Bringing War Down to Earth: The Dialectic of Pity and Compassion in Doonesbury's View of Combat Trauma

Post-traumatic stress disorder among returning veterans from the wars in Iraq and Afghanistan has invoked all manner of public responses, not least of which is a sense of pity that begins and ends with the moment of recognition. As such, the publicity of soldier sufferance ironically mitigates the need for a more complex socialization to the pain of war that might be animated by a more nuanced emotional response rooted in the disruption of common narratives about sacrifice, service, and heroism. This essay argues for the potential of Garry Trudeau's trilogy of cartoons, collected under the titles of The Long Road Home, The War Within, and Signature Wound, to depict a dialectic of pity and compassion while underscoring the inadequacies of discourses of trauma through the use of bathos—a verbal–visual descent that emphasizes the commonplace in the seemingly extraordinary through the trope of the ridiculous.     

Trauma Response and Recovery Certificate Program: Preparing Students for Effective Practice

This paper describes an innovative approach to preparing MSW students for work with traumatized clients via a trauma certificate program. It explores conceptual and ethical principles of the program and presents results of the formative evaluation done with faculty, field instructors and students from the program's pilot year. Students reported gains in self-ratings of their efficacy in working with trauma in children, adults and communities, as well as articulating what parts of trauma theory were most useful to them in post-graduation. Field instructors were enthusiastic about the knowledge and skills students were building, and suggested further refinements to the program, including increased communication and networking on the topic of trauma.     

Creating a Safe Frame for Learning

Abstract

This article addresses the significant responsibilities of teachers of trauma courses to conscientiously create a safe frame for learning, in consideration of the student, who is inevitably exposed to the intense emotional and conceptual challenges of trauma study. During their study, many students revisit earlier trauma or loss, perhaps unexpectedly, and in the context of academic demands for achievement. Learning can be deepened as students experience a safe context for the material, and for the recognition of the demands of trauma study and treatment. Curriculum inclusion of: the impact of trauma study on all students; recognition of additional demands on students with a history of trauma; a teaching process attending to class experience; addressing vicarious traumatization and encouraging enhancement of self-care, is included.     

Modeling life course pathways from adverse childhood experiences to adult mental health

Although the association between adverse childhood experiences (ACEs) and adult mental health is becoming well established, less is known about the complex and multiple pathways through which ACEs exert their influence. Growing evidence suggests that adversity early in life conveys not only early impacts, but also augments risk of stress-related life course cascades that continue to undermine health. The present study aims to test pathways of stress proliferation and stress embodiment processes linking ACEs to mental health impairment in adulthood. Data are from the 2011 Behavioral Risk Factor Surveillance Survey, a representative sample of Washington State adults ages 18 and over (N = 14,001). Structural equation modeling allowed for testing of direct and indirect effects from ACEs though low income status, experiences of adversity in adulthood, and social support. The model demonstrated that adult low income, social support and adult adversity are in fact conduits through which ACEs exert their influence on mental health impairment in adulthood. Significant indirect pathways through these variables supported hypotheses that the effect of ACEs is carried through these variables. This is among the first models that demonstrates multiple stress-related life course pathways through which early life adversity compromises adult mental health. Discussion elaborates multiple service system opportunities for intervention in early and later life to interrupt direct and indirect pathways of ACE effects.     

Acculturation orientations and mental health when facing post-migration stress: Differences between unaccompanied and accompanied male Middle Eastern refugee adolescents,first- and second-generation immigrant and native peers in Germany

ObjectiveThis study examined the mental health of Middle Eastern male unaccompanied refugee adolescents in Germany in relation to the mental health of accompanied refugee peers, first- and second-generation immigrant and native peers. In particular, it was investigated whether differences in the mental health of unaccompanied and accompanied refugees and immigrant peers were related to differences in the perception of post-migration stress, and whether this association changed with different acculturation orientations.MethodIn a cross-sectional study, 193 adolescents (M_age = 18.1 years, SD = 1.74 years; n_refugees = 74, n_migrants = 59, n_natives = 60) completed self-report measures of mental health, trauma, acculturation styles, and post-migration stress.ResultsAnalyses of variance revealed that unaccompanied refugees suffered most from internalizing and trauma symptoms, while accompanied peers, first- and second-generation immigrant and native adolescents did not differ significantly in internalizing symptoms. Hierarchical regression analysis demonstrated that more integrated adolescents were generally associated with lower internalizing symptoms and integration also buffered against detrimental effects of post-migration stressors. Marginalized adolescents showed more internalizing symptoms, especially in the lights of more post-migration stress. Both assimilation and separation had no direct effects on internalizing symptoms. However, assimilation buffered against detrimental effects of post-migration stress on internalizing symptoms, whereas separation amplified these effects.ConclusionAn involvement in host society and an orientation towards the host culture fosters mental health of acculturating Middle Eastern adolescents in Germany when post-migration stress is perceived, particularly for unaccompanied refugee adolescents. Moreover, additionally maintaining the culture of origin seems to be in general most beneficial.     

