the first place.”
The thought behind this argument is that a sexually active person does not deserve to be in charge of their own sexuality and their body.
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Imagine if robbery was treated like rape…
The “real rape stereotype”: blaming survivors for their own violation and exonerating perpetrators
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Photo: Project Unbreakable
Du Mont, Miller, and Myhr found out that if victims do not match the stereotype of a “morally upright white woman who is physically injured while resisting”, and who were raped in a “violent and forceful [act] committed by a stranger during a blitz attack in a public place”, were less likely to report to the police. The argument behind this stereotype is:
“If they didn’t fight back or didn’t scream, if it happened in their own home and/or if they perpetrator was not a stranger, it was their own fault for being violated“.
In reality, 82% of sexual assaults are perpetrated by a non-stranger in their home. Most of the offenders were described as a friend or an acquaintance (47%), a partner (25%) or a relative (5%). Again, by telling victims that the assault was caused by their own behavior, not by that of the perpetrator, this stereotype places the blame for the assault on the survivor, instead of blaming the perpetrator who violated them.
Myths of the “ideal victim” prevailing in the criminal justice system
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Photo: Project Unbreakable
Another reason why a majority of rape cases remain unreported, or many perpetrators remain without conviction, is the existence of rape-supportive stereotypes among members of the criminal justice system. This thesis is underlined by the fact that a high number of reports to the police are dropped or are not investigated further after the first interview with the victim: Of 164 rape cases reviewed in a case study by Jordan (2004), only 34 (21 %) were considered as “clearly legitimate” (ibid.) by the police, 55 cases (33 %) were viewed as “clearly false” (ibid.) and 62 reports (38 %) were considered as “possibly true or false” (ibid.), indicating that the police were unsure if the victim was genuine. The study underlines the extent to which the police rely on stereotypes that involve subjective evaluations and shows how the evaluation of rape cases is negatively influenced by the acceptance of rape myths in the criminal justice system. For this reason, even when an act of sexualized violence is reported to the police, it is unlikely to lead to an arrest and prosecution. Factoring in unreported rapes, only about 2% of rapists will ever serve a day in prison.
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Sources:
Bohner, G. “Rape Myths as Neutralizing Cognitions: Evidence For a Causal Impact of Anti-Victim Attitudes on Men’s Self-Reported Likelihood of Raping”. In: European Journal of Social Psychology 28 (1998): 257 – 268.
Du Mont, J., Miller, K., and Myhr, T. “The Role of ‘Real Rape’ and ‘Real Victim’ Stereotypes in the Police Reporting Practices of Sexually Assaulted Women”. In: Violence Against Women 9 (2003): 466 – 486.
Eyssel, F., and Bohner, G. “Schema Effects or Rape Myth Acceptance on Judgments of Guilt and Blame in Rape Cases: The Role of Perceived Entitlement to Judge”. In: Journalof Interpersonal Violence 26 (2011): 1579 – 1605.
Jordan, J. “Beyond Belief? Police, Rape and Women’s Credibility”. In: Criminologyand Criminal Justice 4 (2004): 29 – 59.
Justice Department, National Crime Victimization Survey: 2008 – 2012.
Most photos in this article are from project-unbreakable.org – a photography project aiming to give a voice to survivors of sexual assault, domestic violence, and child abuse.
I cannot think of just ONE single moment in which I fell victim to catcalling or street harassment. Instead, I have plenty of such situations in mind which were all similar and therefore mingle in my memory. Sometimes it was ‘just’ an awkwardly long gaze; another time a whistle or another sort of (primitive) ‘acknowledging’ sound; then again shouted ‘greetings’ uttered out of a car slowing down and driving next to me. All of it either by a single man or a bunch of them. I have the impression that such cases accumulate and worsen in summer when the temperatures force women to wear less (long) clothing. Even more than the exact actions, I do remember what I sensed during these situations. Suffering from (social) anxiety already, receiving this kind of (perhaps well-intentioned, but terribly performed) attention makes me even more anxious, with various worst case scenarios going through my mind. The biggest fear behind that is the conviction that I do not consider myself assertive enough to set the limits in case this man/these men went any further. All in all, I do not understand how one could possibly think that women feel appreciated, let alone comfortable by being whistled at or the like. As the term ‘catcalling’ already implies, it describes a way of approaching animals and not a human being on equal footing. To me, it resembles a hunt in which I perceive myself as prey.” Anonymous, 27
When I told my female friends about this article and asked them if they would be willing to share their own experiences with catcalling, I received this powerful text from a friend of mine who wishes to remain anonymous. It not only presents some examples of typical forms of catcalling, but also draws attention to its possible psychological effects. What I find interesting is that many men don’t even seem to be aware of the fact that constant, ongoing street harassment is a social reality for women – something that happens to women of different shapes and sizes, ethnicities, ages, and with different styles of clothing. My experience is that it is hard to find a woman who has not been exposed to some form of catcalling, and I personally don’t know of a single woman who feels flattered or complimented by that sort of behavior. I think it is safe to say that catcalling can be perceived as a form of structural violence.
This is why I decided to critically discuss the phenomenon of catcalling from a feminist perspective and on the background of Lacanian and Foucauldian theory. And before you stop reading: there are also illustrations of obscene cats by Garcia Comix. Also: thanks to the amazing people helping me with this article by sharing their experiences with me.
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“I was just leaving the supermarket – wasn’t wearing anything interesting, literally sweatpants, no make-up – when this old man who could’ve been my grandpa came towards me, casually walking beside me, smacked his lips and whispered ‘mmhhh nice’ in a lewd way, just loud enough for me to hear. I was so stumped, I had no idea how to react, so the only thing I did was turn around to him and gave him the most disgusted look I could muster and quickly kept walking. How is it that I can’t even go shopping for groceries without being accosted by some gross man?” Daniela, 28
Let’s start with a definition: catcalling means making insulting and usually sexist remarks in public. Those remarks are mostly coming from men and are directed towards women. The main argument of people defending this kind of behavior is that women need to “learn to take a compliment” and should stop being “overly sensitive”. The logic behind this train of thought is that all women should have the same reactions to being catcalled, while ignoring the (very high) probability of making women (or anyone for that matter) who are leered at feel uncomfortable and unsafe. If that kind of behavior was really based on the need to give an attractive person an innocent compliment, it would stop then as soon as women started talking about how it made them uncomfortable. Instead, this behavior continues. Why so? Do guys catcall because they think it will somehow lead to them having sex? I have never seen this strategy work and all I hear from the women in my social environment is that it is an annoying behavior, making them feel unsafe and insecure.
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“When it comes to catcalling, I can only remember like one or two times, when some guys leaned out of their car and whistled. What makes me much more uncomfortable, though, and happens way more often is the silent staring. Especially at night, when you walk by a group of guys and you see some or all of them looking right you, following you with their gaze while looking you up and down … Guys, don’t do that please. Even if you mean no harm, it looks like you’re a wolf pack sizing me up. And I don’t want to feel like a deer that might become someone’s dinner if I don’t run away fast enough.” T., 28
catcalling is not a compliment!
Some men persistently claim that they are just trying to “brighten a woman’s day” by making remarks about a stranger’s appearance on the streets. This fact hints to the possibility that not all catcalling necessarily has to come from a place of malice, but rather from ignorance. But: an interaction which might be sweet, lovely, and charming to one person might be perceived as highly intrusive by the other party. And although it has to be acknowledged that catcalling is nuanced, I argue that generally this kind of behavior not only reveals a lack of respect and understanding for another person’s boundaries and their comfort zone, but is also based on the underlying assumption that it is appropriate to be sexual towards any woman, and that one has the right to say anything to them. In my opinion, anything that could potentially make people feel unsafe is not flattering and should not be treated as a compliment.
Another argument by which catcalling is often tried to be justified is that there are women who “know how to take” this kind of behavior. I agree that some who are catcalled might enjoy the attention, and might use it to gain self-confidence. What is problematic in this regard is to automatically assume that every woman feels the same way, to assume that they should feel flattered by the attention and that they aren’t allowed to name it what it is: aggressive and belittling.
