What do we experience when we are involved in a motor vehicle accident?

This week’s news was focused on the horrific Ottawa OC Transpo bus-train crash.

When viewing, listening or reading the survivors and witnesses’ reports we are left with one puzzling question; what is a person really experiencing when involved in a motor vehicle accident?

One of the common beliefs is that two people could be involved in the same accident and one person can leave the accident scene happily thinking something like “I am so lucky to be alive”, when the other will instead be totally distressed and overwhelmed by the accident.

How is that possible? In technical terms, what is experienced immediately at the accident is called the peritraumatic experience.

The individual difference reactions to a motor vehicle can be identified in the many different personality traits, characteristics the victim displays or past experiences he or she underwent that could affect the reaction itself.

Naturally, the most visible differences such as gender, age, physical built can affect the physical and the emotional reaction to a motor vehicle accident, although these are just some of the factors that can affect the emotional reaction to a motor vehicle accident.

How the person perceives the motor vehicle accident also is likely to affect the reaction to the accident itself. One of the most striking reactions I often encounter in my psychology practice working with victims of motor vehicle accident is that of disbelief. Especially if the victims are not “experienced” in car accidents, it is difficult “to believe” that an accident is actually happening. In other words, even if the victim is a professional (or a person who is on the road a lot)or a person who is working with victims of motor vehicle accidents it is likely to be “stunned” or “shocked” or in disbelief during the initial stage of the accident.

Some of the factors that may also affect the peritraumatic experience is the victim’ sense of confidence as driver, or how much trust the victim has in the driver (if the victim was a passenger in the crash). If the victim involved in the motor vehicle accident is blaming him or herself for the accident or if the victim is predisposed to emotional sensitivity (for example depression or anxiety) or suffering from a pre-existing physical or serious mental health ailment already.

Finally, another common belief is that the seriousness of the accident is an important variable to determine the victim’s peritraumatic reaction; but this is debatable. Although this point is counterintuitive, just remember that most people have no experience in motor vehicle accidents and that serious long-term effects of a motor vehicle accident cannot be perceived or forecasted at the peritraumatic phase.

Dr. Giorgio Ilacqua

Increasing Self-Esteem in Children and Adolescents

Self-esteem is often misunderstood as simply feeling good about yourself. This is not necessarily the case. Self-esteem, according to Webster`s Dictionary, is actually defined as an acceptance and acknowledgement of one`s limitations, as well as recognition of one`s abilities and achievements. As parents, we all want to raise our children to have a good level of self-esteem, but it is not something that we can simply give them. It is about creating a delicate balance between criticism and unearned praise. We want our children to develop a realistic assessment of their actions, achievements and limitations. While it is almost a natural instinct to want to protect our children from adversity, it is not necessarily the way to raise resilient and self-reliant children. Finding strength from adversity is a much better life lesson to teach our children. Adversity helps our children become more confidence in their ability to take on the challenges that life throws at them. As educator, J. Norris once said, “Think of your child standing to your right and the problem she needs to solve is on your left. If you step between her and the problem, you become the problem. She cannot see around you and she cannot see the solution.” So helicopter parents take note: it is important for our children to experience real decisions, real successes and real failures…after all, isn`t that real life!

If you are interested in learning more about this topic, a great read is: The Self-Esteem Trap: Raising Confident and Compassionate Kids in an Age of Self-Importance by Dr. Polly Young-Eisendrath

Dr. Monique Costa El-Hage

Ford Hood’s Psychological Rampage

Major Nidal Malik Hasan, a U.S. army psychiatrist has recently been found guilty of killing 13 and wounding 32 people in 2009. This event has been called by the media the Fort Hood rampage or the Fort Hood massacre.

Maj. Hasan represented himself in court and while a friend of mine would say that “a lawyer that represents himself has a fool for a client”, the question remains; what brought a career officer to plan and execute such a murderous plan?

In his defence, Maj. Hassan said he acted to protect members of his faith against the U.S. aggression. This would be the case it would entails that either he enter the army in bad faith, namely becoming a sort of Muslim insider or a “fifth column” or that after entering the army he became so disenfranchised and disenchanted to become openly homicidal against his employer and its representatives (namely his victims).

