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Gift From Within - Questions & Answers with Frank Ochberg on PTSD

	PTSD: How common, who gets PTSD? Does PTSD Affect the Brain? Duration Emotional Abuse Childhood Trauma & Intrusive Images Revisiting the scene of trauma and abuse Pregnancy PTSD Symptoms: Anger Flashbacks Loneliness Feelings of Loss and sense of self Anxiety Numbing Re-traumatization Depression Memory Loss Relationships: Helping friends Explaining PTSD to Children Workplace Issues False Memory Toxic Family of Origin PTSD may complicate relationships Inadequate Therapy Recovery: Triggers Rebuilding Self Esteem Life After Trauma Coping During the Holidays Substance Abuse Improving a damaged self-concept. Veterans & PTSD: PTSD A Disease Seasonal PTSD & Anniversary Reaction. Emotional Injury Professionals: Compassion Fatigue Consequences of Emotional Numbing School Teachers and PTSD Other Conditions: Borderline Personality Disorder Social Phobia Complex PTSD Dissociation
		Questions & Answers with Joyce Boaz & Dr. Frank Ochberg Read "Survivor Psalm" by Frank Ochberg
				Relationships: Toxic Family of Origin. Q: Dear Frank: Several GFW pen pals write about very upsetting visits with family members on holidays or on obligated trips to visit sick or aging relatives. Any words of wisdom on this situation? A: Dear Joyce: The "toxic family of origin" is well known to me as a therapist. We select our friends, but not our relatives and some relatives have a knack for opening old wounds. I find this particularly true of older sisters of my female survivor patients. I don't intend to extend this observation to all older sisters or even to most. But there is a pattern affecting some, and it may have a lot to do with secrets. Most of my patients are survivors of trauma. If they come from healthy, loving families, they have a foundation of self-esteem that helps them cope with adversity, and they have empathic relatives to provide support when stress arises. But the "toxic family" is typically one in which individuals have been emotionally abused AND neglected. The abuse may be as profound as incest or as common as teasing. The neglect may be icy indifference or distance due to parental ill-health and overwork. Sibs learn to cope for themselves. Older sibs may try to protect younger ones from an abusive parent, but deny the struggles that they, themselves have had. A big sister may identify with the aggressor, becoming the "kapo" of the camp - the one who carries out a sadistic policy of a punitive parent. Regardless of the details, this means that my patient suffered as a child, and an older sib made her feel worse. When this leads to complete alienation with no meaningful contact, the problem is not so problematic. But most of my patients have a longing for an ideal family. They visit when expected to "come home" although the family of origin is no longer the place called home. And when they visit (or even when they call on the phone) there is a terrible sense of oppression. My patient feels assaulted, belittled, isolated and helpless. She may be able to express her feelings, but she cannot win the support of her sister. Her sister may have suffered similar abuse and neglect growing up, but her defense was to pretend it didn't happen. She may have a form of survivor guilt, having weathered storms herself, but failing to protect a younger sib. She may be jealous of a younger sib who managed to escape the family while she, the big sister, remained. At any rate, all this unfolds through the years without truthful conversation. Roles become fixed. Family members play their parts. These parts become caricatures-- exaggerated archetypes. The Cinderella story is an example of that exaggerated scenario. Reality seldom provides a fairy-tale ending, so the question, "How do I cope with my toxic family?" needs a more practical answer. If you are one who struggles with painful contacts with toxic relatives, consider these suggestions: 1. Don't visit. You have a right to protect your sanity, self-esteem, and mental health. Although the pressure may be enormous and a parent or sib may be extremely critical, you can stand up for yourself and say, "No." There are many who have taken this course and they eventually feel better, with more self-esteem and more reserves of good feelings for their own children, partners, and friends. 2. Keep visits short and superficial. This is really a variant of #1 and it requires a deliberate plan to avoid exposure to old issues and old wounds. It is perilous, since the expression on a sister's face may be enough to cause an upheaval in the gut and sense of dread throughout the body. These are reflexes from times of helpless immaturity. They are very unpleasant. So limit your exposure and dose. In the case of #1 and #2 you may need a ready explanation. Nothing will work perfectly. Some possibilities are, "My doctor told me to avoid certain situations that trigger my stress. I have discussed this and am doing it for medical reasons." Another, especially for suggestion #2 is, "Let's just keep it light." --then change the subject. 3. Bring a cell phone and be sure to have contact with a dependable friend during a family visit. For GFW support pals, this may already be occurring. Those conversations can be relatively brief. They shouldn't "stir the pot" with details of demeaning behavior. Some venting could be good. The main idea is to have a "lifeline" during the visit, serving as a source of oxygen when the air is thin, reminding you that you have friends who understand and have endured similar stressors. 4. Practice everything you have learned about stress management, enhancement of self-esteem, and recognition of reality. By recognition of reality, I mean saying to yourself, "This is now, not back then when I was a child. I have my own home and friends. This visit may be stirring feelings from the past, but I need not live in the past." You might even carry a list of what you admire about yourself, and review it during the visit. It is not to be shared with the toxic family. It is just for you. 5. Family therapy or therapy about your family of origin is always an option. But let's face it. The pattern is usually well established by the time one faces this situation in adulthood. Although I have some direct experience as a therapist with toxic families, it seldom works well. What does work well is counseling about strategies to manage specific events, like weddings and funerals - when to arrive, where to stay, whom to bring along. In sum, the "toxic family" was dysfunctional to begin with and is a source of profound stress during every visit decades later. We have obligations to our families and may choose to "pay our respects" although those payments come with great emotional pain. There are no hard and fast rules that can be applied to all relatives and all survivors. But GFW does provide links, pals, ideas and resources. This Q & A is meant primarily to validate your reality and your self-worth if you come from a toxic family, if you choose to maintain contact, and if you suffer the inevitable emotional cost when you pay your dues to your clan.
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