Question: How likely is it that a child with complex PTSD from some really bad traumatic abuse for the first 7 years of his life can make a full recovery (to about 90%) or so by the time he is an adult? This is regarding a fostering and adoption scenario and regarding making reasonable expectations. It wont’ change that we love him and will raise him anyway.

Dr. Ari Hahn Says...:

First off, I would like to apologize for the delay in
posting this answer. Truth be said, I actually had an answer the moment I
received the question but technical glitches and scheduling prevented by
posting the answer until now. I don't want you to think that the delay was
caused by my considering a question of less urgency. This is an a most
important question even though in some sense it is difficult to answer.

From a very important perspective your question is almost
irrelevant. You ask about the likelihood of a traumatized child of making a
full recovery. Although I do not intend to present a lecture on statistics, I
do need you to understand what's wrong with the question since that will open
up the door for a satisfying answer.

The answer of the likelihood of anybody fulfilling any other
eventuality is based on the percentage of people who fulfilled the eventuality.
In other words, if a doctor says that Joe has an 80% chance of having a heart
attack in the next year, what it actually means that if I had 100 people and I
chose one person randomly from that 100 persons I would have an 80% chance of
choosing somebody who will have a heart attack within the next year. The
percentage is really only applicable to a randomly chosen person from a large
sample of people. Once chose chosen then you might examine his genetic makeup
and find that he has a gene that protects them from heart attacks. Obviously
the likelihood of him getting a heart attack will then change.

Therefore if I were to give you a statistic that says 60% or
80% of the children who are abused on a serious and ongoing basis before the
age of seven will suffer from psychological disorders in adulthood that even if
it were a true it would say nothing about any particular singular child. The
circumstances for that particular child will be much more important in
determining the quality of a child's life than the population from which a
child was taken.

Most scientific and research evidence points to the idea
that children who have not had a significant positive care taking experience
prior to the age of seven will show particular difficulties expressing and
accepting love. The technical name for this is Reactive Attachment Disorder. If
a child has been traumatized to the point that he or she cannot trust anybody
under normal circumstances and the child might merit the label of Reactive
Attachment Disorder and the likelihood of living a normal life is extremely
diminished.

However, there is only one reparative cure for children who
have been so severely traumatized that they do not know how to receive or give
love. That is to give them an unconditional love and an unconditional support.
The more you give the child love in spite of his or her inability to reciprocate,
the greater the chances that the child will recover from the complex trauma
that defined the early years.

There will be very difficult times. Of course, there are
difficult times with all children, but with most children the parents have some
expressions of love to fall back on. You will need to gain strength from a
belief that each expression of love that you show the child, you are raising
the probability of recovery, which will be expressed when he or she knows how
to show love.

Question: What do you think about the practice of using MDMA therapeutically for PTSD? I am in Toronto and they are doing a lot of experiments with it here.

Dr. Ari Hahn Says...:

MDMA, which is also known as the street drug "ecstasy" was studied for its effects as a possible substance that can enhance the therapy for PTSD before it became an illegal recreational drug. Unfortunately, once it became commonly abused and illegal it also became much harder to study. Like you mention, there are studies being done in recent years and they actually look promising.

However, there are a few caveats. First, it is not a form of therapy. The drug does not do anything to relieve PTSD. It is used as an adjunct to therapy and seems to make PTSD therapy more efficient. Second, the studies are still fairly preliminary. That means that it cannot be assumed that a psychiatrist knows how to use it. Third, all the studies are done on people who have had unsuccessful previous therapy. Which means that nobody knows how it works with many different populations.

That being said, if you have PTSD and there is a study that you might be accepted as a subject, I would think that it might be a good idea if your suffering is great and nothing else has helped.

There is a lot more to say about this, and I suggest you stay tuned. I will be publishing an article here on choosehelp.com in a few days about this subject.

Question: I am an Afghan war vet with PTSD who has gone through some exposure therapy and CBT. I have found the therapy to be very helpful and my symptoms are pretty under control. However, I am studying for an economics degree now and I find that my concentration levels are not always up to the task at hand. They are noticeably worse than they were pre PTSD. Is there anything I can do to improve my ability to concentrate? I do not find the course work here all that difficult…that is when I am able to pay attention for sustained periods to what I am doing!

Dr. Ari Hahn Says...:

This is a very difficult and interesting question. While your PTSD treatment successfully addressed the external symptoms of PTSD, there are many internal processes that they do not reach. Although, thank God, I have not suffered traumatic stress, the idea of improving concentration is something that I have been personally researching for some time.

