Marti MacGibbon Tells Her Story

January 16, 2014
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Marti MacGibbon
Author and Motivational Speaker

By Marti MacGibbon

My name is Marti MacGibbon and I am an addiction treatment professional, award-winning author, a professional humorous, and an inspirational speaker. I specialize in addiction, trauma resolution, recovery, resilience, and all forms of inspiration.  I am also a person in long-term recovery from addiction, with 18 years chemical-free. I entered treatment for Chronic Post Traumatic Stress Disorder (PTSD) when the symptoms became unbearable in sobriety.

I am writing this blog for two reasons:

– To summarize my story of personal recovery which I told in detail in the book Never Give Into Fear, and
– To express my gratitude to Terence T. (Terry) Gorski for his life work.

Terry has dedicated his life to creating practical systems of recovery that are describe step-by-step skills that can be learned and used. He presents these skills in clear, easy-to understand, and no-nonsense language. He has always put recovering people and their families first. His primary goal has to help people to live sober and responsible. His methods have always fostered a movement from dependence, to independence, and then to interdependence. His methods are always collaborative and respectful. He believes in rational thinking and sober responsible living.

Terry Gorski has dedicated his life
to helping addicted people and their families
to learn effective skills
for helping themselves to recover.

My Story Encapsulated

In my active addiction, I might have been described as one of the hopeless cases, and looking back now, I know that both childhood sexual abuse (first instance at 14 years old) by authority figures, and the extreme trauma I survived in adulthood fueled my addiction. Knowledge is power, and this is especially true in recovery.  Organized knowledge is even better. The more I learn about the disease, the stronger my recovery grows, and the more positive action I can take to build a better, more enjoyable lifestyle and share experience, strength, and hope with others.

Knowledge is power.
Organized knowledge is even better.
~ Terence T. Gorski ~

In 1984, I was a successful standup comic (check out part of my act on YouTube), with a scheduled appearance on The Tonight Show with Johnny Carson, but I struggled with addiction. I’d been a heavy drinker in an attempt to cope with emotional pain and self-loathing, but couldn’t perform well on stage under the influence of alcohol, so I’d begun experimenting with stimulants.  That’s when I discovered methamphetamine, specifically crystal meth, and it was “game on!”

In the manner described in Gorski’s book, Straight Talk About Addiction, when I used meth I had an addictive brain response that released the brain chemistry of self-confidence. I felt more in control on meth, and I felt excited at the prospect of a new drug of choice that seemed to benefit me. I met a man¾a handsome criminal with lots of contacts in the drug world. The relationship went downhill fast, morphing into a classic abusive relationship. My downward spiral became a power dive, resulting in my being trafficked to Tokyo and held prisoner by Japanese organized crime figures. I endured rape and physical abuse, and lived under threat of death, but someone helped me to escape, and I returned to the U.S.

There’s a good reason
not to get intimately involved with a criminals.
That reason is … Ummm?
Well, the reason is they’re criminals.
As a general rule criminals can’t be trusted!
~ Terence T. Gorski ~

At that point, I began using my drug of choice as a means of coping with the trauma I’d experienced, and, as many trauma victims do, I returned to the abusive boyfriend. He beat me up and almost killed me. After that, I spent a year and a half homeless, sleeping under bridges and in abandoned houses. I lived in terror of reprisal from the traffickers I’d escaped. I suffered from nightmares. I didn’t realize it at the time, but I was suffering from PTSD.  (See Gorski’s Approach To PTSD)

Eventually, I met the man who is my husband today. We’ve been together for 26 years, and although we experienced active addiction together for several years, we both entered recovery during the 1990s, and we still enjoy strong recovery today. When I got clean, I returned to professional standup comedy for some years, and I know the power of laughter as a healing force! For me, gratitude, laughter and fun are mainstays in my recovery program. As I motivational speaker, I still do standup comedy, I just call myself a humorist and my audiences are sober people who enjoy a message of hope delivered in a way that helps them life at the ironies of life.

I always wanted to be a comedian,
but I lacked one thing – Talent!
So I did the next best thing.
I became a therapist!
~ Terence T. Gorski ~

Recovery Is An Action Plan

Recovery is a plan of action that creates motivation, which in turn creates more positive action. During my first few days clean, I took a look at my daily schedule and saw that my average day in addiction consisted of a series of bad habits, negative thought patterns, and self-defeating behaviors. At that point I instinctively knew I needed to learn more effective skills and practice them in every area of my life until they became habitual. When I was addicted, I was driven by the automatic and unconscious habits involved in getting ready to use, using, and recovering from using so I could start the cycle again. I didn’t have to think about it. It was a habit – and habits don’t require thought.

I managed to put the complex behaviors required to get and use illegal drugs under automatic habitual control – and I did it during a drug war, while I was homeless, suffering from severe PTSD, and surround by dangerous people. I certainly could develop a set of automatic/habitual recovery skills when I had a safe place to live, food to eat and meetings filled with sober and responsible people willing to help me.

