Tuesday, May 29, 2012

Ex-prisoners deserve chance

Ex-prisoners deserve a chance
More resources will help overall justice system.

Former maximum security prisoners gather recently for a reunion, where they discussed obstacles to the re-entry process.
Columbia Daily Tribune
A reunion of 20 former maximum-security prisoners, sponsored by Catholic Charities of Central and Northern Missouri, gave me an opportunity to discuss with them the problems of re-entry into civilian life. They offered thoughtful suggestions about what could be done to prevent recidivism, focusing on two areas: preparation for discharge and mentoring during the re-entry process.

While incarcerated at the Jefferson City Correctional Center, the ex-prisoners had participated in the Therapeutic Community program. As a psychologist, I was involved in workshops in the program, which began in 1995 in Missouri. In a special open-door section of the prison, prisoners faced ongoing confrontation of their criminal thinking and tendency to shrug off responsibility for their actions. The group's members unanimously agreed their successful readjustment to life outside prison was attributable to participation in the program.

These men are like Rip Van Winkle, who slept 20 years and awoke to a far different world. One of the worst-case scenarios is a prisoner who was sentenced as a teenager to 37 years. Upon re-entry, the world would be so strange it might seem easier to go back to prison. Consider a few of the changes that have occurred and how long it might take to adjust to them: computers, cellphones, GPS, the Internet, cars that park themselves.

To ensure more success stories, attitudes need to change not only for the prisoners' sakes but also for the state's financial welfare. In Missouri, keeping an individual in prison costs more than $22,000 a year. Better rehabilitation programs could drastically reduce the number returning to prison. Our focus on building more prisons and locking people up for longer periods is not working. Our get-tough-on-crime strategy is a failure. The United States has the largest prison population and the highest rate of imprisonment in the world. Out of every 100,000 Americans, 743 are incarcerated. No other nation even comes close.

Missouri legislators and judges have recognized and have taken steps to cut the number of individuals sent to or returned to prison. They understand long sentences related to the three-strikes procedure and nonviolent offenders have increased the prison population significantly. The General Assembly has passed new laws that will result in fewer prisoners on probation returning to prison. A recent measure approved by the legislature would shorten some sentences and allow for "shock" sentences. An amendment by Sen. Jason Crowell, R-Cape Girardeau, establishes a joint committee to review and potentially revise the Missouri Criminal Code. The unanimous passage of the amendment suggests lowering the number of prisoners is important to both parties. The Missouri Department of Corrections spends more than $660 million a year and incarcerates more than 30,700 people. By keeping some nonviolent offenders out of prison, it could begin cutting costs immediately.

In addition to the legislative action, the Missouri courts have gone to "smart sentencing," a process by which the offender's conviction code, criminal history and other background information are put into a computer that gives a range of recommended sentences, the likelihood the individual might commit future crimes and the financial costs of various options. Because probation is much cheaper than prison, the analysis hopefully will decrease the number of nonviolent criminals and drug and alcohol offenders who are sent to prison and instead place more of them in rehabilitation programs such as Drug Court.

The men at the reunion told about their lives after prison and introduced their wives and children. They all thanked Don Cline, the retired assistant warden who helped start the Therapeutic Community and gave the men considerable freedom in how it was structured. I got recognition as a trainer who helped give the prisoners who were the team leaders both leadership skills and some therapeutic skills in dealing with addictions. Two major issues are attacked in the treatment program: substance abuse and criminal thinking. It is an intensive reorientation of their thinking using direct confrontations and cognitive restructuring. Basically, that means skipping the childhood traumas and dealing with the faulty thinking about who they are and what they have been doing. Applicants who couldn't handle the pressures to change were soon dropped from the program and returned to the locked section of the prison.

Most of the ex-offenders remembered the date they decided to change their lives, a period when most also decided to accept the teachings of Christ. As they introduced themselves, they said things such as, "It saved my life;" "I signed up for freedom;" "My criminal thoughts needed to be worked on;" and "It was a satisfaction to find that police who used to chase me now come to me as customers." One said, "The power of others as examples was very important to me." Several were moved to tears as they told their stories.

I individually interviewed half a dozen men. During my presentation, I asked questions of the group to get their ideas about rehabilitation of prisoners. The following is a summary of some of their comments and suggestions.

  • It is difficult to get an education in a prison system that resists offering college courses even when professors offer to teach for free.
  • People are mad at inmates for their crimes and don't want them to have any advantages. The attitude also affects the legislature.
  • Some programs would work better if they were run by ex-prisoners who had succeeded on the outside after spending a fair amount of time in prison.
  • Ex-prisoners need vocational counseling and job search help.
  • One ex-offender said when he went to the job center for help, he was pointed to a computer. He had never used one and had no idea what it could do for him. At that particular place, he was offered no help in learning.
  • Upon re-entry into society, prisoners need a guaranteed job with minimum pay for six months to get their skills back up to speed. They must pay for things such as anger management programs, and with no resources, they end up in debt right at the start. Prisoners should work while in prison. Some jobs exist, but there should be more. Many prisons could become self-supporting.
  • People don't want a state-owned institution competing with private industry, but the public has to pay the $22,000 a year to support prisoners.
  • Mentors who have successfully made it back into the community could help ex-prisoners readjust. Skills such as anger management should be taken care of before discharge, not afterward at a cost to the inmate.

In the early 1970s, I consulted at the women's prison in Tipton, which I thought of as a forward-thinking institution. The superintendent believed every woman should get as much education as possible, and she mainly pushed GEDs. She believed women should have jobs in the prison and, if possible, the job should be one she could work at after discharge. Women were taught to sew, to do kitchen work, hairdressing and office skills. She invited me and a graduate class I was teaching to give each woman a vocational-interest test, an academic-aptitude test and a personality appraisal. Each had an individual session with a student to go over the test results and talk about their future after prison. I believe investing in a program such as that would cut the recidivism rate for both men and women. The program at Tipton fell apart when the superintendent died suddenly, and the new superintendent did not believe in treating felons so well.