It is obvious that our brains do a lot of work "behind the scenes" that support our thinking. We have all had the experience of being too tired to solve a problem and deciding to "sleep on it" and in the morning we have an answer. We have also experienced insight, when we suddenly come upon a solution that did not come from some sort of logical analysis. These are two examples of what psychologists call "nonconscious" processes. This is a relatively new area of scientific study, and there is very little practical advice directly from this research. It would seem that your problem, since it seems to result from experience, is connected with too many uncontrollable nonconscious processes that intrude into your window of attention. 

There are, however, two possibilities of addressing this problem from other fields in psychology: pharmacology and meditation.

If you go to a physician he might diagnose you with attention deficit disorder (ADD) and prescribe a stimulant such as Ritalin or Concerta. Since these are powerful drugs they have a good chance of improving your attention span. However, you do not have ADD since it is best biologically described as a malfunction of a specific area of the brain (the pre-frontal cortex, or the executive area.) Your problem is most likely generated in a different area of the brain, the part emotional area (the limbic system.) But taking a pill is the easiest solution, if it works, and if the side effects are not too bad.

On the other hand, human beings have been struggling to quiet down emotions in order to be able to think clearly for thousands of years. It is one of the most common tasks of most religions. The most common tool is meditation. Meditation has been studied by psychologists for a few decades, and there have been non-religious applications around for many years (The Relaxation Response, by Herbert Benson.) Today there are many clinical psychologists who use meditation or meditation like practices. Recently there has been a small number of research studies looking at using meditation for PTSD, but there is not enough to draw any strong conclusions (although it would make for a good magazine article.) And even if there were a lot of research, it probably would not apply to you since you are basically symptom free (as far as PTSD goes.)

While I believe that meditation is the best road for you to take, there are significant drawbacks (but no negative side effects.) The first and only really major drawback is that is takes a lot of time, effort and practice. If you dedicate yourself to learning to meditate you would need to spend at least 20 minutes, three times a week for a few months to get the results you want. You might feel some improvement sooner, but significant change takes time. It is much better to practice on a daily basis. Ninety percent (my estimate) of the people who try meditation fail because they cannot keep it up. Of course, most of those people do not have anything near the motivating factors that you have. Second, I do not think it wise to embark on such a project without a skilled mentor. It is just very difficult. Third, while spirituality is not a necessary factor for successful meditation, most people incorporate spirituality after practicing meditation for a while. So, if you are a religious person you should think from before you get very involved about how it can enhance your belief system, and if you are not religious, take that into account also.

I am keenly interested in your situation. It is an area that I continue to study. Obviously, if you are interested in more details, you can contact me (my info is on my choose help home page.) I would really like to hear from you about how you address this problem and if you can succeed, and what that takes and what it feels like. There is no data about people in your situation. If we could gather enough details about your attempts to rebuild your concentration after PTSD treatment we could help myriads of people in similar situations.

Question: I was sexually molested as a child. I have never told anyone about it in real life. Not even my parents know about what happened. I don’t know how to talk about what happened. Now I am 24 and I have real problems with depression and anxiety and drinking. My doctor is recommending antidepressants but I feel like if the way I am feeling now is all caused by the shit I went through as a kid how is taking a pill everyday going to make that all disappear? I feel like if I could get rid of some of the rage and shame I have I wouldn’t need to drink to pass out every night and I wouldn’t feel so scared to fucking talk to another person that I don’t know. How do I get free from this so I won’t need drugs just to feel OK?

Dr. Ari Hahn Says...:

You are absolutely right in assuming that a pill will not help you get through this mess. No pill will make you feelings go away, just as the alcohol is not fixing your emotional turmoil. I think you really have a good idea of what you need to do, but it just seems too damn scary to do it. I don't believe that you are "depressed" in the sense that you have a medically caused depression, even if you are displaying all the symptoms.

You clearly state that you want to talk to somebody to get rid of the rage and shame. But talking to a stranger feels very wrong. That's OK. It's natural and naturally healthy. It is just not very helpful for you in your particular situation. You will need to go to a therapist, but you are not ready to spill you guts out to a professional. And it would be counterproductive if you wind up with a therapist that is not right for you. (If you wind up working with a properly sensitive therapist, it would work for you, but it is hard to know if he or she will be right until you've done some work.)

I would suggest that you first get used to talking in a support group of people who have suffered like you. I have two practical suggestions, although I am sure that there are many more. The first one that I am familiar with is on facebook. There is a group called complex PTSD and is "A non judgemental support group for trauma associated
with C-PTSD including sexual abuse (especially child sexual abuse),
physical abuse, emotional abuse, domestic violence or torture." There are about 200 members who share their daily struggles. You will learn that you are not alone and that other people can understand you.