So I rolled up my sleeves and got started. I replaced bad habits with good: began an exercise program, focused on a healthy diet, learned about cognitive distortions, began using positive affirmations and mantras, and started building a sober support network. The results came quickly and my success filled me with enthusiasm for my new lifestyle and the healing process. One success built upon another building momentum until I had moments of genuine well-being which I call spiritual experiences. The recovery process was a similar but opposite to the process of addiction. When actively addicted one failure built upon another until hopelessness crushed the soul.

Recovery is a plan of action that creates motivation,
which in turn creates more positive action.
~Marti MacGibbon ~

After ten years in recovery, I entered into therapy. I still had nightmares from the experience in Japan, and the additional trauma during my homeless period on the street.

Therapy has been, and still is, a game changer for me.  The healing is deep and profound. After therapy, I knew I wanted more than standup comedy, so I obtained education and training in addiction treatment. My goal was to be able to carry the message of recovery to others who suffer. During my studies, I discovered the work, of Terry Gorski. I learned about his Relapse Prevention Certification School. After earning my CADC-II, I enrolled in the RPT training and earned the ACRPS. I have worked with special populations, (Women and Homeless Veterans), and in outpatient, inpatient, and transitional housing settings.

Terry Gorski’s books provide education about the disease of addiction. His material is well organized. He presents valuable information for therapists and recovering people in plain language that anyone can understand.  When I read his books Learning to Live Again, and Understanding the Twelve Steps, I knew I’d discovered valuable recovery tools! Terry didn’t really say anything I didn’t know. He did, however, give me a better way to put what I knew intuitively into words so I could explain it more clearly to others.  I’ve purchased the two books for sponsees and friends in 12-Step programs as gifts they can use as additional resources and companions to the Big Book and Twelve and Twelve. The women I have shared these resources with have always been enthusiastic about the results they achieve when they study the books and take action.

While reading many of Gorski’s books, and in my addiction treatment training, I was thrilled to learn that fun and laughter are important to recovery even though the evidence for relationship between humor and health is not as strong as many believe it to be. This idea, however, continues to electrify me. Although I do not currently work as a counselor in a facility, I maintain my certifications and work to carry the message about recovery.

Today I am producer, founder and host of Laff-Aholics Standup Comedy Benefit for Recovery, an annual fundraiser in Indianapolis featuring nationally headlining comedians. The purpose of the show is to provide a fun event for people in recovery, with social connectivity and plenty of healing laughter. Newcomers learn it’s possible to have fun in recovery, that our community comes together for our most vulnerable members, and “old-timers” are refreshed and inspired. 100% of the profits from the show go to facilities that provide transitional housing and access to treatment for those who have little or no financial assets. We prefer to benefit facilities that will take clients who have “only the shirt on their backs,” so to speak.

Now I am launching a talk show on a recovery radio network called Pure Motive Radio. The show is on Blog Talk Radio, and it’s called, Kickass Personal Transformation with Marti MacGibbon. The purpose of the show is to provide entertainment, education, and tips on personal development in recovery. I’m booking comedians, authors who write about recovery, and thought leaders in the addiction treatment field. I enjoyed the two guest appearances that Terry Gorski made on my show. I am excited because he has agreed to do more in the future! My listening audience will be fascinated, educated, and enthralled!

Terry’s generosity to the recovering community is extensive. His many books, lectures, and the services of The CENAPS® Corporation provide a wealth of resources for those of us who suffer from the disease of addiction. He’s a brilliant clinician with a keen sense of humor and his contribution to recovery has made it possible for countless lives to be saved, healed and improved.  Terry Gorski Rocks! ~ Marti MacGibbon

C2953-MacGibbon Cover-Mini

Mari MacGibbon’s inspiring story of recovery.

Marti’s MacGibbon’s Website:
http://martimacgibbon.com/

Marti’s MacGibbon’s Blog:
http://martimacgibbon.com/blog/


PTSD and Addiction: A Cognitive Restructuring Approach

January 11, 2014
By Terence T. Gorski, Author
June 22, 2013
Unknown

Recovery Is Possible With
Cognitive Restructuring

 WHEN  TREATING PTSD AND ADDICTION, I don’t use a single approach – I use a consistent set of principles and practices. I strive to be sensitive and adaptive to the emerging needs of patients in the moment. The key seems to be a balance of flexibility and consistency.  Everyone responds in a uniquely personal way in learning to understand and manage PTSD. I like the idea that and the PTSD recovery process results in Post Traumatic Growth. People don’t just overcome their symptoms. They grow and change in positive ways.

PTSD ASSESSSMENT – A CRITICAL FIRST STEP

First I do a comprehensive assessment of PTSD. This includes an analysis of presenting problems, a life history, and a history of treatment and recovery. I include efforts at self-help to be important. Most people try everything they know to get a handle on their PTSD before seeking any formal or professional help.

ADDICTION ASSESSMENT – NOT A LUXURY, A NECESSITY

If the assessment provides confirmation of active PTSD symptoms, I do a comprehensive addiction assessment because addiction is so common in patients with PTSD. If the addiction is not identified and treated concurrently, the PTSD treatment can make the addiction symptoms worse, and the addiction symptoms can prevent patients from benefiting from the treatment/recovery of PTSD.