Part of the solution to Missouri's prison problems might be placing less emphasis on "get tough and punish severely" and more on creating a more helping environment for ex-prisoners, soon-to-be released prisoners and drug offenders. Missouri has been making progress, but there is much room for improvement.

Wayne Anderson is a professor emeritus of psychology at the University of Missouri and a Tribune columnist.Copyright 2012 Columbia Tribune. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

This article was published on page D3 of the Sunday, May 27, 2012 edition of The Columbia Daily Tribune.





Friday, April 6, 2012

Disaster Survivors Grieving


DISASTER SURVIVORS’ GRIEVING

            After the Oklahoma City bombing in 1995 I had an opportunity to work with first responders as part of a training program run in Oklahoma City.  It was made clear to me by the participants that the problems of the survivors who were in the building at the time of the explosion were different from those of the relatives and loved ones of those who were killed in the disaster.  This was confirmed on my many later trips into disaster areas around the world and as a result I developed a training program for helpers to specifically deal with the reactions of survivors who had lost a loved one, usually a family member in the disaster.

            Immediate survivors, that is, those who were subjected to the near death experience or the horrific scenes of a crisis would often have a double reaction.  That is they would be having a post traumatic stress reaction and also be suffering from the other reactions of grieving when they lost someone near to them.  The reactions to those loses needed to be approached as a separate issue.

 The Training Program

            The participants in the training program as I have run it here in America are usually law enforcement personnel, but when I ran the program in trauma zones the participants were doctors, teachers, and others who were in a position to be in contact with survivors.   I didn’t find it necessary that the helpers have any kind of professional degree which is rarity in most trauma areas of the world.

            My instructions to the group were:  “You are going to be put into work groups.  You are to consider that you are all experts on your culture and its ways of dealing with grief.  You will be given some of the critical issues that need to be dealt with and an illustration of how I might deal with it as therapist.  Research has shown that people in all cultures have to deal with the same problems of loss, but that the methods of resolving them may differ.  For each therapy problem, your work group is to develop two other helpful interventions you might make.”

  1. How do you help the individual or family get closure?
One way is through meaningful burial customs.  I had several experiences with funerals were I became angry because they were so impersonal, the deceased could have been any one.  As a result I have been involved in at a least a dozen funerals of friends and relatives to help turn them into a meaningful closer of that person’s life.

I feel funerals as a rite of passage serve the following purposes:

·        Chance for tributes to the recently deceased emphasizing the worth of that individual and establishing that he/she is worthy of the pain of grieving.

·        Draws the family members together by sharing the ritual of preparation

·        Permits the expression of sorrow

·        Crystallizes the reality of the death through contact with the body and performance of ritual

·        Provides opportunity for healing conflicts within the family by requiring agreement on the form of the ceremony

·        Permits acceptable disposal of the body

·        And for most people it is a religious ritual that gives hope for reuniting with the deceased

         This is one way of getting closure, how might it be handled differently in your culture?

2.  I very soon learned that special problems were created when the body of the deceased was not available.  In Bosnia, Kosovo, and Iraq victims were often buried in mass graves, and in other countries like Argentina and Russia victims simply disappeared.  In the two major terrorist attacks here in the US, bodies were vaporized.  In the Viet Nam War many bodies of our soldiers were not recovered.  For many survivors life cannot go on until they are positive the person is deceased, but they refuse to accept the death until a body or other solid evidence is produced. In Bosnia much expense was involved in doing DNA testing on bodies from mass graves to prove to the survivors that their loved one was dead. Short of DNA testing what might you do to help survivors accept the loss?

  • One method I have used is to conduct an imaginary funeral in my office with the client picturing the deceased in the coffin, saying goodbye, saying a prayer over the body, and then placing the coffin in the ground.
  • Another imaging technique I have used is to have the survivor have a conversation with the deceased who is imagined to be somewhere the after life, where the deceased informs the survivor that he/she is dead and in a better place.
  • The use of these techniques is conditioned on the survivors’ religious beliefs.  What might you do to help the survivor accept the finality of their loss?
3.  Anger is not unusual.  Sometimes the anger is toward the system or the government.  In America some people were angry at the government because they did not prevent the World Trade Center destruction by terrorists.  After airplane crashes the anger is often toward the airline.  

  • Some airlines have learned to handle the anger by notifying relatives before anyone else, bringing them to the place where the crash occurred, and doing a memorial ceremony.
  • For some people simply allowing them to vent the anger is sufficient, that is, don’t try to defend the actions that may have resulted in the disaster, just accept the expression of anger and recognize its legitimacy.
  • What might be some ways that you could help the survivor deal with their anger?
4.  It has not been unusual for me have clients where the anger is directed toward the person who has died.  There is unfinished business of one sort or another.  I have talked with women who were angry at their husbands because they died and left them alone and helpless.  “How could you do this to me?”  Or the deceased was a bad parent or an adulterous mate.

  • One method I have used is to have the survivor write a letter to the deceased pouring out all of their feelings about the unfinished business or other emotions they have.  The letter is then read out loud to me and then in a ceremony burned.
  • At this point the reader can conclude that I am very impressed with individual’s ability to imagine scenes or conversations in their mind’s eye that can be very helpful in their dealing with these emotional issues.  One imaginary scene I have used frequently is a conversation with the deceased where after the survivor has faced a chair in which they imagine the deceased to be sitting and told them what they are angry about, they move into the chair and give the deceased reactions.  This evolves into a back and forth movement of the client as the issues are worked out.
  • Consider you are working with a survivor who still carries a load of anger at the deceased.  What else might you do to help them become more comfortable with the loss?
5.  Survivors often feel guilty.  Was there more they should have done for the deceased?  Were there things they should have told them, such as I love you and respect you?  If the person died slowly and painfully was there a sense of relief at the death that the survivor feels guilty about?  Giving the survivor the opportunity to talk about their guilt is very important.