The impact of extrafamilial victimization and poly-victimization on the psychological well-being of English young people

Childhood victimization impacts on the well-being of children and young people, particularly those experiencing an extreme amount of different types of victimization (i.e., poly-victims). However, limited attention has been given to the impact of different categories of extrafamilial victimization (experienced outside of the family), particularly in the UK. The intricacies of the significant detrimental impact poly-victimization has on victims are also poorly understood. In this study, 730 young people, aged 13 to 16 years (mean 13.8 years), from one county in the UK, were surveyed about their lifetime and past year experiences of extrafamilial victimization, the locations in which these occurred, and current trauma symptoms. The results showed that interpersonal forms of extrafamilial victimization (e.g., sexual victimization) were significant predictors of trauma, whilst more indirect forms of extrafamilial victimization (e.g., witnessing the victimization of others) were not. When extrafamilial poly-victimization and number of extrafamilial victim locations were accounted for within regression models, however, this impact was reduced. Poly-victimization within the past year was the strongest predictor of trauma symptoms. Number of victim locations did not significantly predict trauma symptoms above and beyond the impact of poly-victimization, although it was a contributory predictor. These findings suggest that a holistic exploration of a young person's extrafamilial victim experiences is needed in any clinical assessment or research into its psychological impact. Specifically, attention should be given to the experiencing of extreme levels of victimization (e.g., poly-victimization). Further longitudinal research is needed to understand why poly-victimization has the greatest impact on psychological well-being.     

Adverse childhood experiences (ACE) and adult attachment interview (AAI) in a non-clinical population

Adverse childhood experiences (ACE) tend to be interrelated rather than independently occurring. There is a graded effect associated with ACE exposure and pathology, with an increase when ACE exposure is four or more. This study examined a sample of active individuals (n = 129) to determine distribution patterns and relationships between ACEs, attachment classification, unresolved mourning (U), and disclosure difficulty. The results of this study demonstrated a strong relationship between increased ACEs and greater unresolved mourning. Specifically, the group differences for individuals who experienced no ACE (n = 42, 33%), those with 1–3 ACEs (n = 48, 37.8%), and those with ≥4 ACEs (n = 37, 29.1%) revealed a pattern in which increased group ACE exposure was associated with greater lack of resolution for past trauma/loss experiences, more adult traumatic events, and more difficulty disclosing past trauma. Despite ≥4 ACEs, 51.4% of highly exposed individuals were classified as secure in the Adult Attachment Interview. Resilience in this group may be related to a combination of attachment security, college education, and engagement in meaningful activities. Likewise, adversity may actually encourage the cultivation of more social support, goal efficacy, and planning behaviors; factors that augment resilience to adversity.     

Childhood trauma,dissociation, and the internal eating disorder ‘voice’

Many individuals diagnosed with eating disorders describe their disorder as being represented by an internal ‘voice’. In line with cognitive models of voice-hearing, previous research has identified associations between voice appraisals and eating psychopathology in anorexia nervosa. Whether these findings generalise to other eating disorder subtypes remains unknown. The aetiology of the internal eating disorder voice also remains unclear. Traumatic-dissociative models of voice-hearing, which link such experiences to decontexualised material arising from early traumatic events, might also be relevant to eating disorder groups. To determine whether cognitive models of trauma and voice-hearing apply across eating disorder subtypes, 85 individuals fulfilling ICD-10 criteria for an eating disorder completed self-report measures regarding eating disorder cognitions, voice-related appraisals, childhood trauma, and dissociation. The relative power of the eating disorder voice was found to be positively associated with experiences of childhood emotional abuse, and this relationship was partly mediated by dissociation. In addition, eating disorder voices appraised as powerful and benevolent predicted more negative attitudes towards eating across diagnostic groups, but were unrelated to disordered eating behaviours or weight. These findings suggest that the eating disorder voice plays a meaningful role in eating pathology across diagnoses and that this experience might be related, in part, to experiences of childhood maltreatment. Therapeutic implications are discussed.