And this is where the aspect of power and the concept of the male gaze comes into play: catcalling can be interpreted as one example of how the male gaze plays out in day-to-day life. The concept of the gaze was developed by Jacques Lacan and refers to the anxious state that comes with the awareness that one can be viewed. Lacan argues that the psychological effect of this is that the subject loses a degree of autonomy upon realizing that it is a visible object. This concept is bound with his theory of the mirror stage, in which a child encountering a mirror realizes that he or she has an external appearance. In this way a subject comes into being, gains its identity, within the already existing framework of power relations.
In his work “Discipline and Punish” Foucault extends Lacan’s theory with regard to power relations and disciplinary mechanisms by introducing the concept of Panopticism to highlight how a sense of permanent visibility ensures the functioning of an un-verifiable power:
Panopticism is one of the characteristic traits of our society. It’s a type of power that is applied to individuals in the form of continuous individual supervision, in the form of control, punishment and compensation, and in the form of correction, that is, the molding and transformation of individuals in terms of certain norms. This threefold aspect of Panopticism – supervision, control, correction – seems to be a fundamental and characteristic dimension of the power relations that exist in our society.”
power and sexuality cannot be thought independently from each other
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“I was on my way to a party, all dressed up, and waiting for my train at the station. Three guys were sitting there as well, hollering at me: ‘Hey baby, where do you wanna go? There is a party going on – in my pants!’ They were so pushy and annoying, and I was happy to get away from them when my train finally arrived.” Yvonne, 31
In my opinion, claiming that catcalling is merely about power and dominance, and not about sexual desire and attraction at all, would be oversimplifying a social reality. Power and sexual relationships cannot be thought of independently from each other. The question is how one defines power. I am convinced of the fact that, yes – existing hierarchical social structures may be fostered by means of (direct and indirect) aggression and oppression, but those forms of violence are always interwoven with an aggressively charged lust and desire, aiming at pressing others into a passive role by denying them agency through objectification and by reducing them to their outward appearance.
In this context – and on the background of Lacanian and Foucauldian theory – a phenomenon such as catcalling can be interpreted as to reflect, and at the same time reproduce, the current heteronormative societal order. Simultaneously, catcalling as a means of sexualization of women also fosters the reproduction of a certain type of hegemonic masculinity. For this reason, please keep in mind that catcalling is more than innocent complimenting, before belittling or rejecting it as irrelevant.
Sources:
Foucault, Michel. (1979). Discipline and Punish. New York: Vintage Books.
Lacan, Jacques (1977). The Four Fundamental Concepts of Psycho-Analysis. Trans. Alan Sheridan. Ed. Jacques-Alain Miller. New York: Norton.
Image may be NSFW. Clik here to view. According to data collected by the Substance Abuse and Mental Health Services Administration (SAMHSA), an estimated 43.5 million adults in just the United States of America were suffering from a mental illness in 2014. Fewer, but still about 1 out of every 100, are affected by schizophrenia. As most people know, there are a number of different mental disorders with different presentations and varying degrees of severity such as depression, bipolar affective disorder, or schizophrenia.
Nonetheless, mental illness is a topic that most people don’t really like to talk about, and when they do, many people still tend to stigmatize those suffering from it. Plus: May 2016 is Mental Health Awareness Month – this year’s motto is “Life with a Mental Illness”. So what better way to contribute to de-stigmatization and raise awareness for the topic of mental health than to let the people affected by it speak for themselves?
For the rest of April and during May EXPOSING THE TRUTH will publish a series of interviews conducted with people living with mental illnesses. This week I had a nice chat in the sun with John*, a 25-year-old student from Germany who lives with schizophrenia.
According to information provided by the World Health Organization, schizophrenia is a mental disorder affecting more than 21 million people worldwide. It is characterized by distortions in thinking, perception, emotions, language, sense of self and behavior. Common experiences include hearing voices and delusions.
Schizophrenia is not a personality disorder or a behavioral disorder, although these can be present at the same time. Schizophrenia in one person can express itself quite different than in another person, so it is important to know John’s answers are not representative of everyone or even most who have schizophrenia.
Hey John, thanks for meeting me today and opening up to me about your mental health. Let’s talk schizophrenia. Do you remember how it all started?
I guess I have been suffering from schizophrenia since I was a child. I remember one experience from my early childhood that drove me into a kind of schizophrenic state, which was an attempted burglary when I was around six or seven years old. I was lying in bed and suddenly I was awoken by a strange rasping sound and couldn’t fall asleep again. I then went to tell my mom about it and she eventually heard it too. As she was too afraid to check on what it was, she sent me first. When I parted the curtains, I actually saw a man who was trying to break in our flat. I was in such a shock and remember thinking about the meaning of this incident for a long time – what it meant that this man suddenly appeared at our flat, what would have happened if he actually managed to get in… It was hard for me to process this as a child.
Wow, this can be a truly overwhelming experience, especially for a child this young. Do you have any other idea what might have caused your disorder?
There is a genetic component to it as well as there is another person suffering from schizophrenia in my family. At the age of 23 – which was at the time of one of my worst schizophrenic phases so far – I also realized that different environmental factors play an important role when it comes to mental illness. There are certain people and circumstances which can definitely contribute to or worsen your schizophrenia, if you have the predisposition. At that time, I was living in a shared apartment. As I couldn’t lock my room, I felt like every time I left the house, my roommate went in there and messed with my stuff – shifted it around and so on. This definitely contributed to the deterioration of my condition.
Most of the time I do not realize that I am actually in the midst of a schizophrenic phase when it’s happening. Only when I think about it afterwards and reflect on the things that I did, I realize that I was acting strangely.
Speaking of behavior which might seem odd to some people… Many people have a certain clichéd image in their head when they hear the term “schizophrenia”. I guess this conception is mostly based on how schizophrenia is depicted in Hollywood movies as schizophrenics are presented mostly as violent psychopaths. Take for example Jack Nicholson in Stanley Kubrick’s “The Shining”. What do you think about this stereotype?
I think this depiction is definitely flawed. Schizophrenia is characterized by a number of different symptoms. It is a nuanced illness and can also manifest itself in even the smallest details. A schizophrenic person might for example draw a tiny dot on a wall somewhere, thinking that he or she might deliver a big message through it. In this way a small dot might gain a lot of meaning for someone who suffers from schizophrenia. But the whole “deeper meaning” thing can also turn into violent behavior – I am definitely not this way, but maybe this is where the cliché of the psychopathic schizophrenic comes from. When I hear that I have to think about crazy stories, like Charles Manson listening to “Helter Skelter” from the Beatles, thinking it contained a racist message and as a result carving a swastika on his forehead. People like him are of course an extreme and are fortunately rare.
One often reads about schizophrenic people hearing voices. Have you ever experienced hallucinations?
Yes, I have. One time I heard a song, it was a cover of the Beatles by The Flaming Lips… I don’t exactly remember which song it was, but there was talking and noises in the background of the recording and when I heard that, it just felt so real to me. It is hard to describe this feeling. I would say it felt like it was happening live and like the song was speaking to me. It caught me completely off guard and I became really emotional. [An ambulance with a switched on siren drives by]. If I were in an acute schizophrenic phase right now, I probably would interpret this siren as a signal or a personal message for me.
How did you get help and who made your diagnosis?
Originally, I went to the doctor to simply get a sick note for school as I was going through a phase of extreme schizophrenia at the time. When I hinted to the fact that something might be wrong with me, they transferred me somewhere else. They couldn’t help me and I felt like they were putting me off – it was terrible. Fortunately, I didn’t really understand what was going on at the time due to my symptoms and when I was finally sent to a doctor who could help me, I was much more interested in decoding the hidden messages his cat, which was straying around in the waiting room, had for me. I was supposed to directly go to the clinic in an ambulance from there, but that was much too fast for me. At least, I wanted to go home, collect some stuff and get a shower first.
I ended up staying in a psychiatric hospital for two weeks, and felt much better afterwards. Actually, I promised them to take care of outpatient therapy as soon as I got home, but I keep putting it off for some reason.
Studies hint to the connection between relapsing into schizophrenic phases and being undertreated. It is suggested that the probability to suffer from reoccurring episodes of schizophrenia rises without the support of medication. Have you ever received prescribed medication?