I tend to be partial to the second hypothesis; Maj. Hasan was in the military for many years before the 2009 Fort Hood rampage, a long time to premeditate any sort of unlawful action.

Maj. Hasan was a loner, with little social support, not romantically involved, sensitive, with strong anti U.S. views and with rigid beliefs about what is right and wrong with society. According to the media he was distressed by his work with war veterans and likely affected by their combat memories and by their depressive and post-traumatic stress disorder presentations. Also there are some references in the current media that he was in an ambivalent and conflicted position because of his religious faith and by the reception he received from some of his fellow comrades and superiors.

All these information, although not sufficient to provide a complete psychological picture of Maj. Hasan, would suggest a workplace violence scenario (another “burn out” professional, a vicarious victim himself of the ongoing wars in the Middle East) or of a poorly adjusted, angry and extremely distressed human being more than a martyr-like explanation for his behaviour.

Working in the mental health field is quite demanding in itself, a good social and family support are essential shock-absorber to metabolize the emotional toxins picked up in the working day. Maj. Hasan did not appear to have any of the shock absorbers necessary to enjoy a fulfilling, happy life, independently of his professional qualifications and of his religious beliefs.

Dr. Giorgio Ilacqua

Is crack “bad” for you?

Lately there has been a lot of talking about crack cocaine in the news. Crack has been described as an upper class drug. The media has linked it to many popular figures such as the singer Boy George, supermodel Kate Moss and Marion Barry, the mayor of Washington D.C.

But, how “bad” crack can be? Well, the famous stand-up comedian Richard Pryor almost killed himself when freebasing crack (by setting himself afire); the risks associated with using crack cannot be underestimated just look at the pictures of  Whitney Houston over time.

Let’s start from the beginning, what is crack? Crack is cocaine, it comes in little whitish crystals (like lumps of sugar) and can be inhaled or smoked. The name comes from the sound it makes when it is heated.

People who take crack report a “feeling good” sensation, believe to be more alert and above all experience a “rush.” The rush is caused by the fact than when crack allows a high quantity of cocaine to reach the brain quickly. The faster the absorption rate the higher the rush, but also the speed of the absorption causes a brief rush. The rush is usually short lived (few minutes) and it is generally followed by feeling down and outright symptoms of depression (cocaine interferes with the dopamine flow in the brain).

People using cocaine may become depressed, experience mood swings, or become restless and excitable. They may become irritable and anxious; the contact with reality may become loser and people who use crack may experience hallucinations.

Physically, crack increases the blood pressure therefore exerting more stress on the heart, (with increase risks of heart attack or cardiac arrest). The lungs become stressed which may cause shortness of breath, respiratory arrest or damage the lungs themselves; crack can cause seizures.

Cognitively, crack may cause confusion, short-term memory, concentration attention are also affected.

The behaviour of people who use crack may be erratic, bizarre, or violent; users may become aggressive and tend to be impulsive and prone to risk taking behaviours.

Current neuropsychological studies suggest a direct correlation between the frequency and length of use and the deleterious effects crack can have on cognitive, behavioural, physical and emotional functioning.

There is no doubt that crack is “bad”, but it is also important to know what crack does to the user and what could be the consequences for people close to the user; there is no such thing as a “victimless” addiction or a single victim; when people use illicit drugs, the whole community is affected.

Dr. Giorgio Ilacqua

What could happen to a person who has been kidnapped?

Ariel Castro, the Cleveland rapist or the Cleveland kidnapper is back in court and he is back in the news.

The Cleveland kidnapping makes one think about what may have happened to the three victims, Amanda Berry, Gina De Jesus and Michelle Knight? Words like horrible, abuse, torture could really express what has happened to the three victims? What do we know about what can happen in a situation in which a person has total control over another?
The famous Zimbardo Stanford Prison Experiment is in social psychology the closest we can get to conceive what could happen to the victims of kidnapping.

In 1971 Philip Zimbardo wanted to see ascertain whether certain personality characteristics correlated with abusive behaviour. To test this hypothesis he had volunteers undergo a pre-screening and complete a battery of psychological tests to ascertain their psychological stability, health and whether they had any previous criminal involvement. The 24 chosen subjects were mostly middle class and were randomly assigned to the role of guards or prisoners in the Stanford Prison Experiment. The experiment wanted to mimic as close as possible life in jail; for example, the guards used a baton, the prisoners were given baby dolls like clothes and a section of the university basement was transformed in a jail-like environment with locked doors.

