In this issue of Breaking Free we explore trauma-informed dentistry and important reflections for dentistry and trauma survivors.

Meet Kirsty Pratt, her determination symbolized by her blue hair over many months as she campaigned in WA for legislative change, which has now been realised.

There is a writing competition to enter – read more here.

This month’s MY STORY is written by Elise. She shares her experience of PTSD and her personal war “not the kind of war most people understand, I did have my own though”, plus we include a sample of her beautiful artwork.

Given the confusion and misconceptions about trauma and memory among professionals, as well as the wider community, Blue Knot Foundation- National Centre for Excellence for Complex Trauma is please to share with you the paper “The Truth of Memory and the Memory of Truth.”

Find links to the more recently released paper “Talking About Trauma - Guide to Conversations and Screening for Heath and other Service Providers.” This has been followed up with a new range of factsheets for ‘Talking about Trauma’ for the general public which include infographics that are easy to read and share.

In the ‘Self Care Resources’ section we introduce you to a self-awareness app that supports mindfulness, emotional intelligence, and body awareness.

As always if you have comments about what you have read in this issue, contributions for the My Story section or suggestions for future issues, please contact me at newsletter@blueknot.org.au

Warm regards

Jane Macnaught

Hunter Writers Centre is currently inviting all Australians to share their personal experiences of grief through the ‘Grieve Writing Competition’.

With the support of a number of charities and organisations working to assist people in their grief, including Blue Knot Foundation, the competition boasts a prize pool valued at over $8,500. If you would like to find out more about the writing competition, which invites both poetry and prose, please visit the Hunter Writer’s Centre website.

The Grieve Writing Competition closes 8pm AEST, 28 May, 2018.

Blue Hair Exhaustion

Have you heard of Kirsty Pratt?

Maybe you have noticed her hair?

If you live in WA and spend any time in or around State Parliament you could not have missed Kirsty Pratt’s efforts to have legislation passed. Sitting in the public gallery in plain sight of MPs, Kirsty Pratt and her bright blue hair have been hard to miss.

The 42-year-old child sex abuse survivor has vowed to sit and watch Parliament until the WA State Government fulfils its election promise of removing the statute of limitations on taking legal action against perpetrators of child sexual abuse.  Kirsty has been campaigning for almost 4 years alongside 2 state government administrations.  The outcome is imminent.

In early 2017 Kirsty stood alongside the WA Attorney-General John Quigley, when he pledged to end the current time limit on legal action by victims against their alleged perpetrator/s. The bill has been moved from Upper House (where it passed) to Lower House in the past few weeks with an outcome on 10 April a strong possibility.

An excerpt from Kirsty’s Facebook page follows. This page has served as a diary of her campaign. Take a look and you will see a flood of blue hearts.  These along with Kirsty’s bright blue hair are powerful symbols of this campaign.

A day In The Life Of Kirsty

29/3/18

Had an amazing experience yesterday, on what later turned out to be an incredibly tough day for me. It was early and I was sitting in my car awaiting a return call from my Lawyer. A tour group came out of Parliament House, down the front steps. The tour leader made eye contact, we exchanged a smile, she then looked down & noticed my number plate.  Which reads “HAVEMERCY”.

She asked if I could explain our choice of number plate to her group (clearly an ESL class). I got out of the car & led a discussion on the concepts of mercy & compassion, spreading kindness etc. The tour leader then asked me to explain to the group why I was there & I proceeded to do so. I was totally blown away – I witnessed an outpouring of awe, support & gratitude from a multi-cultural group of new Australians. Such lovely people. I really think this positive interaction, is one of the main reasons I was able to get through what turned out to be one of the toughest days I’ve experienced in my Parliamentary vigil - alone. (edited)

Kirsty’s supporters write this heartfelt messages and here are 2 samples:

JGL “You represent the "blue" harsh unspeakable moments of all survivors! You wear it with pride - most people hide it in the darkest crevasses of their minds trying to forget. Yet you wear it on your head with your mind behind it and your story and your soul, and in turn every survivors story. It must be a burden to bear. A burden many could not even try to fathom because of being scared in so any ways.