They put me on Abilify* during my stay in the clinic. Afterwards, I continued to take it for three months, but I felt like it didn’t help me at all. All I felt was strangely neutral, muted, and dull. As a countermeasure, I started to smoke a lot during that time to regain positive emotions – that worked quite well for me. In fact, there were many times when I literally felt euphoric. That’s when I started to talk myself into thinking that weed was a cure for my illness. At this point, my opinion on this subject has changed as my mood is also often negatively affected when I smoke.
Which symptoms affect you the most in your everyday life and how do you cope with them?
There are positive and negative symptoms of my schizophrenia. My condition often worsens when I am hungover and alone. Once I went to a pharmacy and tried to get some natural antidepressants, like Hypericum. Generally, I am not someone who withdraws from social contact when I am feeling low – I try to go out and do normal stuff.
I was told before to take care not to get involved in overwhelming situations or surround myself with people who might have a negative influence on me as I have a tendency to let myself go completely and end up in potentially dangerous situations. I shouldn’t lose myself in those situations too often – although I have to admit that it can be a lot of fun, for example when you are at a club, and you feel like you are in your own world, your zone, and start to make up stories, like “what if…”. But yes, of course there are negative situations and symptoms which might be caused by this behavior. One time when I was at a party I could feel myself relapsing into schizophrenic symptoms, and was just about to have a panic attack. At that moment I told myself to relax, breathe, and calm down.
How openly do you deal with your mental illness and with whom do you talk about it? Do your friends and family know about it? Does talking about it help?
Usually, I rarely talk about it. At school there is one person who also has a diagnosis. I can talk with him. And also with my aunt. She was also the one who told me to take a step back and breathe when I have the feeling that I am relapsing into schizophrenic thinking. There are some moments when I feel really uncomfortable with my illness – for example when I have done something I find ridiculous during a schizophrenic episode. I mostly don’t like to talk about those incidents. Anyways, I do not consider my schizophrenia a general taboo topic.
There are studies which reveal a causal link between high levels of creativity and schizophrenia. Can you agree?
Yes, definitely. My creativity helps me a lot to cope with my illness. In the clinic, there were many possibilities to express yourself creatively. At the moment, I try to invest as much time as possible in creative activities such as drawing or spraying. It helps me a lot to relax and to express my feelings.
How are you right now?
At the moment I am feeling okay, it’s Friday, the weekend is about to begin, and the sun is shining. Everything is fine.
*not his real name.
*Aripiprazole. An atypical antipsychotic drug approved to treat schizophrenia and bipolar disorder.
Image may be NSFW. Clik here to view.To many, mental health issues are still a taboo subject. As it is Mental Health Awareness Month in the USA, we want to contribute to de-stigmatization and raise awareness about the topic of mental health. For this reason and in accordance with the motto of this year’s awareness month – “Life with a Mental Illness” – , EXPOSING THE TRUTH is publishing a series of interviews throughout April and May, to let people affected by mental illness speak for themselves.
In 2014, an estimated 43.5 million adults in just the United States of America were suffering from a mental illness such as depression, bipolar affective disorder, or schizophrenia. Eating disorders are among the most common of mental illnesses: The National Eating Disorders Association (NEDA) estimates that in the United States, 20 million women and 10 million men suffer from a clinically significant eating disorder at some time in their life.
This week Anne, a 24-year-old female who suffers from anorexia since she was 15, shared her story with me. We talked about the pro-ana community, her body image as well as the struggle to maintain a healthy eating behavior.
Eating disorders feature serious disturbances in eating behavior and weight regulation. They are associated with a wide range of psychological, physical, and social consequences. Although they affect both genders, rates among women and girls are 2½ times greater than among men and boys. Eating disorders frequently appear during the teen years or young adulthood, but also may develop during childhood or later in life. The International Classification of Diseases (ICD-10) – a standard diagnostic tool published by the World Health Organization – distinguishes between the following types of eating disorders:
Anorexia Nervosa (AN): Characterized by self-restricted intake of food and fear of gaining weight as well as a strong desire to be thin.
Bulimia Nervosa (BN): Marked by periods of overeating followed by purging, sometimes through self-induced vomiting or the use of laxatives.
Overeating Associated with Other Psychological Disturbances (BED): Is also called “binge eating disorder”, which is out-of-control eating.
Other Eating Disorders: Pica – appetite for substances that are largely non-nutritive such as ice, paper or clay –, or Rumination Disorder which is characterized by effortless regurgitation of most meals following consumption, due to the involuntary contraction of the muscles around the abdomen.
Hello Anne, thank you for letting me ask you some personal questions about anorexia – I understand that some of this might be hard to talk about, so let’s start with a more general topic. What do you think about online communities encouraging or advocating eating disorders? Pro-ana still seems to be quite popular…
I think they are absolutely awful. I’m glad I only visited a pro-ana site once, and at a point in my recovery at which I was feeling like something had to change. I was never proud of being anorectic and I wouldn’t wish anyone to experience it. I don’t understand how people can really think that it is a good idea to encourage others to continue this behavior. Me and my friends try to do it the other way around: we support each other when we are feeling low and try to get through difficult times as healthy as possible. I can only advise anyone who suffers from an eating disorder to never visit those sites and not to get involved with pro-ana.
Unfortunately, it’s easy to argue that an unhealthy eating behavior is normal for a majority of people living in Western societies – especially women. How is your eating different from those of others who haven’t been diagnosed with an eating disorder?
I think the biggest difference lies in the obsessive need to control what you are taking in, which manifests itself in some strange rituals when it comes to eating. Because it terrified me to lose control over the food I was consuming, I always needed to know exactly what was in there or else I couldn’t eat it. During my worst phases, it even had to be very specific times during which I allowed myself to eat. If I had to eat earlier or later than those times – even if it was only a minute – it was absolute hell for me. I also started eating with a little spoon and ate very slowly to trick myself and others into thinking that I was eating more than I actually did.
Another big difference between the eating behavior of a “normal” person and that of one who struggles with an eating disorder is that eating is connected to a sense of fear, I would say. Fear of gaining weight, even if you only eat a little bit. My food looked – and still looks – very much the same every day, because I am too afraid to change anything as changing my diet might lead to weight gain.
Wow, that sounds exhausting. What happens if you feel like you don’t have absolute control over the food you are taking in, for example when you are travelling or eat at a restaurant?
That is really difficult for me. When I go out for dinner, I usually check the menu on the internet beforehand to see if there is something on there that would be “allowed” for me to eat. Most of the time I end up ordering a salad without dressing. When I am invited to eat somewhere else, for example at a friend’s house, I will have to ask in advance what we will be having. When there is nothing there for me, I will find an excuse to show up late and eat food that is “safe” for me at home.
I noticed that you use words like “safe” and “allowed” when talking about food. I heard that many people with eating disorders tend to do this. How is that with you? Which foods do you allow yourself and according to which criteria do you categorize your food?
That depends on the relation between taste, repletion, calories, fat, and sugar. Vegetables and skim milk products are generally allowed. Fruit are a special case, because I only allow myself to eat sweet fruit like bananas or pears when I am having a “good” day. Fast food or anything that contains a lot of fat, sweets, oil or cream is forbidden. When I treat myself to those things, it has to be a special occasion and I have to earn it. I have no idea how I came up with those categories. They are in my head.
How did you come to finally realize that you might be suffering from an eating disorder?
I didn’t realize that myself. When it all started, I was 15 and still living with my parents. One evening when we were sitting at the dinner table, they handed me a list which contained the symptoms of anorexia, and asked me what the difference between my eating behavior and that of an anorectic person was. I had no answer to that question. It was after that talk that it slowly started to dawn on me that something was wrong.
Another situation that showed me that not only my parents, but also my friends, were worried about me, was when I received a text message from my best friend at the time – initially intended for someone else and accidentally sent to me. This message made me realize that my eating behavior might actually be a lot more disturbed than I wanted to admit to myself…
How old were you when you finally received your diagnosis?