  • One of the most powerful techniques I used is to have the survivor close her/his eyes and imagine the deceased is in the room.  The survivor is to tell the deceased his/her concerns and feelings.  Then the survivor is to imagine that he/she becomes the deceased and tells the survivor his/her reaction.  Almost always the deceased in these situations is very understanding and forgives the survivor. 
  • Early in my career I found that doing good works or helping others without claiming credit did much to alleviate guilt.  I was as this was an atonement for what they felt they had done wrong.
  • I explain that relief at the death of a loved one is a normal response that almost everyone has, for some survivors just an explanation of this as a normal is sufficient to help them deal with the issue.
  • When faced with this guilt what might you do to help the survivor deal with it?
6.  Returning soldiers will often have strong guilt feelings that are difficult for them to discuss with someone who has not undergone the same experience. They often feel responsible far beyond what they should given their position and real power to influence the situation and take a hundred percent of the blame for the death of fellow soldiers, or civilians. 

  • Have a discussion of what percent of responsibility can be assigned to each of several groups involved in the action for the loss of life; the military, the enemy, the government, other soldiers, the dead person, the world situation, what ever factors look like they placed a role in the death.  The goal is to cut down on the sense of responsibility.
  •  
7.  Men and women in the United States differ in how they handle the death of a partner.  We know that for most people it is the most stressful thing, other than their own near death experience, that can happen to them.  What might you do differently for men than you would for women?

·        Men in our culture often lack support groups.  One thing you could do is encourage them to volunteer to work in an agency such as a soup kitchen where they could feel that what they are doing for others is highly significant.

·         

8.  What might you do differently for women than you would for men?

  • Many older women in the United States have lost contact with their own special skills and abilities.  Some practical counseling about what roles they see for themselves and rediscovery of talents can be very important.  In our community there are many courses available to older persons to help them learn new skills.
  •  
9.  In conflicts around the world children are often victims.  In Bosnia the mothers who had lost children told me that memories of the happy times were very important to help them deal with their pain.   How can we help mothers deal with their loss?

  • Jot down favorite memories of the good times with the deceased.  Make a scrapbook of pictures and memorabilia to keep the memories alive.
  •  

10.  In the case of suicide or murder there is often special pain and confusion.  The survivor has a strong feeling that no one can possibly understand what they are going through.

  • Support groups of persons who have gone through similar situations can be very helpful.  It is especially good if some members of the group are further along in the grieving process.  It is also helpful if a leader can be provided who has been through a similar experience and the group members know that.
  •  
11.  Working with other people’s grieving can be very stressful.  At times you will be accused of not being able to understand what they are going through. How would you handle that accusation?

  • Reassure them that, “Your story is very important to me. Knowing what you are feeling and thinking will help me understand others who have had similar losses.”
  •  

Monday, March 26, 2012

Responding to Disaster


Disasters and First Responders  

In any disaster or critical event, there are four groups of survivors. Although individuals in all these groups are likely to have traumatic stress reactions, there are important differences between them. The groups are:

  • Immediate victims of a disaster.
  • Rescuers on the scene — this would include paramedics, law-enforcement officers, firefighters and other first responders.
  • Relatives and friends of those killed or severely injured in a disaster.
  • Doctors, counselors and therapists who work with the first three groups of victims after a crisis.
First Responders

            Among those involved in rescue operations after a traumatic event are firefighters, paramedics, military and police personnel, medical doctors and nurses and specialists in the use of rescue equipment. They help the immediate victims and pick up the remains of those who died. In some situations, such as 9/11, because of the way the buildings collapsed, many rescuers became immediate victims.

            Although these workers have been trained to handle critical events, all can encounter horrendous situations that overwhelm their own defenses. Some events like 9/11 are so beyond ordinary human experience that almost anyone involved will suffer a traumatic response.

            Rescuers sometimes feel stressed because they have been involved in an operation where something went wrong or they thought they should have been able to do more. For example, they thought they should have been able to save someone they were not able to save.

            The dedication of the rescuers is intense. Many refuse to stop at the end of their work period. As bodies are uncovered of people who survived the initial destruction but died later, some rescuers will feel guilty because of a belief that they were responsible for the person’s death by not getting there in time.

            The following example given to me by one of my students in Criminal Justice illustrates the kind of situation that creates stress reactions in rescuers.



The life of a firefighter

Twenty minutes before the wake up call you are sound asleep in the bunk room, when the bells go off.  You rise to listen to the call.  The first thought that runs though your mind is, I sure hope it is a false alarm.  As the dispatcher calls out that there is a fire in the fourth quadrant. You run to the bay where you step into your boots.  You run toward the truck as you pull your pants up and slide your red suspenders over your shoulders.

Now that you are on the truck you begin to replay your training.  Do I need to get the hose?  Who am I going to work with?  Am I ready for this?  As you finish putting on your coat, gloves and stokes mask you slide your arms into the straps of your oxygen tank.  I sure hope I can get this tank to pop out of its holder.  Why does it have to be so secure?

As you pull up on the scene another fireman jumps off the truck to hook the hose up to the hydrant.  You jump off the truck and run down your gear.  Do I have everything? Is my oxygen tank on right?  As you put on your mask you take your last breath of fresh air and secure the seal.

One of the residents grabs your captain by the arm and is talking in hysterics.  You wonder, what is she saying?  Please don’t tell me there is still someone in there.  You look up at the burning house.  You tell yourself if there is someone still in there they don’t have much chance of survival.  Your captain comes over to tell you and your partner there is a five year old little boy still in there.   As he continues to talk you have blocked him out as you go off to think about your little girl at home.  What if she were in there?  What would she be thinking?  Where would she be within the house?

As you come back to the scene you are entering the front door.  You make a mental picture of your path as you can not see your own hand in front of your face.  You lead the way further into the fire as you work your way around the walls on your knees.  You have to continually tell yourself to breathe and to breathe slowly so you don’t use all of your oxygen before you are able to locate the child and exit and building.

