← Turning Points: Navigating Mental Health
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A
Hey listeners, before we dive in, just a heads up. This episode covers topics like sexual assault, suicidal thoughts, and suicidality. So if you're not up for that right now, no worries. We'll catch you next week. You can also preview the content with the Transcript posted@globe.com TurningPoints.
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I'm Kate. I like to think of myself as a human. I think when we're human, first we hold space and that's what it's all about.
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That's Kate Speer. She's someone who is on the journey of proactively healing from ptsd.
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I grew up with a learning disability, so a processing disorder and undiagnosed adhd. I was labeled as the wild child and the disruptor, but really I was just neurodivergent. Like on the scale. I'm all the way out there. Colorful, zesty. You got it.
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Kate describes herself as an outspoken, advocacy driven teenager. But in high school, everything snowballed.
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I started to cry literally all the time. The depression was loud and persistent and honestly very severe. And so my first diagnosis was major depressive disorder. And then I was also diagnosed with adhd. All of this kind of resulted in more and more mood lability coming out. And I was then diagnosed with bipolar disorder. I don't have bipolar disorder, however, because my grandmother had bipolar disorder, it was very much a like one and done deal. This woman has bipolar disorder. This is what we're dealing with now. We need to go into treatment plans.
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Kate then spent the next 10 years living under the shadow of this misdiagnosis. Instead of getting the support she needed, she was enduring treatments that made her mental health worse. She experienced psychosis and severe mood instability, all while up against a mental health system that just wasn't getting it.
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I think throughout that process, interestingly, I was able to be myself in a lot of ways. And then I spent a summer at a residential psychiatric program to help manage my symptoms. And I was sexually assaulted repeatedly by a fellow patient. Of all the things I've lived through, and I've lived through literally a decade of being chased by demons, the sexual assault was the most detrimental to my well being. It shattered my ability to recognize myself as a human and as an advocate.
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Welcome back to Turning Points, a show about navigating mental health sponsored by Point 32 Health. I'm your host, Frances Lees. Today we're diving into a topic that deeply affects many but often remains hidden. The impact of PTSD in women following sexual trauma. We'll break it down and talk about how this can affect women's lives. Then we'll explore some therapeutic approaches that have shown real promise, like emdr, eye movement desensitization and reprocessing, and cbt, cognitive behavioral therapy. These treatments have been effective in helping manage ptsd. But first, here's Kate again. She tells her doctors at the residential treatment facility about the sexual assault.
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It was just a really hard time. And when I came forward, which took more bravery than I think anything I've ever done, the doctors told me I was lying and I was, quote, crying rape. And this shattered me in ways that I still haven't fully processed. As a result of that, of feeling like even in this deep, courageous step, I had put myself out there, that I was then told I was literally an attention seeker. I started to have fugue states. And so this is where my PTSD really came into play. I think prior to this, I would have been diagnosed with what most people would call classic complex ptsd. But after that, I started to live with ptsd. Dissociative fugue.
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Disassociative fugue states are rare alterations in a person's mental state, often triggered by extreme stress or trauma. A person experiences loss of personal memory and time, causing them to travel somewhere else, and they may not know why.
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And for those unfamiliar, fugue means to flee. And it's the body's way of protecting itself. It's when the mind and the body sever so completely that the body takes, one literally flees away. I used to call them losing time. I was consumed by this paranoia, like I'm losing time because I would end up in the woods or I would end up in my truck. I'd run out of gas on the side of the road somewhere and five hours from home. But all of this compounded. So I was still having intermittent psychosis. And then as a result, they would increase my meds, which would cause more psychosis. And then on top of that, my sense of self was completely shattered. I think of PTSD often in terms of what it does to the identity as like a shattered mirror. But we take that mirror and it's scattered around.
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She then spent years trying to put the pieces together bit by bit.
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After about three more years, after the sexual assaults, I really was at a place where I was not safe. I had chronic suicidal ideation and I actually attempted. And this is when the care team had said, you know, we have tried everything. We have tried every evidence based protocol, we have looked at your diagnosis and treated it with every single thing, every med that's out there, every treatment. I mean, I did electroconvulsive therapy, I did every behavioral therapy. And they basically told me that there was no way for me to live safely, nevertheless survive independently outside of a long term blocked ward.