That was also at the age of 15. Because there were – and still are – long waiting lists for therapy programs, and I needed help quickly, I ended up going to a counseling center where I was diagnosed with anorexia. At a later point, my physician gave me the same diagnosis.
Did you manage to receive therapeutic treatment afterwards?
Yes, apart from a one-year pause I have been in therapy ever since, both outpatient and inpatient. I first spend seven weeks in a clinic in 2009 and received outpatient care since then. Unfortunately, I relapsed in 2012 and became dramatically underweight, so I had to return to the clinic for another twelve weeks. I was stable and feeling well afterwards, satisfied with going to see my therapist once a week until summer 2015, when I relapsed and got caught up in anorectic behaviors and attitudes again. My condition worsened due to an additional metabolic disorder that I am still struggling with at the moment and I will return to the clinic in June.
I am really sorry to hear that! How do the things you learned in therapy help you in difficult times like these?
I definitely learned to become more realistic and reasonable in assessing my condition. The degree of suffering is high, and I know that I wouldn’t be able to recover on my own this time.
Do you talk about all of this with your friends and family? Do you feel supported by your social environment?
I am dealing very openly with my disorder. Of course, I don’t write “ I have anorexia” on my forehead, but if someone confronts me then I don’t deny that I have an eating disorder. The feedback so far has always been positive – be it in school or at work. I tell my family about it when I feel low or go through a difficult phase. The only thing I find kind of hard is to talk about the thoughts which are directly connected to my eating disorder with people who are not affected by it. I try to keep specific fears and thoughts about this topic to myself, and only talk about those things to friends I have made in the clinic.
Can you tell me a bit more about your treatment? Did it help you for the time being?
I am a bit conflicted when it comes to outpatient treatment. It rather dealt in depth with the possible causes for my eating disorder and how I deal with those things, rather than trying to change something in the present. Nonetheless, I felt supported and I guess I would have relapsed much quicker if it hadn’t been for outpatient care.
Concerning my inpatient treatment, I definitely have to say that both stays in the clinic helped me a lot – especially the second one. I don’t regret going there at all because it not only helped to regain weight but also with normalizing my relationship towards food. When my weight became more stable, I was allowed to participate in therapy sessions. In those I learned that, instead of starving myself in stressful situations, I have the ability to handle my emotions much more productively. It also helped me to understand how my perception of myself was – and at times still is – distorted by my eating disorder.
Yes, I have heard from many people suffering from eating disorders that they struggle with maintaining a stable and undistorted image of their own bodies. A person who suffers from an eating disorder might look at themselves in the mirror and see themselves as overweight, even if others tell them that they look absolutely normal, or even underweight. How to you perceive your own body? Does your body image change, depending on your mood and daily form?
Retrospectively, and looking at old images of myself, this is definitely applicable to me. Even with a BMI of 13, I felt like there were still parts of my body which were “too fat”. I didn’t notice at that time that this image of myself was totally skewed. Still today, the acceptance and perception of my body still very much depends on my daily form. There are days on which I can much more accept some parts of my body than on others.
Anorexia and other mental illnesses such as depression are often intertwined. Did you also receive medical support to help you ease other symptoms connected to your disorder at that time?
I would say that I definitely have depressive tendencies, and in the clinic my therapists and I also discussed the possibility of supporting my treatment with antidepressants. In the end, I dismissed this option as I wanted to try to recover without the use of medication first.
Would you recommend therapeutic treatment to others who have been diagnosed with an eating disorder?
Yes, definitely, and best as soon as possible because the sooner you deal with your difficulties the easier it will be to overcome them. I have met different people in the clinic who went there at a young age or at an early point of their illness, and it was much easier for them to overcome their fears and destructive behaviors – I guess that’s because the destructive behavior hasn’t asserted itself so much yet.
Another thing I would like to advise others who struggle with their eating behavior is to open up about it as much as possible. I did the same and it was one of the best things I could do in my situation. When you speak openly about how you feel and what is happening to you it will be much easier for friends and family to deal with your situation. Also, it will help you as a person because people will be more empathetic and understanding if you let them know what you are going through.
Image may be NSFW. Clik here to view.May 2016 is Mental Health Awareness Month in the USA. For this reason, and to raise awareness for the topic of mental health as well as to contribute to de-stigmatization, EXPOSING THE TRUTH lets people with different diagnoses speak for themselves. I already spoke with John* about his schizophrenia, and last week I interviewed Anne, who was diagnosed with anorexia in her teens.
In part three of our interview series, 33-year-old Nicole talks to us about Generalized Anxiety Disorder (GAD), and gives us an insight on how anxiety feels to her. According to the Anxiety and Depression Association of America, GAD affects 6.8 million adults, or 3.1% of the U.S. population, in any given year. Women are twice as likely to be affected.
There are several different types of anxiety disorders specified in The International Classification of Diseases (ICD-10). Examples include Generalized Anxiety Disorder, Panic Disorder, and Social Anxiety Disorder.
Generalized Anxiety Disorder: marked display excessive anxiety or worry for months and face several anxiety-related symptoms.
Panic Disorder: characterized by recurrent unexpected panic attacks, which are sudden periods of intense fear that may include palpitations, pounding heart, or accelerated heart rate; sweating; trembling or shaking; sensations of shortness of breath, smothering, or choking; and feeling of impending doom.
Social Anxiety Disorder: a fear of social or performance situations in which they expect to feel embarrassed, judged, rejected, or fearful of offending others.
Hi Nicole, thank you for talking to me about your anxiety disorder today. How old were you when you first started showing symptoms of anxiety? Was there a triggering event that started it all?
I was 21 years old when I had my first panic attack. It literally came out of nowhere: I was playing cards at a friend’s house and everything was all fine. Suddenly, my whole body felt like it was burning on the inside, I was getting dizzy, my heart started racing, my legs were shaking… It was horrible. I had never experienced something like that before. I hyperventilated and collapsed. My friend called the ambulance, but they didn’t find anything that might have caused this reaction.
What do you think is the difference between generalized anxiety disorder, and general feelings of anxiety that everyone gets from time to time?
I think the consequences of suffering from Generalized Anxiety Disorder are much more severe than experiencing anxiety from time to time as GAD affects you both physically, and mentally. There are the physical symptoms like dizziness, nausea, muscle aches, and trembling, which someone who is afraid of something also experiences in a milder form. But then there are psychological symptoms like a sense of dread. I lose touch with my surroundings during an anxiety attack. It is hard to describe, but everything feels somehow unreal and dull in those situations.
How do you cope with that? When the panic is coming, can you feel it beforehand? Do you have any strategies to deal with such cases?
Unfortunately, I don’t feel it coming at all. It hits me by surprise every time because there seems to be no trigger. When it happens, I either try to distract myself or don’t fight it and allow it to happen, try to breathe through it and use muscle relaxation techniques.
Which role does GAD play in your everyday life?
I feel like my disorder affects me a lot and prevents me from living life the way I want to: I avoid most social situations – I can’t remember the last time I went out partying. Most of the time, I even have difficulties carrying out simple activities like shopping. But it is worst when I am home alone with my little daughter…
How openly do you speak about all of this? And do you find your family and friends supportive when it comes to dealing with your diagnosis?
I don’t have a problem talking about it. In fact, I think it is better to let people know about my issues because then they know how to help me when I have an anxiety attack. My family knows the most about my condition, but I feel like they don’t really understand me. But how could they? I think you would have to experience this yourself to be able to fully understand what I am talking about.
Before this interview ,you mentioned to me that you are writing a book about your life with GAD. First of all: congratulations, that is amazing! Can you tell me more about it?
Thanks a lot. It is a biography in which I also talk about the possible reasons for my anxiety disorder. My intention is to empower others who also struggle with anxiety and to give them strength. The title of my book is “And Every Time I Get Up Again”. Unfortunately, I yet have to find a publisher.
By the way you talk about your condition, I assume you already received psychotherapy? In how far did it help you?
True. I have been in and out of therapy since I was 21, and tried different therapeutic approaches, none of which really helped me to cope with my illness until I was finally treated in a psychiatric day clinic. Being there really helped me a lot, not only to find strategies to more effectively deal with my illness, but also to better understand my anxiety. Now I feel much better equipped to handle my feelings when the anxiety shows up again. Plus, I also use medication – Cymbalta* and Lyrica* – which helps me to stabilize my condition.