The experiment was supposed to last two weeks, but was interrupted after only six days because of the abuses inflicted by the guards to the prisoners. In such a short time the guards assumed a sadistic role, created degrading procedures, while the prisoners felt powerless and they assumed a passive role.

After an initial attempt to “resist” the guards, the prisoners broke down emotionally and demonstrated unexpected symptoms such as depression, distress, skin rashes, or changed their behaviour trying to become “good prisoners” or assuming a “more than the guards” attitude when performing guard’s requests.

According to Zimbardo, by the sixth day, the prisoners behaved very much like prisoners of war of hospitalized mental patients. Interestingly, none of the guards quit, while the “good guards” felt themselves powerless to do anything to change the situation.

The Stanford Prison Experiment was by definition an experiment which could have and was interrupted. Knowing what we know about how normal, healthy, stable, middle class humans can behave, we can only imagine what being kidnapped by Ariel Castro (described in the news as a violent individual with sexual sadistic tendencies) and being abused for a decade would have been like for Amanda Berry, Gina De Jesus and Michelle Knight.

Dr. Giorgio Ilacqua

Psychological characteristics of a sexual predator kidnapper: Ariel Castro

People have been shocked by the Cleveland kidnapping and with good reason; what can bring a person, Ariel Castro, to kidnap three victims, Amanda Berry, Gina DeJesus and Michelle Knight, at different times and keep them enslaved for years?

Ariel Castro, like most known kidnappers, was a reclusive person with some minor brushes with the law. We know he has a violent history against the former spouse and children, but the charges were eventually dismissed by the courts. He had been recently been fired from his school bus driving job; one of his daughter is in jail for the attempted murder of her own daughter; both his brother have some family violence entries. This information do not tell us much about Ariel Castro and we are still left with the puzzle to explain the jump from a poorly socially integrated individual to a decade long multiple victims kidnapping.

What we know about kidnappers is not much. We know that pre-existing history is hit-and-miss, sometimes providing relevant information, sometimes not. They are often solitary, have psychological problems, poor social skills, they are not socially stable (although Ariel Castro was employed), and they found it difficult to cope with life. They tend to have a grandiose sense of themselves, but their aspirations and self-perceptions often go well beyond their abilities and skills; in other words, their emotional and intellectual capacities do not square up with their desires. Kidnappers are not physically or mentally lacking, but are short tempered and impulsive and they may make poor decisions; in other words they do not seem different from the garden variety psychopath or the frequent law breaker.

Most kidnappers tend to act alone; the Paul Bernardo and Karla Homolka duo seem to be more the exception than the rule.

Psychologically, kidnappers tend to have violent and sadistic fantasies and often picture themselves living their fantasies in real life; this is probably the quality jump we were looking for. Most people can watch a movie or day dream but realize it is a movie or a passing wish; sexual-predator-kidnappers want to live their own fantasies. Sexual sadism is the label that comes to mind when thinking of Ariel Castro, at least based on what can be inferred by the news.

Dr. Giorgio Ilacqua

The Richard Kachkar and Sgt. Ryan Russell’s tragedy: a story of murder and of thousand miseries; what is the outcome?

The January 2011 murder of a Toronto police officer by a person found not criminally responsible by reason of mental disorder has shocked the city of Toronto.

The facts are gruesome; Sgt. Ryan Russell, a Toronto police officer, was murdered on the line of duty by Richard Kachkar while he was operating a stolen snow plow.

The immediate public reaction to the news was to demand “justice”, but as the story unraveled, the public was left with a growing sense of frustration. Unfortunately, nothing can be done to bring back Sgt. Ryan Russell; no legal outcome can soothe the absolute pain his supreme sacrifice brought about.

The public asked: how did we get to a police officer being murdered downtown Toronto? Why weren’t there enough resources (public agencies, social workers, parole officers, police officers, nurses, family members, coworkers, neighbours) to prevent the murder of a police officer? Why nobody recognized the signs that should have triggered an intervention before Richard Kachkar went onto a mad snow plow chase? And above what should we do to avoid another Sgt. Ryan Russel’s murder?