PSYCHO-EDUCATION – TEACHING A LANGUAGE OF RECOVERY

Then I use psycho-education to give people a new cognitive frame of reference about PTSD. This is extremely important because, although most people are familiar with the general idea of PTSD, most lack accurate information or a useful way of understanding the symptoms and the pathways to recovery.

SURVIVORS – NOT VICTIMS

The most important thing I want to teach is that patients are trauma survivors, not trauma victims. I also want to be sure that the trauma is over. You work differently with PTSD if the trauma is still ongoing It makes a difference if: a soldier needs to return to combat or is home from the war; if a battered child is still living under the control of violent parent and will have to go home; if the abused spouse is out of the marriage or still involved due to children or financial issues; if the person is in prison and going back to the cell block or if they have been released. If they are actively involved in an ongoing trauma teach survival and coping skills, safety plans, and ways to responsible get out and get safe.

GET PATIENTS SOME INITIAL RELIEF FROM PAIN

The first goal is to provide relief for the most painful mediate symptoms. This often involves referral for EMDR. I am not skilled with this method, but many patients find it helpful. This also involves basic training in relaxation, diet, and exercise as a part of overall stress management.

THE LIFE AND SYMPTOMS HISTORY – A COLLABORATIVE APPROACH

Then I do a guided life and symptom history so people can see how symptoms have affected their life negatively through pain, problems, and losses; and positively through a process of making decisions that lead to positive change, growth, and development. This is a positive psychology intervention called Post Traumatic Growth (PSG).

THE COMPREHENSIVE SYMPTOM LIST

I develop a comprehensive list of the PTSD symptoms that patients are struggling with. This often involves showing them a list of symptoms because they lack the words or language to describe what they are experiencing. It is easy for me to forget how important it is to give patients a language of recovery so they can identify and communicate their experiences.

Once I have a comprehensive symptom list, I ask patients to evaluate the frequency (how often) and severity (how disruptive) the symptoms tend to be.  Then explore each symptom. First I want them to tell me real-life stories about what happened when they experienced each symptoms. I like to get at least two stories about each – one story in which they managed it pretty well, and one story in which they managed it poorly. This helps them to take ownership of their symptoms and get a feel for the new language they are learning. I get stress enough how important I feel this process by relating symptoms to actual lived experiences is for most patients.

I look for patterns of symptoms. Many symptoms appear in clusters that are activated by the same trigger event and once they appear, they mutual reinforce and intensify each other. I treat these symptom clusters as a single symptom and help patients to find a meaningful name it.

STRENGTH-BASED – WHAT ARE YOU DOING RIGHT

I make it a point to discuss how patients have managed to survive up to this point. I want to find periods of time when they have successfully managed their symptoms or been symptoms free. What were they doing at those times. What was going on or not going in their lives. What thoughts, feelings, behaviors, and social styles are associated with successfully coping with the symptoms?

THE IDEA OF PTSD SYMPTOM EPISODES

I also like to introduce the concept of PTSD symptoms episodes – moments in time when the symptoms get turned on by triggers and turned off by things like rest and safe environments. The idea is that the symptoms are not always there. Most patients believe that they are, but they are usually wrong. The symptoms are usually turned on some of the time and turned off at other times. Once a symptoms episode is activated by a trigger, it starts, runs a cycle, and then ends or significantly diminishes in intensity. Know that it will end gives strength in facing the symptoms. Naming the symptoms identifies the enemies or the monsters to be dealt with. At the very least, at some times the symptoms are less severe and more manageable than at other times.

SYMPTOM SELF-MONITORING

I encourage patients to do conscious self-monitoring o their symptoms at least four times per day (breakfast, lunch, dinner, and before bed) and note the specific symptoms experienced, how severe the symptom is, what is happening that is making it more severe, and what could be done to make it a little bit less severe. This starts patients on a journey of Post Traumatic Growth by showing them they are not totally at the mercy of these symptoms — that they can choose to do things to make their symptoms a little bit better or a little worse.

FLASHBACKS – TEACHING PATIENT TO GET OUT SAFELY

I find that many patients are fearful of the flashback and dissociative states that they get into that are often a part of PTSD. They fear that if they get into these states they will fall into a bottomless black pit and never be able to crawl out again. This is why a believe so many people are afraid to start talking about past experiences or the triggers that activate symptoms. They are afraid that once the symptoms start they won’t stop.

FINDING A SAFE PLACE INSIDE YOURSELF

To counter this, I like to have patients find a safe-memory or fantasy that they can go to and practice going there when they are feeling pretty good. I want them to learn and practice relaxation exercises that work for them. I give them a smorgasbord of relaxation methods to choose from. Giving choices, it seems, reduces resistance. I also avoid “one size fits all” methods of relaxation — but no methods really do work for everyone. I avoid using guided imagery at first because I find it unpredictable. Once patients relax and engage their imagery processes, they often are vulnerable to intrusive thoughts, feelings, and flashbacks.