How do you feel at the moment, regarding your GAD? Did your condition change over time? What would you say is the general trend?
I have to say that generally the trend is positive: I am feeling much better than at the beginning of my illness, and with the help of therapy I managed to develop different strategies to cope with my illness. Most of the time it works, but of course there are days when I am still feeling very low.
* Not her real name.
* Duloxetine. Serotonin-norepinephrine reuptake inhibitor, prescribed for major depressive disorder, GAD, fibromyalgia and neuropathic pain.
* Pregabalin. Central nervous system depressant, used to treat epilepsy, neuropathic pain, fibromyalgia, and GAD.
Approximately 1 in 5 adults in the U.S. – 43.8 million, or 18.5% – experiences mental illness in a given year. Nonetheless, mental health issues are still often either scandalized or turned into a taboo subject. For Mental Health Awareness Month, EXPOSING THE TRUTH lets people affected by mental illnesses speak for themselves in an interview series published throughout April and May 2016. So far, I already spoke to John* about his schizophrenia, Anne opened up to me about her eating disorder, and Nicole shared her experiences with generalized anxiety disorder with me.
In part four of our series, I speak with Matthew* who lives with a dissociative identity disorder since he was a little child – by the way he was also the one who provided and drew all the pictures featured in this blog post. Due to the complexity of the condition, I have to admit that it was and still is hard for me to understand how it must feel if you don’t only have to deal with one sad, happy, tired, nervous, or moody voice inside of your head, but have to coordinate and cope with 20, 40 or 50 people, or even a small village inside of you.
What Exactly is Dissociative Identity Disorder?
While most people can’t imagine more than one identity living within the same person, that is what is going on when you live with dissociative identity disorder (DID): people with DID do not live with only one, but multiple personality states which are called “alters”. According to the DSM-5 criteria for DID, these alters must each have their own enduring pattern of perceiving, relating to and thinking about the environment and self, and can have different physical affects, accents, memories, ages, names, functions, genders and other traits. Collectively, all the alters together are known as a “system”. Also, people with alters often refer to themselves as “we” due to the multiple alters within the single person.
Dissociative identity disorder affects around 1 to 3% of the population in the USA. It used to be called Multiple Personality Disorder, and is classified as a dissociative disorder, not a personality disorder in the ICD-10 classification of mental and behavioral disorders. Most people with dissociative identity disorder have a mix of dissociative and posttraumatic symptoms as well as non-trauma related symptoms which may include:
Different personalities, each with a constant performance
Inability to remember large parts of childhood
Frequent bouts of memory loss
Sudden return of memories, as in a flashback and/or flashback to traumatic events
Episodes of feeling disconnected or detached from one’s body and thoughts
Out of body experiences
Suicide attempts or self-injury
Differences in handwriting
Allergies which appear or disappear related to which personality shows up
Somatoform disorders/convulsions related to single personalities
Depression or mood swings
Anxiety, nervousness, panic attacks
Eating disorders
Sleep problems
Severe headaches or pain
Sexual dysfunction, including sexual addiction and avoidance
Thank you for taking tImage may be NSFW. Clik here to view.he time to talk to me today, Matthew! How would you describe dissociative identity disorder to someone who has never heard of it before?
To put it simply, dissociative identity disorder means that one brain and one body contains a number of personalities – we call them alters – that can totally differ from each other and perceive themselves as independent persons. In more complex terms: if a multiple personality disorder, or dissociative identity disorder how it is called today, manifests itself, it means that a little child has experienced a lot of violence and therefore separates its different lives from each other. It goes to kindergarten or to school like any other child – and then there is also this parallel life in which it is abused and experiences sexualized violence again and again.
And because those two different lives cannot be brought together, because its feeling of self, the identity of the child, isn’t stable yet, it starts saving its memories in different folders. This means the child will have one folder for its everyday experiences and another one for its violent experiences, and if the abusive experiences start adding up, another folder to store all those new violent experiences will be created until different alters with an own sense of self start to develop.
Metaphorically speaking, the memory of a person with dissociative identity disorder resembles a computer which is used by different persons with different user accounts. Every user can save data on their own drive, but there are also data that are saved in a shared drive which is accessible by every user. In my case this means that there are things that almost everyone of us is capable of doing, even though only one person has learned those things. Most of us can read for example, even though only one of us went to school. But there are also things that only single alters can do.
Maybe the readers would like to take a second and think about their own sense of self. I am sure they will see that their identities are defined by a whole lot of memories und experiences. And if different memories which cannot be reconciled are made, it is the perfect basis for different alters to develop. Some are loud, some are quiet, some are shy. There are angry ones, some are really tender and sad, some are outgoing and energetic. All those alters share one body.
In the media, schizophrenia and dissociative identity disorder are often confused with each other. There are many people who don’t know anything about DID, and if you explain it to them they will say something like: “Oh, I thought that’s what schizophrenia is…”. Do you have any idea why those two diagnoses are so often mixed up?
Schizophrenia and dissociative identity disorder really don’t have that much in common, but I guess they both are often confused with each other, because schizophrenia translates as “split soul”, meaning that the borders between what is outside and what is inside your own head dissolve. To people who are many – a term which people with dissociative identity disorder prefer to be called by the way – it is very clear what happens outside and what is going on inside of their heads, but on the inside there are different things going on, depending who is there at the moment.
Alright, enough with the general questions. If it is okay with you, I would like to ask you some personal questions now. How and at which age did you first realize that your personality differs from that of others?
That depends on who of us you ask [laughs].
Well, who is speaking now?Image may be NSFW. Clik here to view.
Matt. I knew it very early that there was something different with me, and I found it rather funny that other people don’t have others inside of their head causing them to have memory lapses and so on. Some of us noticed that something was different earlier than others… And when I say “us” I mean: “All personalities who live in this body and that I know”.
Are there alters who have different roles in your everyday life?
Yes, of course. There are some alters who can do certain things better than others. There are some who are extremely traumatized, for this reason are afraid of everything, and can’t deal with people very well. Naturally it is better if those alters don’t go to work. I, for example, am very good in dealing with others – I like talking with other people. But there are also some who don’t like doing that at all, and prefer to hide away from others, and to write texts… Some like animals, some don’t. The skills and preferences of the alters are very different.
Are there different age groups and different genders?
Definitely. There are women, and men, and trans-persons. There are also alters who don’t care about that and who say about themselves that they rather have a function than a gender. There are alters who are still little – many of those have developed in the course of traumatization. Some of those start to grow a little bit older as they notice some things going on the here and now. Others decide that they want to remain young. And there are of course also alters who are older than the body.
Is there something like a controlled switching between the alters?
Yes, we can do that, but it takes a bit of practice – to be able to do this depends on how well you know each other. You first have to get to know the others, which is something you can learn, but takes its time. Image you are part of a group which is to deliver a speech in front of a room full of people. You would have to plan beforehand who of you will deliver which part of the speech. That’s something that can be a bit stressful from time to time, but it is definitely possible.
What would happen if you were in a really stressful situation? Could this cause a switch between alters that cannot be controlled by you?
That depends. We have a lot of practice in controlled switching, but let’s just assume that I would witness a horrible accident after we’ve finished this interview and leave this room. I would automatically make room for someone who has better first aid skills than I have. I wouldn’t do this. I would maybe come back later to help calm other people who might have also witnessed the accident down. Even though it happens fast, this is also a form of controlled switching. But then there’s also the possibility that switching happens on its own, automatically.
There are two good reasons for “being many”. One, to protect a child from its awful memories during its everyday life when it goes to school and so on. The phenomenon that horrible memories are stored somewhere in the back of your brain is well-known to everyone who has ever been involved in a car accident or who has experienced sexualized violence as an adult. The other reason why a person becomes “many” is when the switching between the different alters becomes so well-practiced that you start doing it automatically, adapting to situations like a chameleon. This means the small child won’t be able to control the switching, and – depending on the context – it will switch automatically to the alter who is best equipped to handle the current situation. Let me give you an example: The child is doing its homework in the afternoon. Suddenly, the mother who abuses the child on a regular basis enters the room. The child will then automatically switch to the alter who has the best abilities to survive the abuse. This is a mechanism that still works in different contexts for me today.