The Sgt. Ryan Russel’s family is the only and real victim of this murder, with no hope of righting the tort they suffered, period. No words, no actions can bring back the father or the husband.

Extending the review period for people found not criminally responsible would really reduce the chances of another Sgt. Ryan Russell’s murder? The timing of this idea tastes of political opportunism; any intervention to be effective should be implemented before, not after the fact. Hiring more police officers, community nurses, parole officers, social workers, better funding of grass-root community support organizations may (yes it may) reduce the chances of a future Sgt. Ryan Russell’s murder. Reviewing Richard Kachkar’s mental health condition every year or every three years will not change much in the greater scheme of things for the public or for the family.

Balancing the need of Richard Kachkar (a person who is obviously not well), the future risk he may be posing to society and the Canadian belief that people with mental disorders should be treated humanely and with fairness is a tricky balancing act. The Ontario Review Board will have to assess and re-assess Richard Kachkar’s mental health condition on an annual basis. And granted the Board is doing a wonderful job at balancing all these conflicting expectations.

The public probably perceived Richard Kachkar’s diversion to a mental health facility as a subterfuge to avoid jail, a lawyer’s trick, an unsavory solution to a disheartening problem. The public also may dismiss the cruel reality as legal mumbo-jumbo; a reality indifferent to the pain of the real victims.

Reality is that the test to be not criminal responsible is extremely narrow; many people with florid symptoms of major mental health disorders are found able to stand trial and responsible for their actions.

Reality is that if Richard Kachkar met the stringent criteria for not criminal responsibility; he is really “insane” in the common parlance.

Reality is that the number of the Ontario Review Board hearings is going up, while the number of discharges is not.

Reality is that, from a clinical perspective, it is unlikely that a person found suffering from an unclear mental health disorder (such as Richard Kackhar was) will be “cured” in one, or three years. Reality is that the chances Richard Kackhar will be a free person anytime soon are quite slim.

This is not a happy ending story; it is a never ending story. The public will eventually forget about Richard Kachkar and Sgt. Ryan Russell; Richard Kachkar will probably spend the rest of his life in a mental health institution; Sgt. Ryan Russell’s family will have to live with the thousand miseries of their loss for ever.

My family and I know that, we have been in their shoes since January 16, 1970.

Dr. Giorgio Ilacqua

Is love enough to overcome chronic pain?

We all have seen movies or read books in which the hero (or the heroine) is saved from a terrible situation through love. Children stories like the Beauty and the Beast or Sleeping Beauty are typical of this genre. Is this at all possible, or this is it just a romantic idea? We just want to believe that “loves cures all” or there is some scientific basis for this?

The answer to this question goes something like; “yes, at least theoretically.”

The quality of a relationship is generally estimated through the quality of the attachment between the partners. Attachment theory posits that the way we appraise and react to threats is determined by our attachment style; this can be functional (i.e. secure) or dysfunctional (i.e. avoidant, anxious, insecure). When the threat we are facing is pain, the attachment style of the sufferer and the attachment style of the healer become important. The current literature supports that generally speaking, pain sufferer with axious, insecure or avoidant attachment styles have higher pain perception and pain related disabilities. Just as to be expected, pain sufferers with a more secure attachment style tend to report lower pain perception and higher levels of perception of control over pain.

Similarly, the helper’s attachment style is important for the helper’s well-being, the pain sufferer and the dyadic relationship. Anxious, insecure or avoidant helpers tend to report higher levels of personal distress when a partner is suffering from pain, the sufferer in turns tends to respond with negative emotionality to the dysfunctional attachment style of the helper and the relationship among the two is generally described in more negative terms.

The intriguing aspect of the connection between love and pain is that the above findings can be replicated in pain-free couples; pain-free people involved in a relationship with less than functional attachment styles exposed to experimental pain (i.e. cold pressor) tend to report higher levels of pain and perceive having less control over the pain experience while at the same time being less satisfied in their romantic relationship when compared to couples whose attachment style is more secure.
So after all, may be love is not the answer to chronic pain, but definitely it can go a long way to sweeten the deal for the sufferer, the healer and all the people directly or indirectly involved.

Dr. Giorgio Ilacqua