IMMEDIATE RELAXATION METHODS – CHOICE AND SAFETY

I like to teach centering, deep-breathing, and mindful (detached) awareness, I want to be sure that patients learn how to get back into the here and now and stop intrusive symptoms as soon as they start.

I avoid what I call “big bang catharsis techniques” which take the patients quickly into deeply re-experiencing the memories of trauma. I have just had too many b ad experiences with patients regressing and getting worse as a result of these techniques. I personally don’t find using them worth the risk.

I would rather take patients into the memories as they emerge in the assessment and recovery skills training process. I want to be sure that patients have the ability to stop and crawl out of the experience and get back into a tight anchor with here-and-now-reality.

SUPPORT NETWORKS 0 CRITICALLY IMPORTANT

I also focus on building support networks of people, places, and things that can be used when things get tough. Simple things like: Who can you call if you need to talk? Who should you avoid if your symptoms are bad in the moment? What can you do that will help? What should you avoid doing because it will make things worse? I am especially concerned about having a support systems that can be used during the night. This is when the symptoms tend to be more intense and the support less available.

COGNITIVE RESTRUCTURING – TFUAR MANAGEMENT

The general structure I wrap these general principles of cognitive restructuring. I use the word cognitive to mean total information processing with the brain and the mind. This involves Thoughts (T), Feelings (F), Urges (U), actions (A), and relationships. It also involves subtle intuitions and openness to spiritual experiences which seem to be very common in people who survive trauma. using a cognitive restructuring process. I ask patients to complete these sentence stems, or I turn them into open-ended questions. Using active listing is critical. Patients must feel listened to, understood, taken seriously and affirmed as a person. This process turns a sterile and “objective” assessment into a highly personalized and collaborative self-assessment.

COGNITIVE RESTRUCTURING FOR PTSD

Here is a general structure for the process:

1.  The symptom that I am experiencing is …

2.  When I experience this symptom I tend to think …

  • A more helpful way of thinking might be ….

3.   When I experience this symptom I tend to feel …

  • A more helpful way of managing those feelings might be ….

4.  When I experience this symptom I tend to manage it by doing the following things …

  • A more helpful behavioral strategy for managing this symptom might be ….

5.  When I experience this symptom what I do to try to get help from other important people in my life is …

  • A more helpful strategy for getting the help and support if others in managing this symptom might be ….

6.   he overall daily plan I have for managing my PTSD recovery is …

  • Some ways of making my recovery plan more helpful for me might be …

A SIMPLISTIC SKELETON OF A COMPLEX PROCESS 

This is a simplistic skeleton of the basic principles and practices of a cognitive restructuring approach for PTSD. This sketch, of course, just covers some of the steps on the critical path to recovery and relapse prevention. It also presents my preferences as a therapist based upon my past experiences with clients. I am sharing this as a personal report on lessons learned.

 Gorski Books


Show Me A Hero

December 12, 2013

By Terence T. Gorski
December 12, 2013

Laffey April 10 2010

Photo Credit: Artist Tom W. Freeman’s painting “Trial by Fire” depicts the April 1945 Japanese Kamikaze attack on the destroyer USS Laffey (DD-724).

I was watching a news program at home. The Viet Nam War was on my mind. I was on the short-list for being drafted.
I was still shaken by recently attending funerals of several high school friends who came home from Viet Nam in a box. I was in college and deeply struggling with my position on The War.   I wanted to be the hero. I wanted peace. I didn’t want to go to war. I had “skin in the game” as the saying goes.

A disabled Viet Nam Veteran was on the news. The veteran  stood briefly at a podium and spoke to a gaggle of reporters at a news conference. The veteran stood on his government-issued prosthetic legs. They were not as good as the current issue, but they were the best available at the time.
This veteran was one of the very few who qualified to receive them.  He needed help getting up from his chair.

The veteran was very much the hero. In a strong unshakable voice he put out a message of courage and gratitude for his opportunity to serve God, country, and Viet Nam people. He supported the war even though the war had cost him his legs.

His courage impressed me. I asked my Dad, who was watching the show with me, what he thought.

My Dad was a WW II combat veteran. He watched more than a dozen of his closest friends burn to death in a deluge of flaming gas after a Kamikaze crashed into his transport ship. He watched helplessly as they died before his eyes. There was nothing he could do to save them. He was helpless.

“I guess they were dead already,” my Dad told me in one rare moment of talking about his war. “They were dead, except for the burning and the screaming!” he told me. Then he brushed it all away by saying: “There are some things in life you can’t do anything about.”

“What to you think, Dad?” I asked.

His response burned itself into my mind forever. It wasn’t just the words – it was the pain behind the words. The pain from the deep wounds of his war, WW II,  that he carried in his soul. My Dad did not talk about the war very often. He rarely showed his pain. This was one of a very few times that he did. So I listened carefully.

“It’s easy to be a hero for a few minutes at a time when other people are watching and counting on you to be strong. I wonder what he does in the dark of night when he confronts the demons that ripped off his legs?” ~ Thomas S. Gorski, WW II VETERAN, May he rest in peace.