Alright, so on the one hand we have the controlled switching and on the other a switching which is more of an automatized coping mechanism in emergencies. How did you learn to switch controlled between the alters?
To do so, leImage may be NSFW. Clik here to view.arning to communicate with each other was essential. Some alters were able to do so for a long time, others first had to learn to listen to the others and acknowledge their presence. And if you manage that, then arrangements are possible, maybe through a calendar or a diary first, and later on it might be possible to communicate with each other “inside the head”.
Which part does therapy play in this process?
Therapy can be very helpful in this regard, especially if one of the alters doesn’t want to admit that they have memory lapses or if one of the others doesn’t want to see that there are other alters beside of them. Of course, experiencing that you are not the only one inside your own head is a huge shock if you have previously thought that you are on your own. Especially if you then realize that you don’t even like the other alters that are there, if a alter who is very quiet and peaceful has lived the everyday life for a long time and then has to realize that they now also have to live with a brutal bully inside of their head. To accept that one of the systems might be very brutal, judgmental, and mean is a process that takes time and effort. In those cases, therapy can help.
But I have to say: therapy is a good thing, but it’s not everything. There are for example great self-help groups. And you have to remember that you are the one who does most of the work. That means besides this one hour that people spend on going to therapy each week, there is still a whole lot of work that you have to do on your own.
Do you want to tell me how long you have received therapy so far?
I have been in therapy for seven years now, but during the first years I was misdiagnosed and therefore received the wrong treatment. Unfortunately, this is something that happens to many people who are many. They get treatment for paranoid schizophrenia, or are “only” diagnosed as depressive or with borderline personality disorder – which is a very popular misdiagnosis. Or only the posttraumatic symptoms are taken into account and people who are many consequently are diagnosed with posttraumatic stress disorder. For me, it took some time until I told someone about it, then some time went by until I found a therapist who understood my condition and finally it again took time and effort to find someone who wanted to treat me. There are therapists who don’t want to work with people who are many, because it’s similar to doing group therapy with a single person. I would like to advertise people who are many: we are very interesting clients [laughs].
You just mentioned that you were misdiagnosed., and there seem to be many parallels to other mental illnesses. Are there any symptoms which are specific to dissociative identity disorder?
One of the specifics of dissociative identity disorder is that the different alters are at least partially amnestic towards each other. This means that they will always miss some bits and pieces of each other, even though they don’t want to. This manifests itself in memory lapses. And of course single alters can also become mentally or physically ill. One alter who is responsible for managing everyday routines might suffer from amnesia that much that they become depressive. Another one might have made almost exclusively really shitty experiences, and for this reason might eventually have developed borderline personality disorder. Alters might suffer from an eating disorder, or might even seem psychotic. Anything is possible. So you have to get to know each other, you have to learn to live with each other, talk to each other. And it doesn’t get easier if there are alters with mental health issues.
Is there any prescribed medication that is used specifically for the treatment of dissociative identity disorder?Image may be NSFW. Clik here to view.
No, there is none. What is often problematic for patients with dissociative identity disorder is that the alters might react differently to a specific medication. To be more specific that means that there are some alters who can handle to take a lot of Diazepam*, and feel energized by it. This is called a paradox reaction. Then there are some alters who instantly fall asleep if they take this kind of medication, and others who would never – under any circumstances – take it.
I think I can already tell, but what is your standpoint on the treatment of dissociative identity disorder as it is today? Is there any need for improvement?
A whole lot needs to improve in this regard. I think it is absolutely necessary that psychiatrists start to talk much more openly about the side effects of prescribed medication with their patients. Also blood values need to be controlled on a much more regular basis. It becomes a standard that liver values aren’t controlled anymore, so no one really knows how the patient handles their prescribed medication. Also people get prescriptions for high doses of addictive opioids as everyday medication which should be used for emergencies only.
… You already mentioned Diazepam.
Yes, amongst others. This happens a lot if anything else fails. It is highly addictive and has terrible side effects. Therefore, it is necessary to improve education about side effects and possible consequences of long-term use of psychiatric drugs. Also, we don’t have enough therapists in general, especially therapists specialized in trauma therapy. Plus, we need more therapists who are willing to work with people who are many and an elongated duration of therapy, because two or three years are not sufficient in this case. At the moment, health insurance companies in Germany do no pay enough… Shout out to the Phoenix Initiative which put together and published a nice list of demands for the therapy of people who are many and others. If you imagine that there are 20, 30 or even 100 people who have to get connected to each other in the first place, then this takes a lot more than a single therapy which isn’t mostly even sufficient for a person who is not many.
Speaking of not being many: can you imagine how life would be if you were only “with yourself”? If there were only Matthew and no one else?
Not at all. And most of the others cannot imagine that as well. We are used to the way it is, have lived this way ever since we can remember, and we wouldn’t want it any other way. What has the most negative consequences on us is something that isn’t specific to dissociative identity disorder, but rather the typical posttraumatic symptoms such as flashbacks, and nightmares. There are horrible memories that we have to live with. But those are the exact same problems that are also known to people who suffer from PTSD, and are alone in their own head.
* Not his real name.
* Not his real name.
*Diazepam, first marketed as Valium. A benzodiazepine that typically produces a calming effect, and is used to treat a range of conditions including anxiety, alcohol withdrawal syndrome, muscle spasms, seizures, trouble sleeping, and restless legs syndrome.
Throughout Mental Health Awareness Month (May 2016), EXPOSING THE TRUTH publishes an interview series to let people living with different psychiatric diagnoses speak for themselves. So far, John* let us in on his experiences with schizophrenia, Anne talked about her anorexia, we learned from Nicole how generalized anxiety disorder feels like, and got an interesting insight in dissociative identity disorder from Matthew*.
Depression is one of the most common mental disorders in the United States. In 2012, approximately 16,000,000 U.S. adults had at least one major depressive episode. This amounts to approximately 6.9% of all adults in the country. Those suffering from depression often have to deal with people misunderstanding their condition, and often face people telling them to just “pull themselves together”, and “stop being whiny”. But depression is more than feeling unhappy for a few days; it is when you’re persistently sad for weeks or months. Besides of feeling low, depression comes with a wide range of other possible symptoms, which will vary from person to person.
As “depression” is more of an umbrella term for many different types of symptoms, I decided that I needed to portray a greater image. Therefore, I speak with Martin* – a 32-year-old college student diagnosed with moderate recurring depression in 2009 –, and Nadja* – a 28-year-old female who is about to graduate from college, and who developed depression in the course of a crisis after experiencing a series of traumatic events.
Image may be NSFW. Clik here to view.
There are many different types of depression specified in the ICD-10 – a standard diagnostic tool published by the World Health Organization. Examples include bipolar affective disorder**, cyclothymia***, and recurrent depressive disorder****.
Research has consistently shown a strong link between suicide and depression, with 90% of the people who die by suicide having an existing mental illness or substance abuse problem at the time of their death. If you struggle with suicidal thoughts, please reach out for help. If you feel that you don’t have a friend or family member to talk to, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255), or the National Hopeline Network at 1-800-SUICIDE (1-800-784-2433). These toll-free crisis hotlines offer 24-hour suicide prevention and support. Your call is free and confidential.
Hey Martin and Nadja, nice to meet you and thank you for opening up to me about your mental health. How and when did you first notice that you might be suffering from depression?
Martin: Oh, that’s a good question. I was diagnosed in 2009, but at that time I myself didn’t realize that I might be suffering from a treatable medical condition. All I knew at this point was that I had problems in my relationship, I was feeling low, and retreated socially. Somewhere in the back of my head I was vaguely aware of the possibility that what I was going through might be something that would receive a diagnosis, but at that time my depressive episode was acute, so I wasn’t really able to think about that. Eventually, I went to my physician, and he gave me the numbers of different therapists, and I started going through this list, trying to get therapeutic help…
Nadja: For me, things are a bit different. I experienced sexualized violence when I was in my teens and was diagnosed with posttraumatic stress disorder some time later. When diagnosed with PTSD, there is a high probability of developing comorbidities such as borderline personality disorder, or depression. In fact, many symptoms of other mental illnesses overlap with the symptoms of PTSD. Therefore, I wasn’t really surprised when my therapist told me that while my posttraumatic symptoms are recurrent, I am now diagnosed with moderate depression.