Your blue is their blue.

Your strength is their strength.

You are a way of hope!

And may every person in those sittings feel the blue pour into their souls. Whether they want it or not. You are the blue sky to their sun and in the end, you will cover the sky in your might!!! The might of all survivors will bring blue sky's to darker days.”

DB: “ Hang in there, beautiful lady. Ultimately we know that this “colour” is not the definition of Kirsty Pratt. It is but her legacy (and future parliamentary legend) of the Blue Haired Survivor/Advocate.“

The Hair - It’s Exhausting  💙

22/3/18

I’m exhausted. My exhaustion is not just a function of the amount of sleep I’m getting, how hard I’m working or even how many people are relying on me. There’s another factor that no-one else would be aware of – and in part, it’s the hair.

No, the hair itself does not take a lot of work or maintenance. I am not in any way emotionally invested in how “good” or otherwise my blue hair looks. Rather, my hair is a symbol & a tool – and therein lies the rub.

For survivors & those who follow survivor issues, it has helped to make me an accessible touchstone, easy to find & identify. I’m delighted that survivors keep telling me how easy it was for them to approach me & share their stories with me. I feel incredibly privileged to be so trusted by complete strangers, with such intimate details about their lives. But I don’t think I need to point out that it can be a heavy load at times.

And here’s the big one: as survivors we carry our trauma, our emotions, our damage and indeed our very status as a survivor at varying “depths” on our person as a matter of course in our daily lives. Yes, that depth is frequently “just below the surface”, but we are in general masters at concealing our emotions and keeping these things private.

That privacy, specifically of my status as a survivor, is no longer in any moment mine, since the day over 2 years ago that I began colouring my hair brightly to bring attention to survivor issues.

This is at it’s most extreme when I’m in Parliament – which is quite frankly, A LOT. When I’m here, EVERY MP, EVERY member of staff KNOWS who I am & why I’m here. Even if they can’t recall my name in the moment, they might think of me as “the lady with the blue hair”, but they will always remember that I’m a survivor & connect me with those issues. Blue Hair – there’s Kirsty Pratt / that lady, sexual abuse survivor.

It’s raw, to the point of almost visceral with every personal encounter I have here in Parliament House, because that is the unspoken truth which is always underlying, even when we’re talking about the weather. I can get to the end of a full day here, feeling like I was holding my breath the entire time. It’s exhausting. My bright blue hair serves a fantastic purpose, helps me to kick incredible goals that most people who encounter me outside of this campaign will never know about. But it is also my very own “Scarlet Letter”, on display on my body 24/7, from which there is nowhere to hide & I’d be lying if I didn’t admit that at times it feels like it is slowing killing me.”

Stop Press: On Tuesday 10th April 2018 the legislation, to end limitation periods for civil action by survivors of child sexual abuse, has been passed through both houses in the WA State Parliament. Kirsty Pratt’s hair will stay blue until the proclamation of the legislation, expected in a few months.

https://www.esperanceexpress.com.au/story/5337050/bill-passes-for-child-sex-abuse-survivors/?cs=1898

https://thewest.com.au/news/wa/child-sex-abuse-survivor-kirsty-pratt-vows-to-keep-watch-of-wa-parliament-until-labor-deliver-on-election-promise-ng-b88636316z

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Tips and Facts for Having Conversations About Trauma

How to relate to and engage with people who may have underlying trauma

As a society we are becoming increasingly aware of the prevalence of trauma and its devastating impacts. The recent Royal Commission into Institutional Responses to Child Sexual Abuse shed light on the wide-ranging prevalence of trauma and the significant toll it took on victims.

Pam Stavropoulos Blue Knot Foundation – Head of Research spoke with PROBONO:                                          

“I think as a result of the Royal Commission, so many more people are aware of just how prevalent trauma is. Prior to the Royal Commission, often people thought ‘oh this is terrible but it’s just a few people’,” she said. 

