Healing from Sexual Assault

-Sharie Stines, Psy. D

“Resilience, rather than pathology should become the standard expectation in the aftermath of trauma.” –Aaron Levin

Are you a victim, parent, or in a counseling capacity, wondering how to help yourself or your loved one cope with the trauma and horror of sexual assault?  Whether the crime was child molestation, rape, sodomy or some other sordid type of sexual perversion inflicted upon you or your loved one, the aftereffects can be devastating.  Victims of sexual assault struggle with their sense of safety in the world, sense of personhood, and value as a human being. After experiencing the crime of being objectified and humiliated by another human being for base purposes, the victim is never the same again.

This is not to say that healing is not possible, because, in fact, healing is very probable; however, once you have been the victim of a violent sexual crime you have been through a “life defining event” that changes you forever.

The road to healing is not “one size fits all,” for each person’s journey is different.  One victim of sexual abuse may tell his family what happened and be told that they’re lying; while another person may be able to experience full cooperation from their family members as well as the community, and may even see their perpetrator brought to justice. This is to say, the events surrounding the assault have their effects as well as the crime itself does on the victim.

One thing I am most certain of is that you cannot heal from sexual assault unless you are willing to face the truth, talk about it, share your story with empathic others, grieve your loss of trust and sense of security in the world, and feel your pain until you have completed the process of grief.

In order to face the truth, defense mechanisms must be challenged. These have the faces of denial, minimization, forgiving too soon, dismissing, dissociating, addictions, intellectualizing, and a variety of other creative methods of numbing reality.

Resilience must be built.  Resilience factors include: healthy connections with others, the ability to self-soothe difficult emotions, cognitive flexibility, principle-driven living, positive outlook on future (hope), an internal locus of control (that is, you see that you have some power over your own life), and the ability to experience positive emotions more often than negative ones.  If you don’t have the qualities required for resilience already, the good news is that they can be learned and developed over time.

Resilience, in my opinion, is the number one necessary ingredient for overcoming any type of trauma, and this would include sexual assault. One aspect of resilience is to not only focus on the need for healing the wounds caused by the trauma, but also to focus on the “Post Traumatic Growth” resulting from the life altering experience.  Post Traumatic Growth emphasizes that strengths can emerge through suffering and the resulting struggle to overcome.

Yes, PTSD is a result of trauma and must be addressed; but, PTG has been found to exist as well.  Many survivors and thrivers of trauma actually realize that they have learned some valuable wisdom.  Survivors have found their inner strength and resolve, tenacity and hope.  Without embracing denial, reality can be faced, challenged, grieved, and accepted.  The survivor of sexual abuse rises up and discovers that he or she is whole.  She or he triumphs in self-empowerment, able to face the rest of his or her life boldly.

Whatever Doesn’t Kill You, Will Only Make You Stronger?

-Dawn C. Carr MGS, PhD

Rethinking what it means to be resilient.

A few months ago, my father-in-law turned 80. As a gerontologist, I’m a big fan of celebrating major milestones when it comes to aging. But, for my father-in-law, I find this accomplishment more exceptional than usual. You see, we’ve suspected my father-in-law was a cat for years because he seems to have nine lives! Despite a barrage of serious health setbacks, and there have been some biggies, he always seems to bounce back.

We often ponder the reason for his amazing resilience, despite all odds. Is it something about his genetics (which would bode well for me given that I’m married to someone with half of his genes)? Possibly, though research suggests that genetics explains less than one-third of health outcomes in later life, so that’s definitely not the whole story (1,2). Perhaps it could be something about his lifestyle? Given his fondness of McDonald’s, Reese’s Peanut Butter Cups, Johnny Walker, and five decades of heavy smoking, I’d say that his health behaviors were unlikely beneficial to how well he’s fared. So that leaves us with psychosocial factors.

In a paper I recently published with colleagues (3), we examined how their level of psychological resilience influenced people faced with a major health event. Specifically, we created an index of self-reported resilience factors (e.g., how much they agree with the statement “When I really want to do something, I usually find a way to succeed at it.”) and examined how they influenced the extent to which getting a new chronic condition led to increased disability two years later. For example, if someone suddenly had a heart attack, we were interested in seeing whether he lost his ability to do things like bathe, go grocery shopping, or manage his money. Our study showed that the least resilient individuals were likely to experience a new disability, and those who were the most resilient recovered in less than two years such that they had no more disabilities than those who hadn’t experienced a major health event.