“Show me a hero and I’ll write you a tragedy.” – F. Scott Fitzgerald


Is there a recognizable post-incarceration syndrome among released “lifers”?

November 5, 2013

Terence T. Gorski developed a construct for counseling long-term offenders returning to the community which he called THE POST INCARCERATION SYNDROME (PICS).

A study conducted by Marieke Lima and Maarten Kunst reviewed Gorski’s PICS model which suggests that some released prisoners experience a unique set of mental health symptoms related to, but not limited to, post-traumatic stress disorder. They sought to empirically assess whether there is a recognizable post-incarceration syndrome that captures the unique effects of incarceration on mental health.

They conducted in-depth life interviews with 25 released “lifers” (individuals serving a life sentence), who served an average of 19 years in a state correctional institution.

They assessed to what extent the symptoms described by the participants overlapped with other mental disorders, most notably PTSD.

They found that a specific cluster of mental health symptoms that is related to long-term incarceration. In addition to PTSD, this cluster was characterized by:

1. Institutionalized personality traits,
2. Social–sensory disorientation, and
3. Alienation.

Our findings suggest that post-incarceration syndrome constitutes a discrete subtype of PTSD that results from long-term imprisonment.

Recognizing Post-Incarceration Syndrome (PICS) may allow for more adequate recognition of the effects of incarceration and treatment among former inmates and ultimately, successful re-entry into society.

ON THE INTERNET:
The Psychological Impact of Incarceration: Implications for Post-Prison Adjustment The Psychological Impact of Incarceration: Implications for Post-Prison Adjustment
Craig Haney
University of California, Santa Cruz
December 2001
http://aspe.hhs.gov/hsp/prison2home02/haney.htm

Comprehensive Incarcerated Persons Reform,Rehabilitation, And Reentry Act
(C.I.P.R.A.), Presented To Hon. Eliot Spitzer, Governor of The State of New York
http://www.realcostofprisons.org/writing/cipra.doc

PICS Article In Science Direct
http://www.sciencedirect.com/science/article/pii/S0160252713000344

The Psychological Impact of Incarceration: Implications for Post-Prison Adjustment:
The Psychological Impact of Incarceration: Implications for Post-Prison Adjustment Craig Haney University of California, Santa Cruz December 2001 http://aspe.hhs.gov/hsp/prison2home02/haney.htm


The Post Incarceration Syndrome (PICS)

October 26, 2013

By Terence T. Gorski
Permission is given to reproduce this article with proper referencing.

BARS_Black_HandsThe Post Incarceration Syndrome (PICS) is a serious problem that contributes to relapse in addicted and mentally ill offenders who are released from correctional institutions. Currently 60% of prisoners have been in prison before and there is growing evidence that the Post Incarceration Syndrome (PICS) is a contributing factor to this high rate of recidivism. (Haney 2001, Ditton 1999)

The concept of a post incarceration syndrome (PICS) has emerged from clinical consultation work with criminal justice system rehabilitation programs working with currently incarcerated prisoners and with addiction treatment programs and community mental health centers working with recently released prisoners.

This article will provide an operational definition of the Post Incarceration Syndrome (PICS), describe the common symptoms, recommend approaches to diagnosis and treatment, explore the implications of this serious new syndrome for community safety, and discuss the need for political action to reduce the number of prisoners and assure more humane treatment within our prisons, jails, and correctional institutions as a means of prevention. It is my hope that this initial formulation of a PICS Syndrome will encourage researchers to develop objective testing tools and formal studies to add to our understanding of the problems encountered by released inmates that  influence recovery and relapse.

Post Incarceration Syndrome (PICS) – Operational Definition

The Post Incarceration Syndrome (PICS) is a set of symptoms that are present in many currently incarcerated and recently released prisoners that are caused by being subjected to prolonged incarceration in environments of punishment with few opportunities for education, job training, or rehabilitation. The symptoms are most severe in prisoners subjected to prolonged solitary confinement and severe institutional abuse. (

The severity of symptoms is related to the level of coping skills prior to incarceration, the length of incarceration, the restrictiveness of the incarceration environment, the number and severity of institutional episodes of abuse, the number and duration of episodes of solitary confinement, and the degree of involvement in educational, vocational, and rehabilitation programs.

The Post Incarceration Syndrome

(PICS) is a mixed mental disorders with four clusters of symptoms:

(1) Institutionalized Personality Traits resulting from the common deprivations of incarceration, a chronic state of learned helplessness in the face of prison authorities, and antisocial defenses in dealing with a predatory inmate milieu,

(2) Post Traumatic Stress Disorder (PTSD) from both pre-incarceration trauma and trauma experienced within the institution,

(3) Antisocial Personality Traits (ASPT) developed as a coping response to institutional abuse and a predatory prisoner milieu, and

(4) Social-Sensory Deprivation Syndrome caused by prolonged exposure to solitary confinement that radically restricts social contact and sensory stimulation.

(5) Substance Use Disorders caused by the use of alcohol and other drugs to manage or escape the PICS symptoms.
PICS often coexists with substance use disorders and a variety of affective and personality disorders.

