MISSION:
Develop a template of psychological protocols for documentation and investigation of emotional harm. Infliction of emotional harm has been cited and studied as a tort. A body of legal and psychological research has developed over the past ten years which studies issues of intentional v negligent infliction of emotional harm (distress) by the actor to the injured party. The model outlined here presents channels of investigation, documentation, and treatment relevant to these issues.
DOCUMENTATION OF PSYCHO-SOCIAL/MEDICAL HISTORY AND TREATMENT:
The victim’s “story,” since the point of trauma, is critically important in this line of investigation. Major areas include: medical history, developmental history (emotion/psychological and sexual), employment/career history, relationship history, family history, and so forth and so on. How did the trauma/abuse impact any, or all, of these life spheres? Have any of the victims developed psychosomatic syndromes which can be legitimately linked to the point of injury? Can other physical syndromes, diseases, or illnesses be linked to the trauma? The mind-body connection is exceptionally powerful. By way of example: I treated a patient who witnessed the murder of his father when he was 7 years old. A world renowned MS neurologist confirmed that the “shock” of this event triggered the development of MS in my patient when he was in his 50s.
I have created a standardized interview and questionnaire template which I utilize in my study of the victim and their history. I “weave” the individual’s data into a narrative of the person’s life highlighting key elements vis a vis the abuse and the profound impact it’s had on the person’s adjustment as an adult. This technique humanizes the victim which is critically important as it stimulates the emotionality/empathy “systems” of juries and judges. The emotional reaction and response of the jury and the judge are essential for persuasion as well as education.
In addition to reviewing the person’s history as outlined in the above, I review any/all psychological/psychiatric treatment, counseling (standard and pastoral), sex therapy, psychotropic medications (typically SSRIs), sleep/weight disorders, parenting issues, phobias, anxieties, depression, sexual functioning (arousal, inhibition, identity, performance issues), marital adjustment, addictions, and post-trauma stress disorder (PTSD).
PSYCHOLOGICAL TESTING:
The field of clinical psychology is based on a scientist-practitioner model. Two well-known and well-researched clinical testing instruments are utilized in the assessment of personality, thinking, mood, trauma, and other clinical syndromes. These tools are rooted in hard, empirical data. They are exceptionally robust, predictive, and they produce very powerful and descriptive reports.
The MMPI 2 (Minnesota Multiphasic Personality Inventory) was initially developed in the 1930s at the University of Minnesota (Starke Hathaway and J.C. McKinley). Literally, thousands of research studies sustain it. It is invaluable for the diagnosis and treatment of mental illness and emotional disorders. It produces 10 clinical scales: Hypchondriasis, Depression, Hysteria, Psychopathic Deviate, Masculinity/Femininity, Paranoia, Psychasthenia [OCD], Schizophrenia, Hypomania, Social Introversion, and six validity scales. Customized subscales which assess trauma are embedded within it.
Millon Clinical Multiaxial Inventory-III (MCMI-III):
Theodore Millon developed this instrument 30 years ago. It produces 14 Personality Disorder Scales, 10 Clinical Syndrome Scales, and a variety of other subscales. Subscales which assess trauma are embedded within the Millon Inventory.
SHR-R Clarke Sex History for Males-Revised:
This instrument was created by clinicians from the Centre for Addiction and Mental Health, Toronto (formerly the Clarke Institute of Psychiatry). It has six components: the first focuses on Childhood and Adolescent Sexual Experiences, and the second focuses on Sexual Dysfunction for example.
Elsevier, a Dutch publishing firm produces the official journal of the International Society for Prevention of Child Abuse and Neglect. Their journal, Child Abuse and Neglect: the International Journal, highlights a variety of research studies relevant to the issues at hand.
NEUROSCIENCE HIGHLIGHTS:
Trauma is “etched/embedded” in the victim’s amygdala which is located deep within the brain’s limbic system. The limbic system regulates emotion. Metaphorically, the amygdala functions as our “eyes” in our brain. Memories of trauma are stored in the amygdala, as is fear. The amygdala triggers emotions more quickly than conscious awareness. It’s almost like a speed dial circuit where the sympathetic nervous system is activated, and goes into overdrive causing emotional pain and/or anxiety. Amygdala irregularities/dysfunctions impact OCD, social interaction, addictive behaviors, depression, personality dysfunction, and a host of other dysfunctional behaviors and clinical syndromes.
POST TRAUMA STRESS DISORDER (PTSD)
PTSD is a severe anxiety disorder that develops after exposure to events which cause psychological trauma. Threats to one’s sexual and psychological integrity qualify for inclusion for this syndrome. Victims typically experience flashbacks, nightmares, increased arousal, anger/rage, hyper vigilance, and emotional disturbance throughout their lives. The DSM IV-TR (Diagnostic Manual of the American Psychiatric Association) formally documents PTSD symptomology. Symptoms cause significant impairment in social, occupational, and general life functioning. A variety of medications, therapies (CBT-Cognitive Behavioral Therapy, EMDR: Eye Movement Desensitization and Reprocessing), and interactive/interpersonal psychotherapies are utilized to treat this disorder.
I utilize the following instruments in my investigation of PTSD:
- Posttraumatic Stress Diagnostic Scale (PDS, Pearson Assessments)
- Children’s PTSD Inventory (CPTSD-I): National Child Traumatic Stress Network
- PTSD Symptom Scale (PSYMED)
HUMAN-EXISTENTIAL ISSUES:
I focus on the following constructs when I develop case narratives and prepare for testimony. The myriad of issues outlined below have been derived from my treatment and studies of sex abuse victims over a 20 year period:
- Trust
- Betrayal
- Dignity
- Self-esteem
- Sexual Identity & Functioning
- Emotional Intimacy
- Self-doubt
- Depression
- Under achievement
- Shame, guilt, inadequacy
- Spiritual damage
- Empathy: the fundamental human building block for relationships-how badly has the capacity for empathy been damaged
OTHER CONSIDERATIONS:
Frequently, a major challenge in terms of research and testimony vis a vis sex abuse cases involves utilizing the construct of emotional harm, psycho-social history, and current psychological testing so long after the traumatic event. “Retrospective Cohort Study” is a valid research technique in psychological research and in medical research. It comes from the Latin retr which means literally “to look back at events that have already taken place.” In looking back at a patient’s psychological and medical history, and life adjustment, retrospective studies are valid.