So, what causes someone to be resilient? There are several hypotheses.

1. Some people are innately more resilient and, therefore, are able to withstand more adversity than others.
2. Resiliency is a measure of social class—it’s related to whether or not people are born into a family that offers opportunities that allow them to do well in life.
3. People learn from bad things happening and develop tools to handle additional challenges later on.

For the first hypothesis, we have no reason to believe that resilience is a trait that you have or you don’t. Rather, like other individual characteristics, we may have a propensity towards certain personality traits at birth, but this propensity is activated by our environment, by our development, and by the people in our lives to collectively shape our psychological responses over time. This is not to say that we are unable to change our responses to our environment, but there is significant evidence to debunk the idea that resilience is something that we’re either born with or we’re not.

So let’s consider the second hypothesis, that resiliency is simply a measure of social class. If you are brought up in a family in which there are expectations and opportunities to experience success, and you observe success in others, you are likely to feel as though working hard will pay off. Furthermore, success (regardless of how you might define it) is more likely to be an expectation. On the other hand, if you grow up in a family in which your parents (or parent) spend many years struggling to find a job, pay the bills, and provide for your basic needs, you likely have fewer examples of how working hard allows you to overcome major challenges, and you probably have a narrower set of choices from which to make decisions that lead to success.

There is no doubt that social class plays a critical role in resilience. But, social class alone isn’t the whole story. We all have examples of these unique people who thrive despite all odds, and similarly, those who fail despite all odds. Is it possible that by having bad things happen and overcoming them, we learn how to have a better life? The answer seems to be…maybe, but it depends.

Recent research has emphasized the long-standing impact of early life traumas on health outcomes in adulthood. The more traumatic experiences an individual has during childhood, the worse his or her physical and psychological health fares several decades later (4). Part of this is likely related to social class, too. Those most likely to experience significant early life trauma are apt to be brought up in households with greater financial strain, less parental education, and in neighborhoods with greater crime and instability. But regardless of the factors that cause these early traumas, it seems that such significant events can dramatically alter our self-concept, our expectations, our early-life stress levels, and other factors that set in motion a series of problems. But what happens when difficult experiences happen after childhood?

My father-in-law did not face significant trauma early in life, but seems to have spent years sporting his resiliency in adulthood. After his early military service derailed him from his college trajectory early in adulthood, he managed to return to civilian life and complete his architecture degree while raising a young family—barely getting any sleep along the way. As a self-employed architect, he had a career that came with major ebbs and flows, which meant working excessive hours and experiencing a lot of stress. After about two and half decades of marriage and two sons (and I can tell you, they couldn’t have been easy kids to raise!), his wife had a brain aneurysm and subsequent brain surgery, followed by a diagnosis of lung cancer and two years of chemotherapy. He was left with a pile of medical bills and widowhood in his late 50s. He remarried, only to face a similar scenario a decade later.

At age 72 and widowed twice, he remarried once again. When his current wife strongly encouraged him to stop smoking, to eat a healthier diet, and start exercising, he obliged. I am certain those changes have had a remarkable impact on his continued survival. And today, I’d say he’s happier than I’ve ever seen him. But, what allows my father-in-law to manage his current health challenges, make hard changes in his life, and get us to laugh hysterically when he shares his version of stories behind these and many other life circumstances, rather than complain, give in, and resign himself to the health problems plaguing him now? Some would say that he is simply more resilient than the average guy, his doctors included.

When bad stuff happens to resilient people, it appears that in the short-term they don’t do anything different from what nonresilient people do. Instead they feel something different about their ability to handle things. And as a result, they fare better physically and psychologically over the long-term. But as a colleague of mine pointed out, complaining about all of this fuss about resilience, “If something bad happens, what choice do you really have? You have to keep going.” And have you heard that manta: “Whatever doesn’t kill you will make you stronger”? Yet, people who have terrible things happen to them don’t always respond with such a mentality—some complain about the hand they were dealt. Others throw in the towel and stop trying so hard to get back up again. What do you do?