Symptoms of the Post Incarceration Syndrome (PICS)

Below is a more detailed description of four clusters of symptoms of Post Incarceration Syndrome (PICS):

1. Institutionalized Personality Traits: 

Institutionalized Personality Traits are caused by living in an oppressive environment that demands: passive compliance to the demands of authority figures, passive acceptance of severely restricted acts of daily living, the repression of personal lifestyle preferences, the elimination of critical thinking and individual decision-making, and internalized acceptance of severe restrictions on the honest self-expression thoughts and feelings.

2. Post Traumatic Stress Disorder (PTSD)

Post Traumatic Stress Disorder (PTSD) [ii] is caused by both traumatic experiences before incarceration and institutional abuse during incarceration that includes the six clusters of symptoms:

(1) Intrusive memories and flashbacks to episodes of severe institutional abuse;
(2) Intense psychological distress and physiological reactivity when exposed to cues triggering memories of the institutional abuse;
(3) Episodes of dissociation, emotional numbing, and restricted affect;
(4) Chronic problems with mental functioning that include irritability, outbursts of anger, difficulty concentrating, sleep disturbances, and an exaggerated startle response.
(5) Persistent avoidance of anything that would trigger memories of the traumatic events;
(6) Hyper-vigilance, generalized paranoia, and reduced capacity to trust caused by constant fear of abuse from both correctional staff and other inmates that can be generalized to others after release.

PTSD related to PICS may be the result of the traumatic grief that arises as a result of interpersonal trauma experienced as a betrayal of attachment. Leach and colleagues reported in The distinct set of symptoms associated with it were first recognized in the 1990s. Losses associated with traumatic grief can be either death or non-death related. A variety of studies have demonstrated that many prisoners have suffered from losses and trauma throughout their lives, and in many instances they have never received any support or interventions to address resultant problems. There is convincing evidence that there could be a relationship between many of the maladaptive behaviors demonstrated by the prisoners reported in the paper as PICS and may be related to  the high rates of recidivism seen in many developed countries (and which in Australia have been reported as high as 77%) may be related to traumatic grief. (Leach et al 2008)

3. Antisocial Personality Traits
Antisocial Personality Traits (APA 1994,  Forrest 1994, Hemple et al 1995) are developed both from preexisting symptoms and symptoms developed during incarceration as an institutional coping skill and psychological defense mechanism. The primary antisocial personality traits involve the tendency to challenge authority, break rules, and victimize others. In patients with PICS these tendencies are veiled by the passive aggressive style that is part of the institutionalized personality.

Patients with PICS tend to be duplicitous, acting in a compliant and passive aggressive manner with therapists and other perceived authority figures while being capable of direct threatening and aggressive behavior when alone with peers outside of the perceived control of those in authority.

This is a direct result of the internalized coping behavior required to survive in a harshly punitive correctional institution that has two set of survival rules: passive aggression with the guards, and actively aggressive with predatory inmates.

4. Social-Sensory Deprivation Syndrome

The Social-Sensory Deprivation Syndrome [vi] is caused by the effects of prolonged solitary confinement that imposes both social isolation and sensory deprivation. These symptoms include severe chronic headaches, developmental regression, impaired impulse control, dissociation, inability to concentrate, repressed rage, inability to control primitive drives and instincts, inability to plan beyond the moment, inability to anticipate logical consequences of behavior, out of control obsessive thinking, and borderline personality traits.

5. Reactive Substance Use Disorders
Many inmates who experience PICS suffer from the symptoms of substance use disorders [vii]. Many of these inmates were addicted prior to incarceration, did not receive treatment during their imprisonment, and continued their addiction by securing drugs on the prison black market.

Others developed their addiction in prison in an effort to cope with the PICS symptoms and the conditions causing them. Others relapse to substance abuse or develop substance use disorders as a result of using alcohol or other drugs in an effort to cope with PICS symptoms upon release from prison.

PICS Symptoms Severity

The syndrome is most severe in prisoners incarcerated for longer than one year in a punishment oriented environment, who have experienced multiple episodes of institutional abuse, who have had little or no access to education, vocational training, or rehabilitation, who have been subjected to 30 days or longer in solitary confinement, and who have experienced frequent and severe episodes of trauma as a result of institutional abuse.

The syndrome is least severe in prisoners incarcerated for shorter periods of time in rehabilitation oriented programs, who have reasonable access to educational and vocational training, and who have not been subjected to solitary confinement, and who have not experienced frequent or severe episodes of institutional abuse.

Reasons To Be Concerned About PICS

There is good reason to be concerned because about 40% of the total incarcerated population (currently 700,000 prisoners and growing) are released each year. The number of prisoners being deprived of rehabilitation services, experiencing severely restrictive daily routines, being held in solitary confinement for prolonged periods of time, or being abused by other inmates or correctional staff is increasing. [viii]

The effect of releasing this number of prisoners with psychiatric damage from prolonged incarceration can have a number of devastating impacts upon American society including the further devastation of inner city communities and the destabilization of blue-collar and middle class districts unable to reabsorb returning prisoners who are less likely to get jobs, more likely to commit crimes, more likely to disrupt families. This could turn many currently struggling lower middle class areas into slums. [ix]

As more prisoners are returned to the community, behavioral health providers can expect to see increases in patients admitted with the Post Incarceration Syndrome and related substance use, mental, and personality disorders. The national network of Community Mental health and Addiction treatment Programs need to begin now to prepare their staff to identify and provide appropriate treatment for this new type of client.