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Kate encountered the stark realities of a mental health care system that often feels indifferent and bureaucratic. She tried to become the perfect patient, all while losing her own sense of self agency.
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What does it mean to be like the perfect patient? It means you're adherent. It doesn't mean that you own your truth. It doesn't mean that you share your story. It means you bow your head, you nod, and you follow orders. It felt like I'd failed everybody. I grew up very fortunate. I have both of my parents, although middle class, are, you know, upper middle class are doctors. So I had the best treatment in the healthcare system.
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And her parents connections did help her gain access to treatment that could help her.
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My parents network came through and they called in a massive favor. So I got an appointment with the head of psychiatry who then put me in touch with one of the world's renowned trauma practitioners. And this is really where my life changed. And it was that point where he said, I'm willing to take you on if you do the work. And I'll never forget, he said, you've worked so hard already and I want you to know you have a choice because this work is going to be harder. You can go to a residential treatment center. And I remember pausing and recognizing the weight of his words because my life really was hard, it was really brutal. And the weight of those words really hit home. And I said, no, I'm going to do the work because I know how to work. And the only thing that matters to me is that I have the right to be free.
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And for many, PTSD can strip away a sense of agency. It was during this time that Kate realized the immense value of self advocacy and reclaiming her own voice in her healing journey.
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I think it's so easy to feel like you don't have a choice, that the doctor's word is bond, that whatever you do, you must obey. And it's your life, it's not theirs. I didn't relearn that until this doctor reminded me of that.
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And as she's done the work to find healing, she's found ways to manage symptoms over time.
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Really, the narrative exposure therapy has allowed me to reclaim a lot of my understanding of self, and that's the work of writing and rewriting and rewriting the truth of these incidents.
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Exposure therapy helps people face their fears and traumatic memories. In a safe, controlled way. It's about gradually easing into what scares us to reduce anxiety over time. Today we'll dive into how this therapy works and how it can be a key part of healing from ptsd.
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I really believe in exposure response prevention therapy, both in the form of physical activities and then I also do narrative exposure therapy. So I love to write. I think hopefully someday I'll be just a full time writer. I dream of just like writing weird birds and frolicking in flower fields. I know that sounds ridiculous, but it's going to happen. I'm going to do aggressive activism to change the fact that you're treated like an incarcerated prisoner in a psych ward. And then I'm also going to just frolic in the field. But exposure response prevention therapy, one of my deepest passions, is the work of exposing oneself literally to the very stimuli that activates the body. Sitting with that discomfort and waiting until in the literal marinade that is the hell of discomfort. Let me tell you, it's hell until it subsides. And the coolest thing about this is that our brains actually change. And this work, I think above all has been my lifeline. But recently to manage my symptoms. And the symptoms are very much like hypervigilance, emotional flashbacks, visual flashbacks. I have ptsd, night terrors, and I still have fugue states. I've been focusing a lot more on somatics. And so I like to think of PTSD. Now. Beforehand, I used to think about it as the misappropriation of past memory on present moment. And I now think of it as my body holding the truth of the past in the present moment. And a lot of the work I'm doing is combining internal family systems work, which has been deeply transformative. Loving all my little parts. I have many and oh, are they colorful. And also doing that in conjunction with a lot of nervous system regulation and also just exploratory somatic body like body work basically. But I really do believe that we can't do just cognitive therapy or just behavioral therapy or just somatic work. It needs to be a multi pronged approach. And I would say in doing that, it's been really transformative in helping me learn how to stay in my body, how to not live in a state of chronic fight or flight, chronic dissociation.
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That's where reclaiming your own agency really matters. By choosing a multi pronged approach, you're not just tackling trauma, you're learning to live fully in your body again. It's about breaking free from the cycle of fight or Flight and taking control of your life. Kate is still on her healing journey, but she's in a much better place now. PTSD and the impact of sexual trauma on women's mental health manifest in various ways and present unique challenges. To better understand these challenges and effective ways to address them, I brought in some experts. First, we have Dr. Tara Golovoski.
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I am a clinical psychologist by training and to work with all kinds of trauma survivors, with a primary focus now on our women veterans and their traumatic experiences.
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She's the director of the Women's Health Sciences division at the national center for PTSD at the Department of Veterans affairs, as well as a professor in the Department of Psychiatry at Boston University School of Medicine. And we also have Sharon Imperrato, who's had over 20 years of experience in the field of sexual trauma.