As you enter another room you add it to your mental picture of the house.  You crawl over some items on the floor.  You instantly think we must be in a child’s bedroom, and we are crawling over their toys.  You yell out to the boy, and get no answer. You get that awful feeling in the bottom of your stomach.  You ask yourself, what if we are too late?  You press further into the room thinking where would a five-year old hide?  Staying in connection with the wall you and your partner work as a team to search the middle of the room.  I need to pay special attention to all hiding spots, you tell yourself.  As you feel under the bed you feel something that could possibly be the young child. You pull the lifeless body out from under the bed.  You think how could this happen?

Again you flash back to your little girl at home.  You know you must concentrate on the task at hand.  You think, what if we had moved through the house a little quicker?  Could we have found the boy in time?  With the feeling of failure you and your partner grab the child and proceed toward the exit.  As you get to the door of the bedroom you think of the mental picture you drew in your mind as you went in, allowing yourself the opportunity to quickly work your ay back to the front door.  On your way out of the burning house you think how am I going to tell this child’s mom he didn‘t make it?  How will I go home and hug my girl knowing this mother will never again be able to hug hers?

Back at the station you wash your gear, help refill the oxygen tanks, replenish equipment and clean the trucks.  You go through your routine very lifeless almost like a robot.  You continue to replay the days event, thinking what if we could have gotten out of the station quicker, drove faster, located the child in less time?  Could I have done anything different that would have saved the child’s life?  You can only come to one realization, that is, you will never know.



            The point is there are events that leave even the professional helper with a traumatic reaction. As a result, it has become standard practice in some places for the workers at disasters to receive critical incident stress debriefing after their tour of duty.

            Critical incident stress debriefing is a procedure developed years ago by paramedic Jeff Mitchell to prevent rescuers from developing post-traumatic-stress disorders. After such disasters as the Hyatt Regency collapse in Kansas City, it was discovered that if rescue workers were not debriefed, a significant percentage of them quit their jobs after the event. As a result, the American Red Cross sends disaster mental-health professionals to do critical incident stress debriefing with all its workers after a disaster.   Some recent research has suggested that debriefing is not of benefit to everyone and in some cases may make the situation worse.

 Positive Self Talk

The Rescuers: Talking ones self through a crisis.

What follows are two scripts prepared by students in my Crisis Intervention class for the Criminal Justice Masters Program.  These illustrate the principles of self talk as way of preparing for a crisis and for working ones way though it.

 A major automobile accident

            You have been called to the scene of an accident where you expect to find a dead body.  You need to remember there is nothing you can do physically to help that person right now.  The best thing you can do to help that person and his family is to discover the cause of the accident, arrest the responsible party or simply report the accident for review by the Highway Patrol and future road planners.

            You reach the scene of the accident.  You have some duties and some concerns to take care of before you approach the vehicle.  You need to be sure you are going to as safe as you exist your vehicle. You make sure there are no traffic hazards or life threatening objects that could hurt you.  You need to be sure there are no life threatening injuries while you are here on the scene because you are going home tonight, unlike the unfortunate person involved in the accident.

            You make sure traffic is blocked off and you do all that you can to be sure that there are no gawkers or rubber neckers.  You then go to the vehicles involved in the accident and determine if there is any life inside either car.  If there is you will do your best sustain that life and to try and relieve the victims fears and concerns about what is taking place.

            As soon as the medical personnel arrive you detach yourself from the care of the victims and turn your attention to the investigation of the accident. You need to remember that you can only help and injured person within your capability.  Your cannot help a person who has injuries beyond your capabilities without medical personnel.  If a death occurs you need to remember it was not your fault.  You did not cause the accident and you were not driving the vehicle.  You will remember that accidents happen and that ultimately if a passenger in a car dies there was nothing you could have done to prevent it.

            You will proceed to investigate the accident to the best of your ability, using all the resources you have available to you, including experts.  You will reassure yourself that no one you know was involved in the accident and that your family and friends are all safe at home. 

            You will most likely be called to aid the medical examiner in collecting the bodies.  This task may be difficult.  It is, however, important to the family of the victim that all of the pieces are collected.  It is also important for you to remove any signs of the accident so that when family come, as some do, to that location, that there is no indication that their loved one suffered.

            If there are pieces of the victim to pick up you will remind yourself that this isn’t enjoyable but that is part of the job you love.  This does not have the excitement of arresting a bad guy, but it is also part of the job.  You can reassure yourself that they are not your family and that you had very little attachment to the person in the vehicle.

            You will remind yourself that it is OK to feel sorry for the victim.  If you feel like joking about the accident outside of the earshot of the family that will be all right if that if one of your ways of dealing with stress.

            Later you will seek another officer out who has had previous experience to speak with about the incident.  By speaking with another officer, even if it is to tell then about the crash, the information is no longer held within you and it is out in the open.  You will not have to carry the sights you saw all by yourself. 

The following scenario was worked out by a student who worked in the State Court’s Judicial Education Building.

 Tornado Warning

            The small brick office building houses staff offices on the upper level and classrooms on the lower.  There are entry points on both levels, but no stairs as the floors are connected by an elevator. 


Crisis Scenario: A tornado warning is issued for our area.  A tornado had been sighted on the ground just as few west of the building.  At the time of the warning, the staff members are in their offices on the upper level while two classes are being held on the lower level.  It is storming outside and you notice that the wind speed is increasing.  Small items including leaves and small pieces of trash can be seen blowing across the parking lot.

My Script: You hear the tornado warning begin to wail.  Your heart begins to pound as you immediately think of the classrooms full of people on the lower level, and the staff members on the upper level. You think about what you need to do.  You know the classroom of attendees were told at beginning of class where they were supposed to assemble in the event of a tornado, and where they needed assemble if they had to evacuate the building. You are unsure of whether the other program administrator’s class was also informed.  You are concerned that in the excitement of the situation, some of the participants and staff members may take inappropriate actions and you know it is your duty to insure their safety.