As you are already mentioned it, my next question would have been if you have ever received therapeutic treatment.
Nadja: From 2011 to 2014, I completed an 80-session trauma therapy which contained elements of psychoanalysis. It really helped me a lot to understand and deal with the symptoms of PTSD. But unfortunately, as it sometimes happens in the course of therapy, I started questioning everything, and became really unhappy with my circle of friends at the time, my relationship, and my family. Shortly after I finished therapy, it all fell apart, and I broke up with my partner, lost most of my friends, and reduced contact with my family. Also at that time, I didn’t know where my career was going. Generally, I was lacking a positive outlook. For me, that was the starting point of my depression.
Martin: I started therapy in 2009, and ended up receiving therapy for almost two years. It was a long-term behavioral therapy with over 40 sessions which took place weekly in the beginning and with greater intervals later on. Starting behavioral therapy was rather a coincidence, and depended on what was offered. Also, I was in the lucky position to live in a city with an oversupply of therapists, so I was able to get into therapy rather quickly.
And do you currently receive treatment?
Martin: No, at the moment I don’t, but I had an initial session two months ago, and… I don’t know. Right now I don’t really know how to proceed. I guess at the moment I am doing better because of the weather, because of spring… The cold and dark fall and winter months always worsen my depression. I generally feel more lethargic during the winter, which for me goes hand in hand with being less able to expose myself to interactions with others.
Nadja: Yes, I do, and I have to say I feel quite well-supported. I regularly see a psychiatrist as well as a behavioral therapist, and go to occupational therapy weekly to learn different tools such as progressive muscle relaxation and mindfulness training to better cope with my symptoms. Plus, I engage in self-help, have a great physician who is quite understanding, and also have a go-to person at a drug-counseling center for emergencies.
Let’s talk about symptoms, if it is okay with you. Would you be willing to go into a bit more detail about how depression feels like for you?
Nadja: As I mentioned before, shortly after finishing my first therapy there were some big changes in my life. I felt alone, unstable, and as if everything spiraled out of control. As a coping mechanism and due to my already low self-esteem at the time, I started some unhealthy, abusive relationships, drank too much alcohol, and did drugs – which of course made everything worse. I made some really horrible experiences at that time which I still think about a lot, and which I am currently still trying to process. After one particular incident, I remember waking up one morning and feeling completely empty. Like all of the energy had been drained from my body. I tried to get up, but I didn’t find the strength. After lying in bed, crying for hours, I finally managed to go to the bathroom just to see a stranger in the mirror: I didn’t recognize myself anymore. I couldn’t even look at myself, because I despised myself for everything that went wrong, and I thought everything that happened was entirely my fault. I remember thinking that I had finally internalized what I really am: completely worthless. I spend the next weeks in bed with a blanket over my head, each day wearing the same stained hoodie my ex-boyfriend left when he moved out. I only left the house to go to work for a couple of hours, or to go grocery shopping at night with a hood on because I didn’t want people to look at me. I didn’t talk to anyone at the time, didn’t answer the phone. I slept a lot, but always felt exhausted even after the smallest things. At some point I even started to hear voices, which I have to say I find quite alarming retrospectively. What was particularly destructive was that in order to punish myself for what I thought were my mistakes, I started to dehydrate and starve myself. When I had to eat and drink something because I couldn’t take it anymore, I felt even more disgusting afterwards. Now I am able to say that this was definitely a major depressive episode, and a lot has improved in the past months.
Martin: Well, I was diagnosed with moderate recurrent depression. Retrospectively, I can say it runs through my biography since puberty. It comes and goes. And while in the past it slowly crept in on me without me noticing, I became quite sensitive to feeling it coming over the years. To me, it feels like standing still, like being totally feeble. My thoughts start to become somehow heavy, and I find it hard to focus. I won’t be in the here and now anymore if that happens, and my mind will start to evolve around things that are bothering me, things that are in the past. It’s a mind spiral that doesn’t stop. Also, it is worrying me that so much time passes while I am sitting at home, feeling this way, and am not able to stop it. It bothers me that I can hardly control it, that it feels like I am wasting my time, and that I didn’t choose to spend my time that way.
A symptom of depression is suicidal thoughts. How is that with you? Did you ever have to deal with that?
Martin: Interesting question. Suicide is not an option for me, and I don’t think about suicide. I was maybe 17 or 18 the last time I thought about that, and even then I guess the thoughts weren’t specific. It was more of a stuck in adolescence hate towards the world with depressive tendencies on top of that. But, I have to say even though I don’t have acute suicidal thoughts, I often think about death. And I don’t mean that in a philosophical sense. Especially in the last one and a half years I often thought about letting go, in the sense of that it just would be a lot easier to leave it all behind. Because depression has a lot to do with discipline for me, with forcing yourself to do stuff, even though you don’t want to, forcing yourself to socialize, to go outside… Wouldn’t it be much easier to let go? But every time I catch myself falling back into this train of thought, some other thoughts start coming up like a mantra: “I want to live. I won’t do it, no matter what happens”. And this mantra, these thoughts, are so fixed that nothing can happen.
Nadja: Yes. And although I thought about suicide before when I was suffering from acute posttraumatic symptoms, the last incident for me one night in August 2015 was really a wake-up call. I couldn’t take being that depressed anymore. Therefore, I wrote a suicide note and started piling up all of my sleeping pills in front of me, all while I was feeling totally numb and apathetic, like in a dissociative state of mind. Luckily, I somehow managed to pick up the phone, called my new partner, told him that something strange was going on with me, and that I think that I am going to kill myself. Although he had been fast asleep before I called, he knew that this wasn’t a joke. He immediately ran all the way over to my house, while still talking to me on the phone. First, he wanted to take me straight to the hospital, but then we ended up talking all night long. I promised him that I would start a new therapy, and decided that I would finally give antidepressants a try as I used to be very critical towards psychiatric drugs. Also, the next day my boyfriend moved in with me, and stayed for almost six months until I was feeling better. If it hadn’t been for him, I don’t know where I would be today. I kept the note that I wrote that night to remind me that things get better in time.
What would you say to someone who suffers who suffers from depression and thinks about suicide?
Nadja: I would advise anyone who struggles with suicidal thoughts to open up, and to tell someone close to them about their feelings. You don’t have to go through this alone. There are people who can, and who want to help you. And even if right now it feels like no one loves you, and no one would ever miss you, and even if this sounds like an awful cliché: I promise you that it gets better. Someone loves you, even though you might not be able to feel it at the moment. You are worthy, and you will get through this.
Martin: That’s a difficult question for me to answer because depression can come in many different varieties and I myself don’t have experiences with acute suicidal thoughts. But as a friend, I would try to support the person affected as much as possible, and would try to get them into some form of psychological counselling, even if it is no real therapy. I think to get them into some form of psychological primary care would be essential.
Speaking of suicide: One paradox side effect of antidepressants is that they might cause or increase suicidal thoughts. What do you think about antidepressants? Did you ever receive a prescription and is that something that you would recommend to others dealing with depression?
Martin: I don’t have any experiences with antidepressants, because my therapist didn’t think it was necessary for me to receive medication at the time, and I wanted to try to recover without medication first. But I have some people in my social environment who use them and I have to say I would do so too. I think they can change something for the positive. And I have to say especially during the past six months, when I was more severely affected by depression, I asked myself the question whether or not I would take something, even though this kind of medication has some severe side effects. And I have to say I would. Because I think psychological pain is comparable to physical pain: if the side effects are tolerable, then why should you go through it? Nothing good comes from this. It neither makes you stronger nor a better person. Of course antidepressants shouldn’t be seen as a universal remedy, but I think they can help to alleviate symptoms insofar as they become psychologically treatable.