Since you used alcohol daily you can also be considered an alcoholic. I do not know whether or not you think you are, but it can be used to your advantage. If you adopt that label you can join AA (Alcoholics Anonymous.) These 12 step programs are the only places in America where you can get unlimited 24/7 emotional support without anybody passing judgement on you. Of course, it is far from perfect and you still need to be careful in how you use their system, but done right it can be invaluable for a person like you to begin to learn how to use a support system. AA has "open" meeting where you can visit before you join, just to get a feel for it. Also, there are many many groups, and each one has its own "personality" so you would need to visit a few before you find one that seem like it might become comfortable (if the sounds like an option at all for you.)

Those two steps are only preliminary because you need to begin to experience how other accept you for who you are and who you think you are. You will need to do good therapy. It can be a difficult process, and you need to have a good therapist. You might consider tele-therapy where you can be flexible with hours, and might feel safer since there is no direct contact. (I can help you with this.) You might feel better working in a face to face format. I need to constantly be aware that you are ultimately in control of this process and in control of your life.

I would very much like to know how you are progressing in solving this. I have seen many people recover from situations like yours and I know that you can do it. If you can, please contact me in two weeks to tell me how you've progressed. Or what obstacles you've encountered. You are likely to experience both.

Question: I grew up in a very sick family home. Both my mother and father were very emotionally and physically abusive. I don’t want to get into the details about what they did but it was pretty bad and I have the scars and broken bone pains still to remind me of what they did. I left home at 17 and I’ve never been back, even though they only live a couple of hours away. I am 25 now. I have maintained civil relationships with my extended family and will get together with my aunts sometimes for meals. They know that things were really bad for me but it’s like that with time they are all sort of forgetting the bad and trying to push for reconciliation. My mother has cancer now and I guess she has been moaning about missing me and they are all trying to make her dying wishes come true. She told me so many times that she wished I had never been born as she beat me that it is hard for me to get my head around her wanting to resume a relationship with me now. I have no interest in doing so and I would be happy if I never had to think about these people again for the rest of my life because every time I get sucked into thinking or talking about them I just get so consumed with rage and shame and a bunch of black and red feelings that are hard to explain… But now that everyone is trying to get me to go back home to see them again why am I all of a sudden the bad person here when I won’t go? Why is that every time someone asks me to forgive my parents for the past and move forward I almost lose my mind with anger and frustration? Why do I have to start crying and pull out humiliating examples from the past before they’ll back off and accept that I am serious about not wanting to go back home? They made my life hell for 17 years and I won’t let them do it anymore. Why can’t people accept this? Am I really being SELFISH for never wanting to see them again?

Dr. Ari Hahn Says...:

Before I answer all of your questions, let me answer the most important one.If you do not feel absolutely ready and confidant to resume a relationship with your mother, don't do it. And if you feel that way, you should get in touch with you mother only under the guidance of a therapist that has gone through the process many times before. If you still get "consumed with rage and shame" then even if your mother had turned around completely (which is unlikely) the contact would certainly backfire.

Your relatives are probably meaning for the best, but they cannot possibly understand what you have gone through. Don't expect them to understand. I am sure that you would like to "move forward" but, for you, it is a long hard process that is beyond them. Time does not heal all wounds. That's a lot of bunk. And the wounds that you describe cannot ever be completely healed.Successful therapy will allow you to live without anger, frustration, crying,and humiliation. Recovery from PTSD means that there is no longer any sharp pain. It means that you would be able to talk about your terrible experiences without having to re-experience them. Relating the stories would incur a dull pain that you would consider worthwhile in certain circumstances. If you embark on the journey of recovery now, and get a good therapist, and work on it in a serious manner, it would take at least three years to get to that point. And,in truth, at age 25, you are at the age when you are fully an adult and it is a good time to start.

If you need an answer for your relatives, do not tell them all the ugly stories. That upsets you too much and (because they cannot understand) make you look weak in their eyes. When in reality you are much stronger than anybody who has not lived through the hell you lived through. I would suggest that you tell them that you are not ready to talk to her because of the anger and rage that you still have. Tell them that you are working on it, but until you are ready,such a meeting would be harmful for everybody involved. So it is just not worth it. Tell them to think of it this way. Let's say you meet you mom in order to give her the satisfaction that she dies with a good relationship with her. Then it goes terribly sour and you leave her feeling more bitter than before. That would be more disrespectful than refusing to meet her.

By now you understand that it is not selfish to refuse to see her now. Even if you do not see her at all. I strongly believe that forgiveness is the highest level of recovery, but it is not for everybody. And for the few who can achieve it, it requires work and caution.