“Now we know the impacts of trauma are society-wide. The danger is that people know about it but feel uncomfortable to engage with people thinking ‘I can’t talk about it, I might upset the person, I should keep quiet’.                                                                                                                                       

“So that’s why we’re releasing these publications talking about trauma, to assist all of us just to feel more comfortable about engaging around potential trauma.”

 Released on World Health Day 7 April, 2018  Blue Knot Foundation’s Talking About Trauma - Guide to conversations and screening for heath and other service providers is a publication for services to help them have safe conversations with clients who have experienced trauma. You can purchase a hard copy or download a free copy.

Many people feel poorly equipped to have conversations with people they know or suspect have experienced trauma. This includes service-providers, including health services. It is as relevant for services which don’t provide clinical treatment, but which engage with people, many of who have a lived experience of trauma, as it is for clinical services.

“All services, whether it’s health, whether it’s Centrelink or whether it’s a police department, need to be trauma-informed. It is not about clinical treatment, but it’s knowing how to relate to and engage with people who may have underlying trauma,” Stavropoulos said.

The report outlines the key principles of trauma-informed practice, including prioritising the foundational principle of “do no harm”, understating the effects of stress on the brain and body and remaining sensitive to client comfort levels and the way in which a service is delivered (not just what the service is).

Pam Stavropoulos said there were a number of ways services in the social sector could ensure they implemented a trauma-informed approach.

“The main thing around that is acting according to the basic trauma-informed principles which are five-fold. These are safety, trustworthiness, choice, collaboration and empowerment,” she said.

“All conversations with clients should be informed by these principles. So if there’s a safe environment, it’s a collaborative approach and people engage in a way that helps them to feel empowered, then that is a trauma-informed way of relating and it will minimise the risk of any underlying trauma being compounded and minimise the risk of re-traumatisation.”

In addition to the Talking About Trauma publication for heath and other service providers Blue Knot Foundation has also released a new range of fact sheets for the general public which include infographics

Talking About Trauma with a Family Member 

How to have a conversation with a family member you know or suspect may experience interpersonal trauma

Talking About Trauma with a Friend 

How to have a conversation with a friend you know or suspect may experience interpersonal trauma

There are a number of ways in which the whole community, including service providers can ensure they are communicating with a trauma-informed approach. This is by acting according to the five basic trauma-informed principles: safety, trustworthiness, choice, collaboration and empowerment.

If we all endeavor for all of our conversations with people who have experienced diverse traumas, including adult survivors of childhood trauma to be trauma-informed we are creating a collaborative safe environment in which people feel empowered and the risk of re-traumatisation is greatly reduced.

“If they feel cut off or not heard or patronised or interrupted or unsafe in any way, they’re more likely to be triggered if they have trauma and to disengage” Pam Stavropoulos

“So it’s very high stakes. This goes for well meaning family and friends as well. We hope you find the fact sheets, info graphics and paper useful.”

https://probonoaustralia.com.au/news/2018/04/social-sector-urged-implement-trauma-informed-approach-service-delivery/

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No One Enjoys Going To The Dentist!

By Jane Macnaught, Breaking Free Editor

Supporting information for trauma survivors

Let’s be honest: No one enjoys going to the dentist. But for people who’ve experienced trauma, the prospect of sitting in a dentist’s chair can be triggering and frightening.

Many people who have experienced adverse childhood experiences, i.e. trauma, avoid the dentist. When I was researching for this article I found lots of reasons to explain why people might avoid going to the dentist.

One person had 7 teeth pulled without adequate pain relief. This is because the medication did not work until she had left the dentist’s office. After that she was numb. Understandably this painful experience meant this person had a great fear of dentists.

Another person described living with tooth pain. She had a series of fears around visiting the dentist related to her trauma history. Other people speak of being unable to concentrate at school due to dental pain and being unable to afford treatment. Some adults report having a difficult time with job interviews, meeting new people or smiling because of issues with their teeth.

