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February 2014 Sounding Board: “The Meaning of Empowerment”

06 Mar

The Meaning of Empowerment

by Dee Wilson

The conditions that commonly occur in cases of severe child maltreatment, i.e., substance abuse, mood disorders (especially depression and PTSD), domestic violence and poverty, lead to a loss of power and control of body, mind, emotional reactions, social circumstances and social behavior and interpersonal relationships. These conditions often co-occur in ways that diminish the sense of self efficacy and result in hopeless/ helpless responses to circumstances and challenges that frustrate and sometimes immobilize helpers. Women with co-occurring substance abuse and mental health disorders usually have had histories of childhood trauma, and have often been victims of domestic violence in late adolescence and young adulthood as well.

There is an extraordinary description in Judith Herman’s Trauma and Recovery of how trauma symptoms exacerbate the effects of depression. Herman states:

Protracted depression is the most common finding in virtually all clinical studies of chronically traumatized people. Every aspect of the experience of prolonged trauma works to aggravate depressive symptoms. The chronic hyperarousal and intrusive symptoms of post-traumatic stress disorder fuse with the vegetative symptoms of depression, producing … the “survivor triad” of insomnia, nightmares, and psycho-somatic complaints. The dissociative symptoms of the disorder merge with the concentration difficulties of depression. The paralysis of initiative of chronic trauma combines with the apathy and the helplessness of depression. The disruption in attachment of chronic trauma reinforces the isolation of depression. The debased self- image of chronic trauma fuels the guilty ruminations of depression. And the loss of faith suffered in chronic trauma merges with the hopelessness of depression. (p.94)

Depression and other mood disorders (e.g., anxiety, panic attacks, PTSD) feed off of and intensify the sense of powerlessness to change intolerable conditions. Groups that are unusually susceptible to depression, for example, the elderly, women, the poor and trauma victims are likely to have an acute awareness of powerlessness not only in respect to social conditions but in respect to their bodies, thoughts and emotional reactions.

In Fear and Courage, S.J. Rachman describes the progression of combat trauma for aircrew members in World War II:

The symptoms of fear experienced during combat included palpitation, dryness of the mouth, sweating, stomach discomfort, urinary pressure, trembling, tension, and irritability. The most persistent of these symptoms were tension, tremor, and sleep disturbance.

Rachman comments that “the theme of helplessness was common.” He then adds, “Helplessness is said by Seligman to arise from the sense of the uncontrollability of important aversive events and to cause fear and then depression.” Seligman proceeds to describe the air-crew members gradual loss of control of bodily reactions associated with depression:

The most common pattern was for air-crew members to show a gradual accumulation of adverse effects, such as insomnia, loss of appetite, tremor, extreme startle reactions, irritability and tension … Muscular coordination was replaced by uncontrollable tremors, jerky movements, and tension. … Their ability to sleep was impaired and they started to experience nightmares. Various gastric symptoms such as nausea, vomiting and diarrhea appeared. They also reported a loss of appetite and various pains and aches, with headaches and backaches being particularly common.

One might object that the air-crew members’ lives really were in danger, whereas this is usually not the case with parents who have trauma histories. However, one of the effects of chronic trauma is to seriously impair victims’ capacity to realistically assess safety threats. Both traumatized children and parents may continue to act as if their lives are threatened by events and situations that seem unthreatening to others. Victims’ perception of extreme pervasive danger may far outlive the events in which trauma originated. It is also the case that some maltreated children (including severely neglected children) and DV victims, the chronically homeless and families living in violent neighborhoods have rational reasons to fear extreme bodily harm and early death.

One of the most disabling effects of trauma on children is the impairment of emotional control in response to stress, and the resulting susceptibility to “meltdowns” that frighten family members, school staff and other community professionals. Young children learn to calm down and gradually achieve control of their emotional reactions by modelling the behavior of trusted adults and turning to these adults for help when they are hurt, or hungry, tired or otherwise out of sorts. However, seriously abused and neglected children usually have little or no reason to trust adults, and are likely to have difficulty in using them to calm down. This is the dilemma facing foster parents and adoptive parents who are caring for severely maltreated children. Equipping substitute caregivers to help traumatized children calm down absent “meltdowns” should be a focus of foster parent/adoptive parent training programs.