Over the last few years, as my father-in-law has experienced several health events that, alongside his existing chronic conditions, he’s had no reason to recover from, he’s left even his doctors bewildered. And, when we sat in a room full of his friends and family, toasting his 80th birthday, I wondered, how does he do it? Not only did he seem to be well recovered from his most recent medical set-back, which had occurred only a few weeks earlier, but he took us to the golf course to hit some balls. And he proudly showed us a picture of himself wearing a huge grin and holding an iguana from his recent trip to Mexico.

We don’t always have control over the health events or all of the situations we are faced with in our lives. But we usually have choices about how we respond to many of the challenges we face. And, it seems that how we respond really matters when it comes to our health. The next time you find yourself in a tough situation, try to take a step back and think about your emotional response to the situation and how you frame the problem in the context of your life story. Remember, resilience is learned and cultivated through life experiences, and learning, particularly about ourselves, is a lifelong process.

1. “Environment, not genes, plays starring role in human immune variation, study finds.” https://med.stanford.edu/news/all-news/2015/01/environment-not-genes-pla…
2. Crimmins, E., & Fitch, C. (2012). The Genetics of Age-Related Health Outcomes. Journals of Gerontology, Medical Sciences, 67A (5); 467-469.
3. Manning, L.K., Carr, D.C., & Kail, B. L. (2014). Do Higher Levels of Resilience Buffer the Deleterious Impact of Chronic Illness on Disability in Later Life? The Gerontologist.
4. Adverse Childhood Experiences Study. http://www.cdc.gov/violenceprevention/acestudy/

Why Are Some Soldiers With Combat Stress More Resilient ?

Genetic differences may explain the difference, two new studies find.

Scientists in San Diego, Calif., think they have at least one of the answers to a question that has puzzled psychologists for years: why some soldiers are more resilient to combat stress than others.

They believe the answer is in their genes.

After studying the DNA of 13,000 American soldiers, researchers have found two genetic variants that they believe may explain why some combat vets are afflicted with PTSD, but others are not.

“The first, in samples from African-American soldiers with PTSD, was in a gene (ANKRD55) on chromosome 5,” said Dr. Murray Stein, Distinguished Professor of Psychiatry at the University of California-San Diego. “In prior research, this gene has been found to be associated with various autoimmune and inflammatory diseases, including multiple sclerosis, type II diabetes, celiac disease, and rheumatoid arthritis. The other variant was found on chromosome 19 in European-American samples.”

A team from the UC-San Diego School of Medicine, the VA San Diego Healthcare System, and the Uniformed Services University compared the genomes of 3,167 combat vets diagnosed with PTSD and another 4,607 combat vets who had not been diagnosed with PTSD.  A second study involved 947 diagnosed vets compared with 4,969 combat vets without PTSD.

“We compared the two groups in all markers for all genes and found differences that were distinctly different between the two groups,” Dr. Stein told me. “But it wasn’t a 100 percent difference. The group with the variant was about 60 percent more likely to develop PTSD.”

Their hope is that one day in the future a DNA test during basic training will tell commanders which soldier will be more able to withstand combat stress and which might be better suited for an administrative role.

“In theory, that is how this could be used, but we’re nowhere near there yet,” Dr. Stein said. “We have a lot of work yet to do to be sure of these findings. But we may be able in the future to analyze this data and say someone would be very good at combat, while someone else might be better as a supply sergeant – or may need additional training to boost his resilience.”

In addition, further testing is needed to determine whether other racial groups – Asian Americans or American Indians, for example – express the same difference with different genes.

-Eric Newhouse

If You Don’t Have a Father Today…

Maybe you don’t have a dad to meet with today. It’s your day, too.

Maybe you don’t have a father anymore, or feel like you never did. Maybe you never knew him, or maybe he was never around enough to know – emotionally, mentally, or spiritually – even if he was often physically in the same room. Maybe you, yourself, are also a father, or will be soon, would like to be one someday, are married to one, have a child with one, or already have a fatherly role toward others as a teacher, advisor, mentor or boss. While we celebrate and honor the great fathers who are here with us today, many millions of us don’t have one, and this day is for you too.