            You tell yourself to stay calm and that you know what to do.  You call the lower-level reception desk where your secretary is working and tell her you need her to go to both classrooms and tell the participants to assemble in the restrooms because of the possible tornado. You plan to gather the staff members on the upper level and ensure they join the class participants downstairs.  You take them on the elevator to the lower level.  You think to yourself, “Once again, it sure would have been nice to have had stairs, but taking the elevator is safer than sending everyone outside where they could be hit by flying debris.”

            On the lower level you direct the staff to join the class participants in the restrooms that considered the optimum safety locations should the tornado hit the building.  You check the building to be sure everyone is in the safe area.  You are aware your heart is racing and your muscles tightening up.  You recognize these as signs of sensory arousal and tell yourself you have planned well and have done everything you have been taught to do in this type of emergency.  You take a couple of deep breaths.

            You join the others in the restroom and comfort those who are stressed by leading them in some controlled breathing exercises.  You commend everyone for cooperating.

            When you hear the all-clear signal you instruct everyone to return to their offices/classrooms thankful that everyone is safe and that a potentially chaotic situation was handled well.  You tell yourself, “I handled that one pretty well!”




Sunday, March 25, 2012

Disasters: The Immediate Victims


DISASTER: THE IMMEDIATE VICTIMS


Early in my working with trauma I became aware that there was a difference in how people responded depending on what their connection with the crisis event was.  There are four groups of people who suffer the greatest impact and in many cases, their lives may never be the same after the critical incident.


Who are these major victims?

            In any disaster or critical event, there are four groups of survivors. Although individuals in all these groups are likely to have traumatic stress reactions, there are important differences between them. The groups are:

  • Immediate victims of a disaster.
  • Rescuers on the scene — this would include paramedics, law-enforcement officers, firefighters and other first responders.
  • Relatives and friends of those killed or severely injured in a disaster.
  • Doctors, counselors and therapists who work with the first three groups of victims after a crisis.
The immediate victims

            Initially our crisis intervention training was directed at helping individuals who had experienced a life-threatening situation, whether they were physically injured or not, who were showing post-traumatic stress reactions.  Much of what I have discussed to this point has been focused on these immediate victims.

            Though symptoms will vary with the individual depending upon his or her background, they usually include nightmares, flashbacks or the vivid reliving of the event, increased sensitivity to sound and sight and highly generalized anxiety. Many victims will have physical symptoms such as sleeplessness, stomach upset, muscle tension and headaches.  As I have stressed it is normal for anyone who was in a situation where he or she could have been severely injured or killed to show these types of symptoms for a period of time after the event.

            If these victims receive no treatment, many will go on to develop a post-traumatic-stress disorder. The symptoms become chronic and interfere with the individual’s ability to live a normal life. Efforts to avoid thoughts associated with the trauma lead to overuse of alcohol or drugs, avoidance of anything that reminds them of the event and a feeling of detachment from others.

            The person’s experiences during the disaster will influence the strength and number of symptoms: How long they were in the life-threatening situation, the severity of their injuries, how prepared they were for the event, effectiveness of rescue efforts and whether the disaster was man-made or natural.  Man make disasters such as terrorists’ attacks may have more potential to create post traumatic stress reactions as there is usually no preparation for the impact, and they are highly life-threatening.  Earthquakes are similar in lack of preparation for impact. All of this suggests the post-traumatic reactions are likely to be widespread and intense.

            A natural disaster that builds more slowly where its effects can be anticipated such as floods result in many fewer cases of post-traumatic-stress.  I was allowed to examine the interview data on individuals who had experienced the Midwest flood of 1993 that resulted in the loss of much property and found that the number of post-traumatic stress reactions was not much larger than the expected base rate among people who have not been exposed to the disaster.  That is there very few new cases. I suspect a flash flood would be more like a tornado or a hurricane in its negative effects. 

            Some personality factors that influence the response are previous experience in coping with danger, the number of other life pressures, age and religious beliefs.

            After a crisis, the world is no longer a safe place for the traumatized person. It will not be safe until some understanding and predictability can be restored to his or her worldview. For many people, the world will never seem safe again.




Thursday, December 15, 2011

RAPE VICTIMS




RAPE VICTIMS: GETTING BEYOND THE GUILT
(From my book The Changing Face of Sex out in January 2012)

            With the entry of rape victims into my client load in the mid ’60s, my education as a sex therapist continued.  I don’t remember the first victim, but I do remember that the receptionist, who was very intuitive about which counselor should work with which client, began assigning me women who had traumatic sex histories.  Although we didn’t call it post-traumatic stress disorder at that time, they had the symptoms we later recognized as such.

            We probably had a greater number of victims coming in at this time because previously victims had not felt they could talk about what had happened to them, but with the change in attitudes toward sex there was a backlog of clients who needed to work on their trauma symptoms.

            Certain symptoms were common with some being severe enough to prevent the victim from living a normal life.  There was an over response to cues connected to the event, nightmares in which the incident was relived vivid enough to wake the victim in a panic, guilt for having caused the incident by some action or inaction on their part, and in some cases a fear of men in general.

            Victims could respond to cues that were visual, auditory or even related to time of day.  One client, who had been captured by the rapist coming out from behind a wall at Stephens College as she walked past it at night, became nervous when walking past any wall at night.  The time cue was from several women who had been raped in their rooms by someone coming in a window.  They would wake in a nervous state at that time of the night. 

            Nightmares were frequent and often lasted for years. One client had been having the same nightmare for six years.  This was one symptom that I was most successful treating with a minimum of work by helping them rewrite the script of the dream and practicing it while under hypnosis in my office.

            The guilt was very difficult to work with and was reported in a number of clusters.  It appeared that if the victims could find things they had done that provoked the rapists, they could feel some control over the events and prevent future attacks.  If the rape was completely out of their control, they had the feeling they were living in a dangerous environment where bad things could happen at any time regardless of what they did to protect themselves.