Question: My boyfriend and I were in a terrible car accident a couple of weeks ago. I was not badly injured but Tony was. He was driving a vintage VW bug and we got hit hard by a truck running a red light and his leg was crushed and trapped in the frame and there was a lot of blood all over his head and he was in such a lot of pain. They had to use the jaws of life to get him out and I thought for sure he was going to die. He is going to be OK and will probably even walk normally again in time, but I am now left to care for him during his recovery. We have been living together for years and I love him so we are basically married and so taking care of him should be no big deal. But now I find that I am just so irritated by everything he does and I just feel no love for him anymore. I know this is terrible, because he is doing nothing wrong and is actually a very considerate patient. I try to hide how I am feeling but he can see it in my eyes so I am not doing a very god job of it. Why am I feeling like this? I feel like I am such a terrible person, after all, I got out with scratches and bruises and he is so badly injured and now I’m so testy with him all the time. Is the way I am feeling going to go away?

Dr. Ari Hahn Says...:

It is very difficult to assess why you have such a radical emotional change after the accident. I would first rule out any physical injury causing your change. Did you get hit in the head during the accident? Are there other unexplained changes in your emotions? (Less initiative, more/less nervousness or irritability?) Before any psychological help you should try to get a comprehensive neurological assessment to rule out even minor brain injury from a concussion that you might have received in the accident. 

Assuming you did not sustain any damage in the accident you need to think about your question to me: is it really important to know why you feel like that or is it more important that you change your feelings so you no longer harbor resentment? Understanding the sources of your feeling can be a long and difficult process, but changing your feelings might be easy even without understanding the whys and wherefores. 

Are you spending so much time caring for him that you do not have your own life? If so you need to re-balance in a way that you can care for him and do things that you enjoy also. That needs to be according to both of your needs, because some people go too far in the other extreme. Usually people who are in your situation find that the person being cared for understands the needs of the caregiver. That certainly seems true in your case.

The second step is to find some pleasurable activity together. Something that will make you laugh together. Laughter will not only reestablish your bonding with him, but strengthens his immune systems and can speed up his recovery. (It also helps your immune system and ability to deal with stress.)

Other questions that need to be explored include ways to improve details of your interactions. Also, how has this accident impinged on you intimate relations? Have you had to make adjustments there? Has the accident effected other relationships such as with your extended family or his?

I hope this has been helpful. Contact me if you still have questions.

Question: I was in a bad car accident a couple of months ago and I am still recovering physically from my injuries. At one point, in the early days, my sister told me that the doctors weren’t sure that I would live. I’ve been thinking a lot about my life since I’ve been laid up in bed and I am worried that I am wasting it. I am already middle aged and I have yet to live any of my dreams. My life has become a terrible suburban boring cliché. Once I am physically able I want to pull the kids from school( aged 9 and 11) get rid of the house and the life-sucking mortgage and see the world as a family for as long as the money will last. I feel like my eyes have been opened and the world is there for the taking and I am more excited about his than I have been about anything for a long time. My wife, however, is not so sure my suggestion is the best thing to do and she is more in favor of baby steps. She says my whole plan is just a reaction to the trauma I’ve experienced – and she’s right! But I don’t see this as a bad thing and I feel like if we don’t really go for it whole-hog we’ll just get dragged back into our everyday life and responsibilities and we’ll miss this window of opportunity to do something great for once in our adult lives. Anyway, this is obviously something for us to sort through as a couple, but what I would like your expertise on is, in your experience, are the life changes people make after a near-death experience usually a mistake, or more normally a case of people finally seizing life by the throat and living it as it should be lived!?

Dr. Ari Hahn Says...:

Life changing experiences after near death experiences are often, like you say, "seizing life by the throat and living it as it should be lived!" However, that is only true for the individual who experienced the trauma and survived. It is not true for those who did not experience it. That means that it would be inappropriate for your loved ones to change their lives radically and it might even be harmful or detrimental for them. they did not have the psychological "kick in the butt" that you had and extreme and sudden change can be dangerous. On the other hand, if you were to make those changes without them you run the risk of losing the most important single factor in a flourishing life, the close relationships that sustain us.

The best path is to find a way of integrating your hard learned insights into your family's view of life and keep your wife and children on the path that is "tried and true" while infusing a new zest for life that comes from your new appreciation.

As a suggestion, you might want to look into building up habits of expressing gratitude in your family, like keeping a gratitude journal, or expressing heartfelt thanks at family dinners. Or talk about realistic plans for increased enjoyment or appreciation of the good things in life. There is much to enjoy and appreciate in your life.

A good life coach can help you integrate your new found insights into your family's philosophy of life if necessary.

I hope all goes well. Contact me if you need additional help.

Ari Hahn, LCSW