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My name is Sharon Imparato. I use the pronoun she, her, hers. I am currently the senior director of community outreach Awareness prevention education at the Boston Area Rape Crisis center, also known as BARC.
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Sharon and Dr. Galavaski's work isn't easy. They tirelessly support patients who have lived through some of the most harrowing experiences. Despite the challenges, they find profound meaning in their work.
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I think that the reason that I genuinely love this work is because although the experiences are absolutely horrific by definition, there really is a light at the end of the tunnel. And so I find that it is an honor and a privilege to walk down that path with trauma survivors. And it's just incredibly rewarding to see them come out the other end with their lives much more intact than when we began.
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Sharon emphasizes the critical role of community education in changing how we understand and respond to sexual violence, thereby supporting survivors more effectively.
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The fact that survivors of sexual violence face so many barriers. Survivors aren't the ones with the barriers, right? They face the barriers from institutions, systems, providers, society in general. And just seeing all of that and wanting to change that for them, to give them a space to understand their experiences, to change how they understand their experiences. As a clinician who works with survivors, I understand that I can't change what was done to them, but I can change how they understand what was done to them. Very often, survivors of sexual violence are the ones that are blamed for their experiences, and that really impacts someone's ability to heal. And so really being able to provide that education, that understanding about sexual violence and putting the accountability and responsibility where it belongs, and really, in the end, being able to reduce the shame that survivors experience is really why I do the work to see that change in folks.
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And after 20 years of doing this work, she's recognized the intersection between survivors as individuals, the institutions and systems they become involved with, and how community members feed into all of that.
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I think it's important to recognize that perpetrators don't just groom victims, they groom communities. And so in order for us to change how we understand sexual violence, we, as communities also need to be educated and understand. And that, again, helps to support survivors and change the landscape of rape culture.
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It's clear that while individual recovery is crucial, societal understanding and support are equally important. Research indicates that women are twice as likely as men to develop PTSD after a traumatic event. I asked them why this disparity exists, especially in relation to sexual trauma.
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We know that most people will experience a trauma in the United States. About 70% will experience some kind of a trauma. And we know that there's gender differences in terms of what men are more likely to experience and what women are more likely to experience. And so women are more likely to experience the types of traumas that will result in ptsd, but women are more likely to develop sexual trauma, particularly before age 18. Intimate partner violence. And those types of traumas that tend to result in higher rates of ptsd, and likely it has to do with a whole host of factors, including the type of trauma that explains it. In part, it might also be partly explained by the context of those traumas. A lot of traumas can occur in childhood, and so there's important developmental points where that occurs in which might have implications for going and developing ptsd. Those types of traumas tend to cluster around other kinds of factors, like having lower resources to treat ptsd. So there's a whole host of factors that are involved in understanding why there is that disparity.
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Sharon highlighted how the disparity is even greater for women of color and trans individuals, who often face additional layers of marginalization and are less likely to be taught about or recognized as survivors of sexual violence.
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I will tell you, one in three women will experience sexual violence, and one in two trans folks will experience sexual violence in their lifetime. Those are large numbers. And when I think of statistics around sexual violence and really people understanding it, it's is that for people to answer the question, have you experienced sexual violence? They have to have learned or be taught that they could experience sexual violence, right? There are many populations of folks, many folks holding identities that are marginalized, that are not taught they can experience sexual violence. Women of color is one of those. Trans folks is another experience of that. And then folks have to be asked. So if survivors aren't seeing themselves as survivors, society is not seeing folks as survivors because they weren't taught that certain folks could experience sexual violence. They're not asking the questions. And so I think for statistics, when it comes to experiences of sexual violence, statistics are low. They're actually higher than we realize because again, we're not teaching folks that they can experience sexual violence. We aren't asking everyone, and people aren't feeling safe enough to disclose.
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The numbers on sexual trauma don't tell the full story. What's undeniable is trauma's profound impact. Regardless of statistics, we often hear that trauma leaves a mark. And that's more than just a saying. Our bodies are the first to respond to trauma, going into high alert during any terrifying event. I asked Dr. Galavatsky about the long term effects of untreated PTSD in women and how the body retains these trauma responses.