            Guilt was exacerbated by the mental set of the time of some police, hospital staff and jury members who felt that if a woman got raped it was her own fault.  One victim had dropped out of school and took a lower level job and took to alcohol.  She saw me two years after the rape and still felt guilty about her part in the rape.  She had been working at the hospital, came out of the hospital and walked to her car, which had a van parked next to it.  When she unlocked her door, the van door slid open and a man reached out and took her into the van.  Two men took her into the country, raped her, and discussed different things they could do with her as if she were an object.  They took her back into town and dropped her off.

            The guilt?  “I shouldn’t have parked my car so far from the door; and when I saw the van parked next to it, I should have been more cautious.”   Statements from other victims concerned what kind of clothes they were wearing, drinking too much, and trusting the offender.

Another source of guilt was not taking more action, such as trying to fight the man off or screaming.  Most of the women described how they went weak and lost the ability to fight as soon as the man got close enough to grab them or make a threat to hurt or kill them if they didn’t cooperate.  This often did serious damage to the victim’s self image.  Having once believed she could successfully fight off an attacker or persuade him not to carry through, she now had lost that image of potency and was left with only feelings of vulnerability.

            Later I got some insight into this when I interviewed a sentenced rapist at Maximum Security Prison in Jefferson City.  He had started as a voyeur, who actually climbed into women’s rooms and watched them sleep.  One of them awoke, screamed and said, “Please don’t hurt me; I’ll do anything you want.”   He fled, but thought about it and the next time raping the victim, not only watching, was his goal.  One victim indicated to him that it had been very exciting.  This was what he had really wanted in a victim, and when she asked why didn’t he come back the next night, he did.  “And you know, the bitch had the cops waiting for me.”  He sounded truly amazed at her strategy.

            Occasionally I would have a client who had successfully fought the offender off.  A classic in my mind was the slightly built woman who was seeing me for vocational counseling who had had a rape incident.  She and her roommate had worked late, taken a swim in a nearby pool and came back to their basement apartment.

  She went to take a shower and heard a noise, cracked the door to look out and saw her roommate being held by a man with a knife in his hand.  Her thought process was, “The cops will be here soon, I need a cover.”  She threw a towel over her shoulder.  “I’ll need a weapon.”  She ripped the towel rack off, and went out swinging it.  She moved fast, knocked the knife out his hand.  He grabbed the rack from her hand; she picked up the TV set and threw it at him.  He yelled something about, “You bitches are crazy,” and ran out the door.

            Later in the week as she was walking down the street, she saw him standing on a ladder painting a house.  She called the police; several victims identified him in a lineup and he was convicted. 

At that time it was estimated that only a small percentage of rapes were reported to the police, and even a fewer number successfully prosecuted. Besides the embarrassment and guilt there were other reasons in those days to avoid reporting.  First was the behavior of some police officers.  Some asked such questions as, “Were you a virgin?’  The implication being that if you weren’t, it couldn’t be rape.  “What were you doing in the area?”  “Had you been drinking?”  The questions did reinforce the victim’s feeling that she had done something wrong or was in some way responsible for the rape. 

Some hospital personnel had similar attitudes, and some victims had been treated rudely when they reported to the hospital.  Since many of them had been injured by the rough handling of the rapists, they needed some care and a checkup.  This was before DNA samples were taken. 

Defense attorneys were tough on victims; after finding out the kind of questions they would have to answer in front of the jury, some victims backed out.  They did not want their sexual histories made public.   It was some years before we could get the laws changed so that victims had the same right to protect their personal history as the accused did.

One of the female defense attorneys who appeared on a panel with me was careful in her choice of jurors.   She wanted at least two women over the age of fifty.  She was sure that they would be convinced that no woman could be raped against her will; and if she really had had sex with the accused, she was responsible for it happening.  At this late date it is difficult to get back into the mindset of the period and see the victim as perpetrator.  The defense attorney also recognized that some men feared false accusations and could be an asset on the jury.

It also saddened me to counsel several women who had men in their life react negatively toward them.  One woman, whose boss had raped her, had a husband who divorced her on the grounds of adultery.  Several had boyfriends break up with them because they considered it the woman’s fault if she had been raped, and they couldn’t deal with the fact of her bad behavior.  (Many years later in Pakistan when I was touring a prison in Lahore, I was informed that some of the women in prison were rape victims who had been imprisoned because they were considered to have committed adultery.)

These experiences led me to the conclusion that we needed a rape crisis center, partly as a basis for educating both the professionals and the public about the nature of rape and how to change attitudes to make them less damning on the victims.

When I went in search for some help, I was told that a woman who called herself “Nexus” would be the person to contact, because as a rape victim she wanted to correct some of the same problems that I saw with the system.    I was also warned that she might not want to work with me because of my reputation among liberated women as being a “male, chauvinist pig.” 

When she found out what I wanted, we became a team with our first goal of educating the professionals involved on the nature of rape, the victim’s reactions, and some things they needed in the way of treatment.  We got excellent cooperation in meetings with the police department, hospital staff, the prosecuting attorney and some lawyers who defended accused rapists.  In addition a local TV station filmed a half-hour program with Nexus and me discussing the problem.

The prosecuting attorney at the time would not prosecute a case unless he was sure he could get a conviction.   His judgment was partly based on how well the victim handled questions.  My understanding was his conviction rate was close to 100% despite the defense attorney’s choice of jury members.  Later when I was talking in a prison to a rapist who had received a 13-year sentence, he said, “I made the mistake of getting caught in Columbia.  Your prosecutor has a reputation for getting convictions.”             

           

Therapy

            First the client needed to tell her story.  That established the fact that it was real; it was important that someone had heard it. I would return to the story later as part of the desensitization process.  Next I needed to normalize the client’s responses.  That gave her the feeling that her reactions were not crazy or out of line, but part of what happens to people who have been traumatized.  The message I wanted to give was, “Your reactions are normal for a person who has gone through a traumatic experience.” 