What can you do today, and how is it that you have made it this far without a dad to reach out to through the years?

Volumes of research on human resilience exist that explain your current success and healthy adjustment. Whether you are a man or woman, taking note of the fact that you do have a good life right now at this very moment is proof that you have everything in you that you ever needed to survive the loss of a father, the absence of a father, the need for a father, and thrive anyway. As someone who lost a father at a young age – and for over a decade has specialized in helping men and women overcome the effects of that absence on their dating, relationship, and career lives – I’d like to share a bit of that research, and some things I’ve learned along the way.

Fathers not only make us more resilient people, but our own natural resilience also assists us in finding the fathering we need. Human resilience has been defined as:

a. a positive outcome despite the experience of adversity;
b. continued positive or effective functioning in adverse circumstances; or
c. recovery after a significant trauma (Masten et al., 1999).

My own dad died when I was twenty-two, in the midst of medical school, and had just broken up with a fiancée. My little brothers were eighteen and about to enter college, and twelve and about to enter puberty. I could safely say that the particular week my dad died was also probably the week I had most needed him, ever. And while my brothers and I dealt with the loss at different developmental stages, with different challenges and gifts, and in unique ways amongst us, there were most certainly universal effects to overcome and actions to take to adapt and heal.

I called my brothers today to ask what they are doing. One informed me that he is going to connect with his former rugby coaches, his former priest, and our father’s best friend from childhood. The second is going to church with his new wife and her parents. I am going to spend time writing about fathers, assisting some of my clients on the matter, and then will meet with some good male friends whose fathers aren’t going to be in the city for the weekend.

I’m also thinking about personal heroes such as an old friend and journalist who passed on many years ago – Starr Wright. He was one of many fatherly people who stepped in to help me along when I needed it. He saw a glimmer of passion for writing in me long ago, encouraged it and nurtured it. With a chuckle thumbing through my earliest clumsy attempts at writing, Starr would put out his cigarette, cough, clear his throat, and regardless of my lack of inborn talent, stoke the pure interest and passion for it, saying, “You’re doing good, kid. Keep at it and don’t let anyone tell you what it’s worth but you. Get to work.”

In all of these personal examples, there is a common thread about resilient humans – men and women both. When we can’t get what we need from a single source, we adapt and get it anyway from diverse sources past, present, and future. We find fathering in our mentors and coaches, our spiritual leaders or the spiritual experience itself, from looking at our father’s life and his past, those who shaped him, indirectly from the fathers of our friends and loved ones, and even from our makeshift families called “circles of friends” – what have also been called “urban tribes” that can substitute for nontraditional or broken families.

We can even look to the future with guidance from men we have never even met, and will never likely meet – our heroes. Feeling fathered, the gifts fathers bestow, life skills they teach, and guidance they provide from a masculine worldview do not have to come from a single source. They can be collected and refined from our life’s experience in the social arena itself, the “school of hard knocks,” and the kind and competent men we meet along the way.

I’m particularly proud of my brothers’ abilities to have graduated college, found excellence in careers, and a solid role in marriage and family with no resources or guidance to begin with.

The absence of a dad is certainly known to affect the young in different ways depending on what their level of psychological development is, but it’s not just what’s in you that matters – how you will do with your life is also dependent on what you surround yourself with, and what you do with the circumstances you are in, to adapt. To take your “lemons and make lemonade.”

Glen Elder in Children of the Great Depression (1974), identified the profound effects of historical change on human development. By comparing the experiences of children born in Berkeley and parts of Oakland, California, in the early and late 1920s, he could show that children born at the beginning of the 1920s were not as susceptible to the effects of family disruption and hardship caused by the Great Depression as children born in the late 1920s (Elder, 1974/1999). The findings illustrate that developmental processes should be viewed not only in relation to individually lived time, but also in relation to the socio-historical context in which they take place.

We live in a time of history right now that has been compared to the Great Depression. And while many of the statistics show job losses taking a heavy toll on men’s health and welfare even more than on women currently, we have different resources at our disposal in the form of social networking and technology, behavioral science and education. The need men and women have for a father hasn’t changed, but the pressures on fathers, and our means of accessing their gifts, have.