Nadja: After my “almost suicide attempt” that I just told you about, I made an appointment with my psychiatrist, and told her everything that I was going through. She diagnosed a major depressive episode, helped me with finding a new psychotherapist, and also gave me a prescription for Sertraline*****. Although this kind of medication isn’t something I would unconditionally recommend because of its severe side effects – especially in the beginning and if you are a long-term user – I have to say that I wouldn’t be where I am today without the help of psychiatric drugs. I don’t think that it would have been possible for me to regain any quality of life, or to rebuild a repertoire of positive experiences, because I was sunken too deep into this depressive state. I hope that I will eventually be able to live life without any medication at some point, but for now I just enjoy feeling better, and slowly taking steps towards recovery. Now there are starting to be more good days than bad ones, and I feel like I am finally regaining a bit of control over my life – it’s a relief.
Would you say that your experiences with therapy have been positive so far?
Nadja: I am definitely conflicted. Sure, it can do a lot of good, and it has helped me a lot to cope with symptoms of PTSD. On the other hand, I have never felt so low in my life as after therapy. It took me some time to realize that although I went through a really difficult episode for quite some time after therapy, what had happened and how I felt was neither my fault nor that of therapy, but rather the result of an accumulation of shitty experiences, and of people who didn’t do me any good.
Martin: I cannot stress enough how much good therapy has done for me. I think, if it is sufficiently treatable, the form of therapy fits you, and if you have found the right therapist for you – because the chemistry between you and them has to be right –, then therapy can change a lot more than just cure some symptoms. It can empower you to create a life for yourself that you want, and that you wish for. Even if it wasn’t possible for years before. And since therapy I made a whole lot of profound experiences that were really good for me… Of course, job, family, friends, generally at which point of your life you stand, all of those things play a role. But therapy can give you chances that life and the circumstances might not have offered you before.
Do you think by tendency that depression is a curable condition or are least manageable?
Martin: On the background of people that I have met so far, and on my own introspection, I have to say that there are different characteristics and there might be great differences in which way it manifests itself. And also a psychological diagnosis is only a frame of reference, trying to label a number of different symptoms. I can imagine that there are some severe forms of depression which might be incurable, I think that is possible. But on the other hand, I think that therapy can help you a lot, and can do a lot of good for you. Personally, I think that the depressive tendencies will always be a part of my life, because I have been living with depression for a long time now, and have been shaped by it. But my therapy has helped me a lot, insofar as to develop different strategies to be able to arrange my life around them so that they hardly ever come up again, and even if they start to show up again I have an inventory of things that I could do to deal with those symptoms. In general, I become a lot more relaxed in dealing with depression. If I am feeling low I can say to myself now: “Well, that’s just a day that I will spend in bed – it’s not the end of the world”. If I had to compare the past and how I am feeling now, I have to say that depression generally affects me a lot less.
Nadja: I think neither depression nor any other kind of mental “illness” defines who you are as a person. For many years, I thought that suffering from some kind of mental issue was part of who I am, part of my identity, something I couldn’t imagine living without. For the first time in my life, I don’t want to be this person anymore. I want to fully participate in life, take all the chances I can get, meet interesting people, make new friends, go outside… Yes, it sounds terribly clichéd, but really: there is a lot to live for. And although I think that therapy can help you with managing different symptoms, there is more to becoming subclinical. You will need a whole lot of social support, and a stable, safe environment. Friends, family, or self-help can do a lot of good. But I think first and foremost you have to be the one to take the right steps towards recovery, which might be exceptionally hard to do if all you feel like doing is lying in bed and staring at the wall. Getting better takes a whole lot of strength, patience, and serenity.
Finally, a simple question: how do you feel at the moment?
Nadja: Right now I am doing great. I feel like this year will bring on many exciting changes in my life.
Martin: You have caught me in a very positive phase of my life. I just moved to a different city, which is a lot of work, but also a lot of fun and a new start which gives me a positive outlook on the future. And also it’s spring time. I had to fight a lot in the past months, but right now I am doing well, and I think and hope that I will be using the “good” time of the year to work on the challenges that still exist.
* Name changed.
** Bipolar affective disorder: characterized by at least two episodes in which the patient’s mood and activity levels are significantly disturbed, this disturbance consisting on some occasions of an elevation of mood and increased energy and activity (mania or hypomania), and on others of a lowering of mood and decreased energy and activity (depression).
*** Cyclothymia: marked by a persistent instability of mood, involving numerous periods of mild depression and mild elation.
**** Recurrent depressive disorder: defined by repeated episodes of depression without any history of independent episodes of mood elevation and overactivity that fulfil the criteria of mania. Individual episodes of any severity are often precipitated by stressful life events.
***** Sertraline (trade names Zoloft and others): an antidepressant of the selective serotonin reuptake inhibitor (SSRI) class, primarily prescribed for major depressive disorder in adult outpatients as well as obsessive-compulsive disorder, panic disorder, and social anxiety disorder. In 2013, it was the most prescribed antidepressant and second most prescribed psychiatric medication (after Alprazolam) on the U.S. retail market, with over 41 million prescriptions.
Image may be NSFW. Clik here to view.Over the past month, I talked with people affected by mental illnesses. Some of the things I heard I could relate to, others were completely new to me, and gave me an intriguing insight into different perceptions of reality. For some people I talked to, their diagnoses caused a lot of psychological stress, others were less affected by that. For some, receiving a diagnosis provided safety and stability, others were critical of the concept of diagnoses as such. Some identified with their diagnosis, others refused to do so in order not to run in the risk of further victimization. While some had a very positive image of therapy and prescribed medication, others were conflicted, or had a negative attitude due to the experiences they had in this regard.
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The consequences of being diagnosed with mental health issues are real, and range from social, and/or financial disadvantages to possibly causing severe long-term damages by misdiagnosing and prescribing the wrong medication. As a sociologist I am keen to find possible explanations for the fact that living with a diagnosis seems to affect some more severely than others. This fact might be the result of intersectional class, race, and gender differences.
More psychologically speaking I argue that how one comes to receive and copes with a psychological diagnosis cannot be predicted in a reductionist manner as the causes for mental health issues are as diverse as the individual forms of treatment. People are not only shaped by structural factors such as those mentioned above, but also by their unique biographies, past experiences, associations, and memories. Plus, the component of a certain genetic predisposition seems to be a factor that shouldn’t be underestimated when it comes to developing some form of condition causing psychological stress.
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What is unquestionable is that a lot needs to improve when it comes to the treatment of people with mental health issues: patients need to be informed much more openly about the side effects of prescribed medication, blood and liver values need to be controlled regularly, and waiting lists to get into psychological or psychiatric care are long which is the result of an underprovision with therapists. Also, the fact that the majority of people I interviewed wanted to remain anonymous hints to the fact that speaking openly about mental health issues is still a taboo. When asked for the reasons why four of my six interview partners didn’t want their names to be published, some said that they were afraid that they would be treated differently by people in their social environment, some feared disadvantages on the job market, and one person even hinted to the fact that they were “embarassed” by their condition. If people would stop scandalizing psychological diagnoses, a lot of pressure would be taken off from those affected.Image may be NSFW. Clik here to view.
It should be kept in mind that every form of psychological diagnosis is the result of science made by people. People with financial interests, possible political agendas, people who are the product of their own individual circumstances. I am not saying that to diminish the positive effects that modern-day psychology and psychiatry can have on the life of those affected by some form of mental condition. Rather I would like to draw attention to, and remind some people once more of the fact that science is not an objective, independent system operating in a “social vacuum”. Thus, diagnoses are the outcome of ongoing social discourses by which science is shaped no less than any other part of life.
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It was important for me to find a balance between working through the list of specific symptoms as pointed out in diagnostic manuals such as the ICD-10 to have a guiding thread, while not losing a critical stance towards the socially constructed image of scientific unassailability. My method was to give my interview partners as much space as possible to express what was important to them. Although I tried to cover a spectrum of questions which I thought were interesting to the specific diagnosis, my interview partners were free to choose on which part they wanted to place their focus on and which stance they wanted to take.
In case you missed out on something, here are all the interviews I conducted over the past five weeks:
Interview five with Martin and Nadja on Depression.