Poverty, Destitution and Hope

According to a Partners for Our Children (POC) 2009 survey, almost half of parents with open child welfare cases in Washington State had an annual income of $10,000 or less, and about one fifth had no source of income and were not living with a person whose income was greater than $20,000 per year. Severely poor parents are destitute or on the verge of destitution. These parents are likely to have spells of homelessness and food insecurity and to lack regular access to medical care or dental care. Poverty traps parents in dangerous neighborhoods and dangerous relationships, and in a myriad of other ways reduces control over life circumstances. It is no wonder that low income children and adults are unusually vulnerable to mood disorders, especially depression, and that poverty has negative effects on health outcomes and mortality rates, even when medical care is accessible.

The severity and chronicity of poverty, and its concentration in poor neighborhoods, effects parenting behavior, but so do the psychological dimensions of poverty, i.e., the extent to which poverty seems like a life sentence for early disadvantage and/or poor choices. Poverty or destitution is more likely to lead to hopelessness when it is combined with low educational achievement, for example the lack of a high school degree, the long-term inability to find employment, a criminal record or inter-generational histories of poverty in extended families. Furthermore, chronic mental illness and substance abuse combined with lack of education and criminal histories may eliminate hope of a better life. In these circumstances, creating a spark of hope that the future can be better than the past is vital in breaking the iron grip of mood disorders and addiction.

Dimensions of Empowerment

Persons who have had histories of chronic trauma, or who have experienced social stigma, oppression and social exclusion are likely to be highly sensitive to issues of power and control. According to Rachman, one of the most discerning researchers of fear and ways of controlling fear, ” The sense of helplessness is particularly acute if a person feels that important life events are beyond his or her control, that the absence of control stems from personal inadequacies, and that the situation is typical.” Therapeutic endeavors need to be informed by this perspective.

Judith Herman writes that “The core experiences of psychological trauma are disempowerment and disconnection from others. Recovery, therefore, is based on empowerment of the survivor and the creation of new connections.” And Herman adds “No intervention that takes power away from the survivor can possibly foster her recovery, no matter how much it appears to be in her immediate best interest.” Child welfare systems in the U.S. depend on coercive practices to an unusual degree compared to their counterparts in Western Europe. A trauma informed perspective applied to the parents of abused and neglected children will consider ways of reducing use of coercion and of continuing to offer choices whenever possible even in the context of legal structure. Coercion is sometimes necessary to protect children; but the use of police power and legal structure should not be viewed as a rationale for ignoring the perspective of parents, or bypassing the use of engagement strategies.

Rachman asserts that “Fear seems to feed on a sense of uncontrollability; it arises and persists when a person finds himself in a threatening situation over which he feels he has little or no control. But a sense of personal competence, self confidence if you will, appears to provide protection against fear.” It is the acquisition of skills, and their exercise, that increases a person’s confidence in their ability to cope with tough challenges. Parenting skills are important and so are social skills, emotion regulation skills, employment skills, self- protection skills. Empowerment practice restores and builds self efficacy in coping with life challenges to the extent possible given time and resource limitations. In child welfare settings, the indicator of therapeutic effectiveness in chronic neglect cases is a parent mobilized and able to help themselves and their children. Sobriety and reduction of depressive symptoms are means to this end, not the end itself.

Poor and destitute parents will often need concrete help. It is a puzzling feature of U.S. child welfare systems that the federal government and state governments will often spend thousands of dollars on substance abuse or mental health treatment; but have difficulty purchasing a crib, or paying a month’s rent for parents working to be reunited with their children. Poverty related services are scarce and one time only, or non- existent, in many states while therapeutic services can be extended for months. However, emergency financial assistance is not enough; many poor parents would psychologically benefit from a renewed sense of economic opportunity that can only come from education or job training. Enrollment in educational programs or job training should be a part of reunification programs.

Finally, no empowerment strategy is likely to be effective unless parents have hope in a better future, including hope that children whose early development has been affected by child maltreatment, substance abuse, mental health problems and family violence can recover from these experiences. Hope is a psychic investment, an act of faith that troubled parents must make to regain a reasonable degree of control over their bodies, minds, emotional relationships and social circumstances. Professionals’ confidence in their skills and resourcefulness, and their persistence through the usual ups and downs of treatment, are of the utmost importance in maintaining the spark of hope.

References

Herman, Judith, Trauma and Recovery: The aftermath of violence — from domestic abuse to political terror, Basic Books, 1992, 1997.

Rachman, S.J., Fear and Courage: Second Edition, W.H. Freeman and Company, 1978, 1990.

The views expressed in this commentary are the author’s, and are not intended to reflect the views of Casey Family Programs or any other organization.

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Posted by on March 6, 2014 in Uncategorized

 

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