It’s a different and more challenging social world for men to contend with than it was a generation ago.

For about a decade I have contributed to teaching an online community of men who – on the surface – seek out information with which to better their dating, relationship, social and romantic lives in general. What I found in that time was something deeper than just a public need for more accessible dating tips for men. I met men of all ages, some single, some divorced, some fathers themselves and all struggling to find a role, a place, and social satisfaction in our changing society. The universal need underneath their diversity ends up clearly being a need for a father – they all identify an absent father, a neglectful one, an abusive one, a father confused over his own role in a marriage, community, or society, or at the very least, the absence of enough practical, genuine, fatherly advice from our media to the degree and breadth of social and romantic guidance that women have enjoyed for decades in that same media.

For the past several years, men haven’t been flocking to the internet “men’s dating community” to learn how to date. They’re looking for a father.

Fathers teach us “how to use our bodies” – which is to say, how to take action out there in the world – to take our resources and use them, face our challenges with courage, adapt, innovate, and solve our problems with our own two hands.

They teach their sons about women, and competition with other men. They don’t just lecture, but literally show their sons how to play sports or fix cars, or get a job that’s meaningful. By example they show sons how to grow a character maturity which will lead to someday having a satisfying marriage, career, and a legacy to give back to the world (as he will have done for us.)

Fathers teach their daughters about men, both through their stories, and through personal example – being the very first man she has ever encountered and “fallen in love with.” Fathers show their daughters they are valuable and precious, and will always, always be protected and safe, but that they have guts and strength and resolve no less than a man. If he can see to it, he will always be there for you to help, to remind you of who you are when you are confused or stressed, and that you are not just any girl or woman, a statistic in today’s confusing social and romantic arenas, or a cog in a corporate wheel, but his daughter.

No matter who you are, a man or woman, or whether your father is alive or available to meet today, you come from a long line of fathers – generation after generation over centuries and ages have led up to making you who you are right now. You are a resilient person from a long line of resilient people. You have the right to celebrate today with all the joy you can muster, honoring those who have fathered you – mentors, advisors, teachers, spiritual leaders, friends, bosses and partners – whether they had one minute to spare which would impact you for a lifetime, or years of devoted concern to give.

It is a day to do – to take action the way fathers are so good at helping us with, rather than just to think or ponder our lives. Here, then, are some actions you can take:

• Contact those mentors, teachers, spiritual leaders, advisors, coaches, and elder friends from your past – to thank them for their impact.

• Be with the friends, supporters, and confidantes of your present life who are your examples of good fathering, and with whom you are striving to go out into the world to make an impact.

• Remember who your heroes have been and who they are now, noticing that their own best features are always aspects of yourself – perhaps qualities you haven’t yet cultivated, matured, and brought to bear in the world around you. Join one new activity that your heroes are gifted at.

• Look to the future and enjoy it now instead of waiting for it to be provided to you. The actions you will take while being your own best counsel – fathering yourself – will lead there.

• Look to the future and wonder who you will provide fathering to, the impact you will make, and the legacy you will leave behind when you’re gone. Start now, and offer to help someone less skilled than you, today.

Regardless of the reasons your father is not around – whether there is unfinished business, anger at him, remorse over what went unsaid or undone , loneliness and missing him, or in a time of stress for which you really wish he was around to provide the answer – you are still here and there are real things that need to get done. You don’t have to impress his memory because you never could get his attention, or vow to be his opposite because he let you down. You are resilient, and can forgive his failings while enjoying the skills for building a life you inherited anyway, if only in his DNA.

Get to work.

Father’s Day is your day too, and in every courageous act in which you do what is right, even if it is difficult or uncomfortable, every ambition in which you fail and pick yourself up anyway for another go at it, you’re living a genuine Father’s Day. Every time you pass on what you know, assisting someone with less competence, less experience or skill than your own, you are honoring yourself, and fathers everywhere. You’re honoring fatherhood itself.

You’re doing good, kid. Keep at it, and don’t let anyone tell you what you’re worth but you.

Paul Dobransky, MD