Furthermore drug use, smoking, poor diet, and excess sugar complicate the potential dental issues – if you experience poverty, household/mortgage stress and homelessness healthy food options can be limited. This makes dental care a low priority.

Researchers have found that children exposed to adverse experiences are more likely to develop tooth decay and gum disease and suffer from conditions such as unfilled cavities, missing teeth and toothache, all of which can have serious implications for overall health.

Chief Executive of the British Dental Health Foundation, Dr Nigel Carter OBE, says the effects of such childhood experiences should remain in the foreground of dental professionals, public health advocates and the government’s social support networks.

“It is important that screening for adverse childhood experiences in dental visits continues to be improved so future research can focus on refining intervention plans and minimising dental health disparities.”

Survivors of childhood trauma and abuse may have DENTAL specific issues:

·         Not being able to make and keep dental appointments,

·         Stress-related dental problems such as excessive tooth wear and sensitivity,

·         High levels of fear, anxiety, nausea, dissociation or flashbacks,

·         Headaches, poor sleep patterns, and periodontal disease,

·         Feelings of shame around being anxious in the dental chair, having poor oral health, or having someone learn about their childhood trauma

Strategies that can reduce these issues include empowering a patient with some sense of control during a dental procedure, and fostering a feeling of safety in a trusting environment.

I read about one dentist who sits with her patients at their first appointment and asks them about any concerns, fears or phobias. She co-creates a plan to help alleviate their concerns and conducts the treatment with the patient feeling they have some control over the process.

Current new patient information forms ask questions about dental history, medications and current dental concerns. Creating more trauma- informed processes could also include questions about a patient’s emotional state. For example, a series of questions assessing the level of stress a person feels about their appointment. Or asking whether the person experiences anxiety, phobias, or other issues that may impact the dental session? 

In discussing fear of dentists or dental phobias we tend to focus on fear of dental treatment, especially of needles and pain. While many survivors of childhood trauma may fear needles and pain, there are often deeper fears and feelings at play:

·         Having to lie back or be horizontal.

·         Having objects such as instruments and cotton rolls in their mouth.

·         Having a dentist’s hand(s) over their mouth and/or nose.

·         Fearing they might not be able to breathe, swallow or gagging

·         Fearing that the treating dentist may become angry or impatient with them during treatment.

·         Fearing an anxiety or panic attack getting out of control, and that they might react in an ‘apparently irrational’ manner which could be embarrassing.

·         Feeling vulnerable in the dental chair due to the loss of control needing to lie down invokes.

·         Being alone in a room with a person who is perceived socially or professionally to be ‘more powerful or educated’ than oneself.

Trauma-Informed Dentistry

With dentistry this means a patient having some control over the procedure e.g. explaining that it is possible to stop at any time, by simply making a hand signal.

It is also helpful for the dentist to be alert to and tune into the fact that the patient may dissociate. In this case the person may be unable to ask the dentist to stop; the dentist and nurse would need to look for other signals.  Changes in breathing changes a rigid body, tears, being easily startled, staring blankly are all SIGNALS that may indicate that a patient is not responding because they are frightened. An understanding dentist would respond by pausing and checking in with the patient.

Dental treatment with sedation can help people who have dental anxieties. However the use of sedation can also raise increased feelings of loss of self-control and helplessness.

This distress may be alleviated by: having a trusted companion in the room, keeping the door open, or inviting the dental nurse to support them if acceptable. Dental doulas are available in some places; they can help and support survivors to access the dental services they need.  There are many creative ways that people manage their dental care – if you would like to share your ideas and stories and we would welcome your input.

REFERENCES:

https://tmjtreatment.com.au/childhood-abuse-and-dental-phobia/

http://www.acesconnection.com/topic/trauma-informed-training

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Memory Misconceptions too costly

"Misconceptions about memory are common. They can also be costly for individuals, systems of care and justice and society as a whole, and have far-reaching repercussions… better understanding of traumatic memory will enhance processes of support and justice as well as informed outcomes for the many people who are struggling with its disabling impacts.”  Dr Cathy Kezelman AM

The paper: “The Truth of Memory and the Memory of Truth: Different Types of Memory and the Significance for Trauma” by Blue Knot Foundation National Centre of Excellence for Complex Trauma was launched at the TheMHS Summer Forum by Mark Tedeschi AM QC by.