            Some responses were unusual, but still normal from my point of view.  For example, one victim had an out-of-body experience and found herself looking down from ceiling watching the rapist use her body. 

            Because of the tensions and anxiety connected with the rape and its aftermath, I routinely gave my clients a session on relaxation.  The method depended upon their reactions, but most frequently I used a combination of progressive muscle relaxation and the visualization of a safe place.  Most clients could learn this in a short time and with practice outside of the session get proficient at it.  Some of my therapists in training preferred to make an audio tape for the client to use when they needed to relax; and some like my wife, a therapist in private practice, used commercial relaxation tapes that the client used in their home.  Regardless of how relaxation was presented, learning to control physical tensions made a significant difference to most clients.    

             I found the easiest problem to work with to be the nightmares.  The treatment was very straightforward.  The client told me in detail the dream that was disturbing her.  The detail was almost always a replay of the rape scene.  The next step was to construct a new script that in some way empowered the victim,  i.e., the new script put her in control.

            All my therapy files have been shredded, but examples I used in my training program are still clear in my memory. 

Story 1.  The rapist came into the kitchen through the open garage door.  He demanded money, and hoping to escape uninjured the victim went into the bedroom and brought back the funds. It was then he grabbed her, took her into the bedroom and raped her.

The new script involved her going to the bedroom; but instead of getting the money she took out her husband’s pistol and  came back into the room.  As he moved toward her, she shot him in the head which exploded like a melon.  We practiced the new dream several times with her in a light trance, and I asked her to practice the dream before she fell asleep.  The nightmare did not return.   Lest this sound too simple, this was the usual response.  Write a new script, practice it and it replaces the old script.  I found it hard to believe it would be so simple, but no clients reported a failure.  I wish the other aspects of the trauma could have been so easily dealt with.

Story 2.  The second husband of a woman, who had been raped six years previously, insisted she see a therapist because the nightmares were interfering with his sleep.  Her first husband had been a criminal and had been in prison.  The rapist had been in a deal with her husband who owed him money on a drug deal, and he decided to take it out on the wife.  He not only raped her but stabbed her with a barbeque fork.   The nightmares had returned when she learned the rapist was out of prison.

The new dream involved the rapist being in a cell with a heavy door like one on a giant safe that she could push closed, double barricading him.  The dream didn’t work.  She reworked it so that she first looked in the cell and saw that he was looking out the rear window and had no interest in her.  Then she pushed the heavy door shut.  The dream did not return; when I saw her a year later for another problem, the dreams still had not returned.

Story 3. This woman was a student in ROTC who had been running on the campus when the rapist came from behind the greenhouses on campus and physically overpowered her.  She used a solution no one else had used before.  She was an observer to the rape and also the victim.  As she watched the scene unfold, she shot the rapist in the leg.  As a ROTC student she was quite familiar with firearms.  She did not want to do permanent damage, but to teach him enough of a lesson so that he would never attack another woman. 

Story 4. This was an acquaintance rape situation.  We wrote a new script which she went home to try.  A week later she reported there had been no more nightmares, but added that “as soon as you said you could teach me a way to stop the nightmares, you wouldn’t have had to do anything more.  Just knowing they could be stopped would have been sufficient.”

Guilt was the hard symptom to work with.   Believing they were in some way responsible for the rape gave victims a sense of control; without this sense of control the situation became even more dangerous because things were so unpredictable and capricious.  Things they felt guilt about varied:  not being defensive enough by yelling or screaming or trying to run away; having trusted the person because they were a friend or relative; not responding to cues that told them the situation was dangerous; having too much to drink making themselves vulnerable. 

What I found I couldn’t do was argue all of these comments away and convince the victim there was nothing she could have done, because it was out of her control and only the rapist was responsible for what happened.  That leads victims to feeling they live in an even more dangerous world. Instead we worked on planning, “What can you do to make yourself safer?”  Take a self defense course, have a companion if you must go out at night, carry a whistle, and don’t drink with strangers.

    In 1992 an honors student, Kimberly Cummings, approached me to do a study of women’s acceptance of rape myths and their sexual experiences.  She felt that with sexual liberation and loosening of sexual standards that more pressure was being put on women to have sex and sometimes this slipped over into rape.  Our sample was only 112 junior and senior women, but the results are consistent with what had been found in other studies with slightly fewer of our students saying they had been raped.   The results of the latter part of the questionnaire we developed are interesting enough that I will discuss them here.  The answers were given anonymously (see Table 1).

            The first part of the questionnaire dealt with their acceptance of rape myths and how closely they identified with feminine stereotypes.  Questions 1 through 40 are the Sexist Attitudes Toward Women Scale (SATW) developed by Benson and Vincent (1980).  A sample item is, “It bothers me to see a man being told what to do by a woman.” 

Questions 41-65 were rape-myth acceptance items from Burt (1980) and explored rape myths and cultural reasons for this support.  A sample item is, “A woman who goes to the home or apartment of a man on their first date implies that she is willing to have sex.”  (Jumping ahead to more recent standards, that statement may now be true given what my students tell me about the frequency of “hooking up.”)

One of our questions was, do women now recognize when they have been raped?  Earlier we found that in date rape situations the women often took the blame and did not recognize that the use of force against the woman’s wishes is legally rape.   The correlation between items 76 and 78 was .88, a very high positive correlation meaning that women now recognize that they have been raped even in a dating situation by someone they know.

Cummings and I, probably influenced by our own acceptance of the rape-myth mentality, had expected that the more a woman accepted traditional feminine roles the more likely she would find herself pressured into sexual intercourse. Although there was a significant relationship between acceptance of a traditional feminine role and being raped, that relationship was very weak (r = .19, p<.05).  This indicates that a woman’s social orientation is probably little protection against having sexual relations when she does not wish them.