The nation’s treatment providers, especially addiction treatment programs and community mental health centers, are already experiencing a growing number of clients experiencing the Post Incarceration Syndrome (PICS). This increase is due to a number of factors including: the increasing size of the prisoner population, the increasing use of restrictive and punishing institutional practices, the reduction of access to education, vocational training, and rehabilitation programs; the increasing use of solitary confinement and the growing number of maximum security and super-max type prison and jails.

Both the number of clients suffering from PICS and the average severity of symptoms is expected to increase over the next decade. In 1995 there were 463,284 prisoners released back to the community. Based upon conservative projections in the growth of the prisoner population it is projected that in the year 2000 there will be 660,000 prisoners returned to the community, in the year 2005 there will 887,000 prisoners returned to the community, and in the year 2010 1.2 million prisoners will be released. [x] The prediction of greater symptom severity is based upon the growing trend toward longer periods of incarceration, more restrictive and punitive conditions in correctional institutions, decreasing access to education, vocational training, and rehabilitation, and the increasing use solitary confinement as a tool for reducing the cost of prisoner management.

Clients with PICS are at a high risk for developing substance dependence, relapsing to substance use if they were previously addicted, relapsing to active mental illness if they were previously mentally ill, and returning to a life of aggression, violence, and crime. They are also at high risk of chronic unemployment and homelessness. (Leach et al 2008)

Post Release Symptom Progression

This is because released prisoners experiencing PICS tend to experience a six stage post release symptom progression leading to recidivism and often are not qualified for social benefits needed to secure addiction, mental health, and occupation training services.

Stage 1 of this Post Release Syndrome is marked by Helplessness and hopelessness due to inability to develop a plan for community reentry, often complicated by the inability to secure funding for treatment or job training;

Stage 2 is marked by an intense immobilizing fear;

Stage 3 is marked by the emergence of intense free-floating anger and rage and the emergence of flashbacks and other symptoms of PTSD;

Stage 4 is marked by a tendency toward impulse violence upon minimal provocation;

Stage 5 is marked by an effort to avoid violence by severe isolation to avoid the triggers of violence;

Stage 6 is marked by the intensification of flashbacks, nightmares, sleep impairments, and impulse control problems caused by self-imposed isolation. This leads to acting out behaviors, aggression, violence, and crime, which in turn sets the stages for arrest and incarceration.

Currently 60% of prisoners have been in prison before and there is growing evidence that the Post Incarceration Syndrome (PICS) is a contributing factor to this high rate of recidivism.

Reducing The Incidence Of PICS

Since PICS is created by criminal justice system policy and programming in our well-intentioned but misguided attempt to stop crime, the epidemic can be prevented and public safety protected by changing the public policies that call for incarcerating more people, for longer periods of time, for less severe offenses, in more punitive environments that emphasize the use of solitary confinement, that eliminate or severely restrict prisoner access to educational, vocational, and rehabilitation programs while incarcerated.

The political antidote for PICS is to implement public policies that:

(1) Fund the training and expansion of community based addiction and mental health programs staffed by professionals trained to meet the needs of criminal justice system clients diverted into treatment by court programs and released back to the community after incarceration;

(2) Expand the role of drug and mental health courts that promote treatment alternatives to incarceration;

(3) Convert 80% of our federal, state, and county correctional facilities into rehabilitation programs with daily involvement in educational, vocational, and rehabilitation programs;

(4) Eliminate required long mandated minimum sentences;

(5) Institute universal prerelease programs for all offenders with the goal of preparing them to transition into community based addiction and mental health programs;

(6) Assuring that all released prisoners have access to publicly funded programs for addiction and mental health treatment upon release.

READ PERSONAL ACCOUNTS OF EXPERIENCES WITH PICS:
– A Personal Case Study With Post Incarceration Syndrome
– http://www.prisontalk.com/forums/archive/index.php/t-327414.html

REFERENCES:

Abramsky, Sasha; When They Get Out, Atlantic Monthly, June, 1999 p. 30
ON THE INTERNET: http://www.theatlantic.com/past/docs/issues/99jun/9906prisoners.htm

American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders (DSM IV), Fourth Edition, 1994 (Pg 424 – 429; Pg 645 – 650; Pg 175 – 272)

Ditton, Paula M. Mental Health and Treatment of Inmates and Probationers, Bureau of Justice Statistics, July 11, 1999 (NCJ-174463), (http://www.ojp.usdoj.gov/bjs/)

Forrest, Gary G., Chemical Dependency and antisocial Personality Disorder – Psychotherapy and Assessment Strategies, The Hawthorn Press, New York, April 1994 