It is a timely release, given the confusion and misconceptions about trauma and memory among professionals, as well as the wider community. False information impacts negatively on clients, therapists, legal counsel and the courts.

The paper, co-authored by Pam Stavropoulos PhD and Dr Cathy Kezelman AM. It explains some of the complexities of memory and traumatic memory to the general public, legal and health practitioners, media and policy makers.

Broad in scope, the paper covers topics such as: different types of memory; understanding memory, traumatic memory, implicit (body - somatic) memory; the protective role of ‘forgetting’; and recovered memory.

Neuroscientific and other research confirms that memory is not a single entity. Rather it comprises different types of memory which do not relate solely to conscious recall. The different types of memory are associated with complex neural networks and are stored in different areas of the brain.

This has major implications not only for our understanding of memory, but for that of the challenging experience of traumatic memory, the ways in which it is expressed, and understood.

Blue Knot Foundation’s paper can be purchased or downloaded here: https://www.blueknot.org.au/ABOUT-US/Our-Documents/Publications/memory-and-trauma

My Story by Elise

I was going into hospital for a long period to have permanent intravenous feeding. I was hesitant about being admitted despite the fact that this was going to drastically improve the quality of my life.

Hospitals are a triggering place for me with so many memories of trauma involving hospital-like treatment.  It’s a place where I feel powerless & voiceless. 

As expected, pain came up and it felt like I was drowning.  As a result I had to tell my medical team (the bare minimum but enough to help them understand the fearful behavior). I met my psychologist.  Most of the team was really good but one doctor came across as cold and heartless  - in my opinion she grew up with a silver spoon in her mouth.

When the panic attacks started with a vengeance I asked for some Valium. The doctor gave it reluctantly. She made it abundantly clear that she was in control and she didn’t feel I really needed it. 

Later, others advised me Valium would be beneficial in similar situations, yet I felt guilty for needing help and took the Valium reluctantly. That doctor looked down on me; I felt judged - as if my trauma was nothing. In the hospital I mentioned Complex PTSD but she implied it only happens to soldiers.

I came home from hospital and wrote this piece.  Not just for me but for others out there who struggle with the perception that PTSD is only for soldiers.

My writing seemed to flow from here.  I have now written a full volume of poems and have created artworks as well.

PTSD

I'm not a soldier

I never fought in wars

Well not the kind of war most people understand

I did have my own though

I’ve battled from the moment I was born

Tested & tried, trained & promoted for bigger & better things.

What doesn't kill you makes you stronger they say.

Walked hand in hand with death from day one

But unlike real soldiers I was never given a medal,

There’s no remembrance day for me,

No land claimed. The battle was over my soul

& hey, who really cares about that?

But I fought; I survived & returned from my war.

Bloodied & bruised, tormented & overtaken by grief just as a real soldier is.

That bullying kind of grief that punches you in the stomach with such force that you feel sick, knocks you to your knees so you can't stand under its weight then grabs your heart & wrenches it right from your chest so you're just left as a shell.

An existing shell; but just a shell.

A shell that has returned from the battle & somehow has to integrate into normal life.

But I’m not a soldier so none of what I feel is valid.

Real soldiers have fought for something great

Real soldiers come home & people understand the anger, the panic attacks, and the hypervigilance

They can’t understand me because my battle wasn’t real.

There was no documentation of it & it’s not in the history books.

No one to confirm that my war even existed

Therefore come home & integrate without complaining.

Just move on.

Look strong & hold it together

But you know what? I did. I held it together for 40 years

But I’m so so tired & broken whether you like it or not,

Whether I like it or not.

I think I've done quite well considering

I’m still reasonably sane

Although some would beg to differ

I have times where I can think & function enough to keep surviving

But many times I can’t breathe

Times where my war seeps out of the very core of me

With its vile terror or rage that creeps out so unexpectedly.