Table 1 gives some additional information about the factors that were and may still be operating in sexual relations between male and female students.  On item 67, 73% of the women reported they had been in situations where the level of sexual intimacy they desired was misinterpreted.  It also appears that some women (items 68 & 69) had sexual intercourse with a man when they did not want to because of pressure in the immediate situation.  A fair number of women also reported they had had force used unsuccessfully against them (items 72, 73, 74).

The data indicate that whether a woman is forced to have sexual intercourse by threats or is raped is not greatly influenced by her ideas about women’s roles or her acceptance of rape beliefs.  Although the women’s mental set or acceptance of certain beliefs has a small relationship to her being pressured into sexual acts, there are other factors that are of more importance in what happens.  The major influence appears to be the attitudes of a subgroup of males who commit sexual aggression and their beliefs about women’s behavior.  The problems in communication about sexual issues evidently go beyond the dimensions we explored in this study.

Since women’s attitudes appear to play such a small role in their having sexual intercourse under pressure, there is a need to place more emphasis on the findings of such studies as those of Kanin (1985) and Lisak and Roth (1988, 1990), which point to a group of sexually aggressive males who see their behavior as macho and who do not label the force they use as sufficient to be called rape.  I will explore these attitudes and behavior in the chapter on date rape.

Sensitizing women to sexual harassment is probably still a worthwhile endeavor, and they should be encouraged to resist male pressure for unwanted sex.  The 25% of the women in this study who had sexual intercourse when they really did not want to because of various pressures from the man may have been contributing to his becoming more aggressive with other women.  Ellis (1991) said, “in the process of courtship, for example, many women may inadvertently reinforce successive approximations of forced copulatory tactics by sexually yielding to the use of mild forms of force” (p. 638).

 Some interesting arguments

            Until the early 1970s researchers acknowledged that while many motivations could be involved in rape, it was assumed that sex was the predominant motive. In the early ’70s women’s liberation advocates began to play a large role in how rape was viewed.  Millet, Griffin, and Greer put forth the view that rape was not a sexually motivated act, and this became widely accepted when Brownmiller published Against Our Will in 1975.  By the early ’80s a researcher could say, “It is now generally accepted by criminologists, psychologists, and other professionals working with rapists and rape victims that rape is not primarily a sexual crime, it is a crime of violence.”

            One effect of this orientation was positive in that it helped us reject the claim that rape is a sexually arousing or sought-after experience on the part of the victim.  But I was concerned about the danger of taking a non-sex orientation.  I thought the outpouring of papers that attributed all rape to hostility toward women and treated rape as a purely aggressive act did more to cloud the issue than to give a handle from which we could think productively about what was happening.

During the ’70s I found myself arguing against the feminist movement’s insistence that rape was mainly a crime of violence and anger against women.  I believed that many factors were involved and that men raped for different reasons.  Let me repeat some of the arguments on both sides.  I will give the feminist side (a) and counter with what I saw as a valid rebuttal (b).

            (a) Sex or sexuality is a drive associated with honest courtship and pair bonding.  In such situations, males report feelings of tenderness and affection.

            (b) A large percentage of males have no difficulty in divorcing sex from love.  Consider the number of them who visit prostitutes or who have casual sex with willing partners.


(a) Rape can not be sexually motivated because of the fact that most rapists have stable sexual partners.

             (b) Having studied rapists, I question that most of them have stable sexual partners; most patrons of prostitutes, adult bookstores and adult movie theatres are married men, but this is not considered evidence for lack of sexual motivation.



        (a) Unlike sexuality, aggression does diminish with age and, therefore, a male’s likelihood of committing a rape diminishes with the onset of middle age.

         (b) Not only does the age of most rapists fail to disprove that rape is sexually motivated, the general correlation between the age distribution of rapists and the general level of sexual activity of males is very consistent with the view that rape is sexually motivated.


           (a) According to Groth and Birnbaum (1979) “careful examination of his behavior typically reveals that efforts to negotiate the sexual encounter or to determine the woman’s receptiveness to a sexual approach are noticeably absent, as are any attempts at lovemaking or foreplay.”

           (b)  That is true of stranger rapes, which are about half of the total.  Date rapists on the other hand, often involve extensive negotiation and foreplay.  These rapists explain their behavior by references to sex needs.  “She stood there in her nightgown, and you could see right through it—you could see her nipples and breasts and, you know they were just waiting for me, and it was just too much of a temptation to pass up.”

(a) “It is not a crime of lust but of violence and power because rape victims are not only the lovely young blonds of newspaper headlines—rapists strike children, the aged, and the homely—all women” (Brownmiller, 1975).

      (b)  This conclusion ignores the fact that rape victims are not a representative cross-section of all women.  It also ignores the possibility that victim selection is based on both attractiveness and vulnerability.  Less than 5% of rape victims are over the age of fifty.   As we will see in the chapter on rapists they are, however, the ones most likely to be killed.

(a) In many cases of rape in humans, assault seems to be the  important factor, not sex. . . (Harding, 1985).

   (b) In my own study of rapists I found a subgroup for whom violence was an important part of the act, but this was not all or even a majority of rapists.  Amir found, “In a large number of cases (87%), only temptation and verbal coercion were used to subdue the victim.”  Other evidence also indicates that it is only in a minority of cases that violence and injury are even one of the goals of a rapist.  Gebhard et al., (1965) also found that the vast majority of sex offenders used force only when required.  If violence is what the rapist is after, he’s not very good at it.  Certainly he has the victim in a position from which he could do all kinds of physical damage.

           Sexual motivation always appears to be a necessary ingredient for a rape to occur instead of a nonsexual assault. “If aggression were the sole motive it might be more simply satisfied by a physical beating” (Rada, 1978).

           
When I studied murderers years later, I was disturbed by the fact that punishment for rape and for murder could be at the class A felony level.  I found rape victims could be murdered, not because of hostile motivation on the part of the rapist, but because the killing of the victim greatly increases the rapist’s chances of escaping punishment by removing the only witness to the crime.