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Left untreated, PTSD can become chronic and enduring. And so as you mentioned, when you're faced with exposure to a huge traumatic event, something by definition that's unexpected, life threatening, all of your body's biological responses really kick in. Fight, flight and freeze are great examples. And so now your body needs to kind of recover from that. And that is the most common outcome of facing of a traumatic exposure is recovery. Most people go on to recover, some people go on to develop ptsd. So what gets in the way of people recovering from their traumatic event? And oftentimes it's the way they're thinking about the event, the way that they're making meaning out of what happened to them, the way that the event then impacts their view of the world of self and others.
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Dr. Galavatsky explains that PTSD can be chronic if left untreated, trapping individuals in a cycle of avoidance and heightened physiological responses that prevent true recovery.
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Let's use for an example the song that was playing on the radio during your traumatic event. And imagine now that you're outside of your trauma at the mall or something, you know, two months later and that song comes on the radio, you might have that kind of same physiological reaction. And it makes sense to want to avoid that, to put that away, to push it down. But when we keep avoiding every feeling and every emotion and every kind of biological response to the trauma, then we never let it run its course and we prevent ourselves from recovering from the traumatic event. So from a biological perspective, the fight flight of freeze response is a very powerful response. And so on paper, it makes sense to want to avoid that. But what happens in PTSD is people avoid it so much that they kind of get trapped there. And you find that people's worlds get smaller and smaller. Right, because the avoidance gets more and more generalized, and that's where those beliefs come in. So I think about trauma as this lightning bolt that comes down and impacts the way you view the world. So most people have this view of the world that the world is a fairly organized and just and fair place. And I mean that very broadly. So, for example, if I go to work, I will get a paycheck. If I step outside my house today, I will come home safely. If I act within the law, I won't be arrested. And what happens with trauma is that the unexpected happens and it often comes down like a lightning bolt and just smashes that belief system. And then we have to make sense of it.
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So as you can see, it's such a multi layered approach. You have the physiological response and then you have the belief systems for ptsd. Cognitive behavioral therapy, or cbt, and eye movement desensitization and reprocessing, also known as emdr, are two of the most commonly used treatments. However, there are specific modifications and considerations when these treatments are applied to those who have experienced sexual trauma.
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Cognitive behavioral therapy is like a larger umbrella, and underneath that umbrella are the top two therapies with the most empirical support for treating ptsd. One is prolonged exposure, and the other one is cognitive processing therapy. And those two therapies have the most trials and the most kind of consistent large effects across trauma populations. And so they're highly effective with sexual trauma survivors. EMDR came a little bit later, is not under the cognitive behavioral orientation, and has more mixed results with fewer trials with sexual trauma survivors. But across all three, they wouldn't be administered differently because of that trauma. And in fact, PE and CPT were both developed in that population. The other thing that I think is really important when people are in the middle of therapy is it can be really hard. And one of my patients said to me one time, what is the end game here? Like, this is just hard. And what is the end game? And I think that we really have to think about that. The end game is to put the past back where it should be. This shouldn't be coming at you like it's happening all over again day after day. Like, we can't change that, but we can certainly reduce this ptsd. So sometimes the end game is getting a good night's sleep, right? Sometimes the end game is enjoying a movie. Sometimes the end game is going for a walk. And enjoying it. Sometimes the end game is hearing your child laugh and having that spontaneous joy that you thought you'd lost, right? Sometimes the end game is just taking back from PTSD what you thought you had lost, regaining that. And so it's those real functional impairments, those real deficits in life that really can be overcome once you get that memory put back in the past to where it should be.
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For listeners in the Boston area, Sharon shared some of the resources her organization, bark, offers.
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D
We offer a lot of services. Our services are absolutely free and confidential. We provide services for all survivors of sexual violence and their loved ones as long as you're the age of 12 and above. We don't work with children, but we do have resources for folks who are younger. So as long as you're currently age 12 or above, we can provide you free and confidential services no matter when the sexual violence occurred. So it doesn't matter if you're an adult who experienced childhood sexual abuse. If you've had multiple experiences, we are here for you. And what I always say to people is if you are unsure if BARK is for you, just give us a call and we can talk to you about it. We offer many services, but our oldest and largest service is our hotline. We have a 24 hour hotline that anyone can call and anyone who's listening to this podcast and needs some support after this can call our hotline number. For survivors who've experienced sexual violence and want to go to the hospital and get any evidence collection done or any medications or prophylaxis can also go to the hospital and possibly have one of our medical advocates go with them. We have volunteers that will go to the hospital and sit with survivors during the evidence collection kit. We also offer legal advocacy and immigration services. So we have legal advocates that can help people navigate the justice systems, the various justice systems, but also answer questions about reporting or what that might look like. And I always suggest if someone's thinking about reporting to just give us a call and find out what your rights are, what this can look like for you so you have more of an understanding. We also have immigration services, which is great. We're excited to have immigration attorneys on staff and our services are offered in English and Spanish and our services range from individual to couples to family to group counseling for all survivors of sexual violence. We also recognize that sexual violence can impact someone's whole life in various aspects of their life, so we offer case management as well.