It flings me loose & wild

Or curls me so tight in a ball that I ache through to my bones.

War changes you, you know.

Its images are etched into my mind

& Sounds that would make your blood run cold

& Sleep doesn't ease this kind of war

Its tapes play in the night on the big screen

Repeating over & pinning you there you to see & feel it all again.

As if once wasn't enough

& That bully grief waves over like a tsunami

But I’m not a real soldier

My trauma doesn’t compare

So how dare I ask for Valium

Don’t you know it’s addictive?

That could cause you problems

Why do you need help?

You’ve survived this far.

You imply that you believe it isn’t really necessary

Because my war wasn’t real.

It cant have been that bad because I survived.

Look closer.

The war may have stopped

But I haven’t really left the battlefield yet.

Do you know the power of those dark moments?

Have you any idea how strong they are?

Those really black ones where the darkness is suffocating & wooing you with its enticing words to follow.

I fight those moments with all I have left.

& Those moments when you have to fight to bring your body back from hell. But you really aren't sure if this isn’t hell that you're bringing it back to.

Look closer

My war has been documented

Look at my body

Look at my eyes

But I don't think you want to see

You don't want to believe in wars like this.

You can look away but...

I am a soldier.

SELF CARE RESOURCES

 

MetaFi is a self-awareness app that supports mindfulness, emotional intelligence, and body awareness.  It is available on most devices.

https://www.metafi.me/

It has been designed to encourage users to move from reacting to responding. Increasing self awareness helps strengthen the emotional connection between your mind and body.  Use of the App encourages the user to be more aware of their emotions and body sensations: moment to moment or login to login.

There are 3 stages: Name it, Locate it, and Log it.  You can start wherever you like.  The app asks you to name the emotion you are feeling in this moment and provides you with an extensive list of emotion words to better describe your feeling e.g. you might choose SURPRISE.  The next screen will prompt you to further define the feeling you have e.g. amazed, astonished or startled. Each of these provides more information about how might be feeling, in the moment. As you refine your ability to describe your emotional state, it can improve your communication skills. 

The next screen provides an outline of body outline which you can tap to indicate where your body experienced the particular sensation of e.g. being startled.  Front or rear of body – perhaps the middle of backbone/spine. The final screen allows you to make some notes as a journal entry for yourself about the experience and what may be going on for you right now.

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IN THE NEWS

The handing over of the sword. (a moment of silence)

We now officially declare this virtuous battle over and that you, noblest of warriors, be truly honoured and free.

AMEN

I have spent decades fighting the good fight against my trauma and how it impacted me, and it seemed that I used a kind of ferocious, unrelenting warrior part of me that was intensely engaged in doing whatever it takes to heal. I was in effect raised in an intense 'emotional war zone', only to ironically find myself engaging in a different war as my adult warrior woman was fighting so hard to right the wrongs and have ultimate victory. Of course this has been incredibly exhausting.

I have come to realize over the past few months that the warrior woman is ready to lay down her sword. It's like I thought that fighting was the only way to regain my power and self. But now I see this as a stage I passed through; an understandable and extremely useful part of my journey – and that now I am ready to continue the journey in a different way. I have come to realize that I no longer need her to fight for me. I feel I'm ready to transition and move away from an external fight against evil, towards some more internal reconciliation.

Every victim of child sexual abuse survives in his or her own way, often by pretending the abuse isn’t happening.

As a criminologist studying organised child sexual abuse, I sometimes feel like I live in the ‘upside down’, the shadow world parallel to our own in the TV series Stranger Things.  Read More

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LOOKING AT THE AUSTRALIAN SOCIAL SECURITY SYSTEM THROUGH A TRAUMA-INFORMED LENS

If we look through a trauma-informed lens, measures aimed at controlling welfare recipients appear likely to do more harm than good. Thanks to the rapidly advancing field of neuroscience, there is compelling evidence that overwhelming, life-threatening experiences can have lasting effects on the structure and functioning of the human brain. Read More

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