Haney, Craig, The Psychological Impact of Incarceration: Implications for Post-Prison Adjustment: 
The Psychological Impact of Incarceration: Implications for Post-Prison Adjustment
, University of California, Santa Cruz
December 2001 (ON THE INTERNET: http://aspe.hhs.gov/hsp/prison2home02/haney.htm

Hempphill, James F.; Templeman, Ron; Wong, Stephen; and Hare, Robert D. Psychopathy and Crime: Recidivism and Criminal Careers. IN: Cooke, David J.; Forth, Adelle E., and Hare, Robert D. ED: Psychopathy: Theory, Research, and implications for Society, Kluwar Academic Publishers, Boston, 1995

Grassian, Stuart; Psychopathological effects of solitary confinement, American Journal of Psychiatry, 140, 1450 – 1454 (1983)]

Leach, Raelene M.; Burgess,Teresa; and Holmwood, Chris(2008) “Could recidivism in prisoners be linked to traumatic grief? A review of the evidence”, International Journal of Prisoner Health, Vol. 4 Iss: 2, pp.104 – 119   ON THE INTERNET: http://aspe.hhs.gov/hsp/prison2home02/haney.htm; Permanent URL: 0.1080/17449200802038249

Sabol, William, Urban Institute, Washington DC

 

 


Transformational Experiences

April 12, 2012

hope (1)By Terence T. GorskiAuthor
GORSKI BOOKS available from www.amazon.com

Many people have told me that we can recover from anything and everything that happens to us. I wish that were true, I really do, but if we define recovery as returning to the kind of person we had been before the trauma, I don’t believe it.

We cannot totally recover from all of the things that we experience. Once we know something we cannot unknown it. Once we see something, we cannot unsee it. Once innocence and the naive idealism of inexperience are lost they cannot be regained.

Some things change us. Even if we are resilient, when we bounce back we are difference. This is because some of what happens to us in life are TRANSFORMATIONAL EXPERIENCES. The most common transformational experience for most women is childbirth. You don’t just have a baby and go on with your life unchanged. Childbirth transforms most women.

Combat is a transformational experience. You don’t train and then put yourself in harm’s way knowing you are at risk of being maimed or killed or being called upon to maim or kill others without the experience transforming you on a deep level.

The are POSITIVE TRANSFORMATIONAL EXPERIENCES that build us up and give us hope: our first love; the birth of a new child; the hug of a loved one; meeting a new friend; falling in love again when we never though we could; a spiritual experience that opens us with joy and reverence to the beauty around and within us. These powerful experiences change us, because as we make sense of what has happened our view of ourselves, others, and the world opens us to new possibilities.

There are also TRAUMATIC TRANSFORMATIONAL EXPERIENCES that wound us deeply, crash our dreams on the jagged rocks of harsh reality, and shake the very foundations if our faith human goodness.

We all experience them from time-to-time. As unpleasant as they may be, maturity teaches us that they are a part of life. We will all experience: the death of a loved one, the loss of a true love; the violation of trust by a close friend; or the personal confrontation with violence and brutality. Most of us will face serious injury or illness. We will all grow old suffering the loss of youthful ambition.

Most of us will survive even the worst of these experiences, recover from the trauma, and then start making sense out of what happened to us, why, and it means. The traumatic moment unbundles the deepest part of our spirit. Our will to live pushes us to move on step by step.

We assign meaning to he experience. We do an in inventory noting the parts of ourselves we have lost in the experience and the new parts of ourselves we have gained. We realize we are the same person, yet somehow we are fundamentally different. Our conscious awareness of ourselves, others, and the world has changed and it can never be put back the way it was.

Transformational experiences change us. We are no longer the same people we were before the experience. We have changed, either for the better or the worse. And the change is governed by the choices we make in interpreting and responding to the trauma. That is the choice we have to make – how will I allow this trauma to affect me?

In the aftermath of a trauma we can make decisions to adapt and grow in ways that strengthen us and make us better people; or we can make decisions to adapt in a way that weakens us, blocks our growth, and makes us bitter and miserable people. That choice is always ours.

If you’re feeling sorry for yourself think of Christopher Reeves. In spite of staggering losses, he made massive contributions to all around him and left a legacy for us all to follow.

Why did he do it? He chose each day to struggle to hold the emotional high ground — and I am sure it wasn’t easy. I am also sure he didn’t stay on the high ground all day every day, but he was resilient. He always bounced back to the best of his ability. This is all any of us can do.

Trust in yourself. Do the best you can in the moment. Believe that will be enough because it usually is.

In the aftermath of a transformation life experience, it is best to move slowly and carefully. We are on new ground and need to regain our footing. How we choose to move forward will set the stage for what we will do next in our lives.

The most important thing, however, is to know that you can stand up again, even if you are afraid you might fall; to be willing to try again even if you are afraid you might fail; to know that you still have a life to be lived and that there are still people you love and who love you.

Bill White has an excellent article describing recovery from addiction as a process of transformational change:

GORSKI BOOKS: www.relapse.org

LEARNING TO LIVE AGAIN – A Guide To Recovery

Straight Talk About Addiction by Terence T. Gorski

All of the books of Terence T. Gorski
are available from
www.amazon.com


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