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24 July, 2015

Most of the survivors I worked with were Americans.  Some acquaintance with psychology being common within that larger cultural group, it is perhaps not surprising that the number one conclusion survivors come to about their hallucinations was that they were going crazy.  One researcher used an inspired methodology to highlight that fact. Internet chat boards for persons with chronic and severe mental illnesses like schizophrenia, single parents and sexual abuse survivors were analyzed.  Posts were scrutinized for the appearance of terms and phrases regarding craziness.  Terms and phrases ranged from such things as “going (or being) crazy” to colloquial expressions like “bats in the belfry”.  It was found that sexual abuse survivors used such self-descriptions more than single mothers and even more than persons with actual psychoses.

However, it was fairly common to hear other, culturally-based self explanations.  Survivors steeped in traditional Mexican culture, for instance, might attribute their symptoms to “el ojo” — having been cursed by “the evil eye”, or witchcraft.  Within American culture, some attributed hallucinations, especially the visual ones, to being haunted by ghosts.  Others having fundamentalist Christian backgrounds explained their symptoms as an attack by the Devil.  Versions of witchcraft or evil entities are common in many cultures and someone from China or eastern Europe might have parallel explanations.

What is striking is that nearly no survivors I saw made any connection whatsoever between their symptoms and their histories of childhood sexual abuse.  When, in initial interviews using mental status examinations, survivors were asked if such things as seeing a shadowy figure at the foot of their bed didn’t make sense, given their histories, they were usually able to make the connection rapidly.

Interviewees were never told they had been abused, which is a bad way to handle such interviews.  Instead, once the examination was completed, they were told something like “I think you have a secret about something very bad that happened when you were little.  I wonder if you’d be willing to tell me about that.”  Emotions often exploded at that point, confirming* the suspicions.  I would, now and then, say the same to women who did not fit the profile.  They would answer with experiences which might be troubling but far less dramatic in emotions – things like the death of a cousin or a fire they had witnessed.

That single incident, the making of the connection between symptoms and history, was usually a tremendous relief, especially for those who thought they were losing their sanity.  It was relatively easy to point out to clients that their symptoms were entirely normal reactions to catastrophic events and, though they had a lot of hard work to do, offered tremendous reassurance.  Making that connection was highly effective as well in engaging survivors in therapy when they might otherwise have run away from the arduous task.

Helping them make the connection not only relieved them of their fears, it modeled early on what the process of psychotherapy would be and suggested that meaning could be gleaned from otherwise apparent chaos.  For the most part, the hallucinations of persons truly suffering from psychoses and their reactions to same were far different.  Their explanations are, in addition, far more apparently “crazy” — things like lasers being used to put thoughts into their heads and the like.  The explanations of survivors, on the other hand, stuck to those within cultural norms.


* The famous psychoanalyst, Robert Langs, best explained the concept of confirmation.  Analysis has often been criticized as not being scientific.  However, one can determine immediately whether an intervention was spot on or not using the concept of confirmation.  If the therapist has been on the money, clients will verbalize associations to persons who were wise and helpful, reveal important new material, experience the recall of previously suppressed memories, or recall an important dream.  On the other hand, lack of such confirmation — usually verbalizations containing negative material or withdrawal in the form of shutting down of productive, important verbalizations — appears when the therapist has been off of the mark.  Rather sadly, many therapists think they are filled with wisdom about clients.  The truth is that spot-on interpretations are rather rare, even for the best of therapists.  The good news is that an occasional, accurate interpretation leads to permanent insight and growth.

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