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A
BARK is a hub of essential support, providing an extensive range of resources for the Community and, and also survivors, they touch the entire ecosystem of care, but considering all the resources they provide. Sharon also talked about some of the common challenges survivors face in seeking treatment and ways to overcome these barriers.
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One of the questions I often get is why don't survivors disclose or why don't survivors seek services? And I also learned if you don't like the question, change the question. Right? The question is more about what is it about us that doesn't allow survivors to seek services, that doesn't allow survivors to disclose. And I think that's important because when we talk about challenges or barriers for survivors, they're not the ones with the barriers. It is actually us. So we have to think about how do we make sure that all of our services, that all the supports that we offer are really accessible and available for everyone. Right. So we do acknowledge that it can be difficult to seek services such as this, right. Because people are afraid of what barriers they're going to run into. But there are ways to again change the barriers that we as institutions, systems, providers have is to ask ourselves the questions, be aware of our own bias. Representation is important to say what you are going to do and actually follow up and do what you say to build that trust. So I think, in all honesty, as an educator and a therapist, I want to end sexual violence. Right? That would be the hope. But before we get there is, I want people honestly to believe survivors because the biggest barrier to services or to these treatments is survivors aren't even given the space to recognize what was done to them. They aren't given the space to talk about what was done to them without judgment. And so to be very honest with you, before we even get to types of strategies, I think for women with PTSD is to again, give a space to believe, to listen without judgment. And that's what I hope, because that will then drive everything else.
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While we still have a long way to go in ensuring our society believes survivors, when they speak up about their trauma, we, they're courageous individuals challenging the narrative and paving the way for change. Here's Kate again.
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If I could give any advice, it's that every tiny step matters and is worthy of celebration, like a home run, because that's the foundation for your future resilience and the neural pathways for more growth. In addition to giving yourself credit for it's hard. Keep track of it, because when you can see how incredible you are, when you give yourself credit for how much work you're doing, even if no one in the world other than me, I'm here and I'm counting it just for you, even if I don't know you yet. It adds up. And with self efficacy, we empower ourselves to remember that we're worthy of showing up. And when we show up for ourselves and can see that we've shown up for ourselves, amidst the fractured identity we wake to or the night terrors that ruin every night, we have something to hold onto. And that's the truth, that we're still here. But I think above all, believe yourself. Because the world gaslights us all day, every day. And what you lived through was hell and you're still here. And that's nothing short of incredible.
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Here's what I learned from these conversations. Number one acknowledgement is crucial. Believing survivors and giving them the space to share their experiences without judgment is the first step toward healing. Number two Complexity of Trauma Trauma affects both the body and mind, creating a multifaceted challenge that requires comprehensive treatment approaches. Number three Importance of tailored treatments Effective therapies like CBT and EMDR must be adapted to address the unique needs of sexual trauma survivors. Number four Barriers to seeking help. Institutions must work to eliminate barriers and biases that prevent survivors from accessing necessary support. And lastly, Number five Community support organizations like Bark play such a vital role in providing free, confidential services, demonstrating the importance of accessible resources for all survivors. If you need support, you can use their 24 hour hotline by calling 1-800-841-8371. Thanks for listening and visit globe.com turningpointsone word for more information on mental health care and resources. Turning Point Season 4 is produced by Point 32 Health, the parent company of Harvard Pilgrim Healthcare and Tufts Health Plan and the Studio B team at Boston Globe Media. In partnership with Pod People, Point 32 Health, Harvard Pilgrim Healthcare and Tufts Health Plan are committed to connecting the community to personalized solutions that empower healthier lives.