Other Actual Or Immediate Threat Of Death Or Injury: How Does It Work?

[Ed Norton]

@scout86 my last psychologist, 'Steve', said exactly that-Re: perception! He was doing his doctoral work on exposure therapy for trauma and phobias.

Edit: based on the efficacy PE had on me and I'm not perfect by any means but a lot better after that (terrible) treatment and that he did a majority of the 'hard stuff' whereas my new psychologist 'Stephany' does miminal PE and more DBT and addressing miscellaneous sequelae of my trauma like depression. I trust him entirely wrt to his assessment.

 

[dnp]

I think you're going to have a lot of problems with the definition of "catastrophic injury" the way it reads in the hypothetical definition. I don't have time to research it right now though. There's a statutory definition under an unrelated Act and a working definition supposedly used by the AMA (which I haven't been able to source yet), neither of which would include the torture victim that doesn't have severe, permanent injury but does have severe, permanent psychological injury. The current working definition is more along the lines of permanent spinal injury (paralysis), possibly loss of limb, etc. If you intend for "catastrophic injury" to include more than the current statutory or working definitions, you need to write that in when defining the criteria. Otherwise you can't expect a doctor to say that the experience of injuries to nonessential body parts are "catastrophic injuries" and sign their name to it and submit the claim to the insurance company where it could be considered a fraudulent claim. Even though in context the manner in which the injuries occurred was horrifying and traumatic and did in fact cause permanent dysfunction in the limbic system, there isn't room to consider that when you just say "catastrophic injury."

It's hard to explain what I mean by the definition being problematic. It has to do with the term already being used to mean X, and if you want it to mean X and also Y you need to spell that out, otherwise insurance will consider it to mean X. I hope I was able to explain it well enough.

 

[lostforgottensoul]

Catastrophic injury means "consequences of an injury that permanently prevent an individual from performing any gainful work."

I think I have a Catastrophic injury to my mind, from growing up in a cult, however due to my great ability to section off my mind (theres another word for that and its escaping me but basically ignoring or numbing certian parts of it) and dissociating (not that any of that is good) i have the abilty to completely numb myself at certian times to function, like working.

This also happens automatically like in my thetapists office and have yet to control it, though that is changing.

Since PTSD is a wound in the mind, I would say that that defintion doesnt hold water.

 

[joeylittle]

Wouldn't it make sense that your brain is going to respond to what it THINKS it's experiencing, regardless of what might literally be true? I don't mean that I think the criteria should be expanded to include watching a scary movie, I mean, if you fear for your life, you do, whether or not you're accurately perceiving the threat and your brain is going to respond accordingly, isn't it?

I think that we do perceive things in layers that we are not always aware of. I spend time studying the effectiveness of communication in different formats: live, recorded, etc. And people respond very differently to many elements of these - scale is one of the biggest. A movie is usually not in human scale - it's either big (at a theatre) or small (on your tv at home) - which really affects how humans perceive it, vs. how they relate to something that is 'live', ie, scaled to their actual size. We take in information on multiple levels. That's why you can notice the difference, I think, between when you are on a roller coaster and think you might die, or whether you are dying and think you might die.

But yeah, there's a spectrum of perception going on. Some things about perception seem to be nearly absolute - but only within a control group. Children, for example, are a whole different ball game. I always read different ages, but I think somewhere between 4 and 8 years old is when a child can fully grasp the difference between 'real' and 'fiction'. Which is also why I'm with @Chava, in terms of needing to create a separate diagnosis for developmental trauma. I don't think it plays by the same rules.

 

[joeylittle]

I hope I was able to explain it well enough.

You did. I was just researching this. There's really no solid, agreed-upon definition - meaning, in a court of law, there are various precedents that one can use.

But I think that it's important to remember we are talking about fear of catastrophic injury - which does leave it open, and open is important to a certain extent.

In a couple of different studies, the things that were referred to as working definitions of catastrophic injury were: injuries resulting in fatality, permanent impairment causing functional disability, and significant (if transient) impairment to head, neck, spinal regions.

But, short answer - yeah. 'Catastrophic' is a term of art across multiple disciplines, which makes it a messy word.

 

[illusionist]

A child's perception of the threat of death may be entirely different from an adults perception of the threat of death. They don't hold the same logic.

 

[Chava]

I think somewhere between 4 and 8 years old is when a child can fully grasp the difference between 'real' and 'fiction'. Which is also why I'm with @Chava, in terms of needing to create a separate diagnosis for developmental trauma. I don't think it plays by the same rules.

Sounds about right. I don't really buy the fictional part, because we know it's...fiction. But we also, ideally, shelter young children from violent programs (and why movies are rated). Media would affect them differently...doubtfully a case for trauma, but I don't know. "Developmental" often refers to those earliest years where brains and foundation of socialization is developed (fundamental wiring of lifelong patterns). Developmental trauma can happen in perfectly loving families...multiple surgeries, separations, shock trauma at that age, etc. But also obviously abuse and neglect. The symptoms end up very global, potentially looking like possibly up to ten other possible diagnosis (and some probably valid). But I like "complex" as separate to account for things like captivity, multiple trauma later childhood or adulthood...

I'd fit the sketched out definitions for developmental trauma (understood and described by trauma experts like Heller, Fisher, and Van Der Kolk)...quite close to inhibited form of reactive attachment disorder, loads of somatic issues, dissociative with certain triggers, lots of derealization shit, self-destructive, connect more with gadgets and ideas than humans (why I might seem a little Aspie but I'm not ASD). I was hit, had a door and chair broken against my back, and generally terrorized in middle childhood. But I think the earliest stuff (age 0-4 traumas) is still what I still deal with most painfully day to day. I was already starving, drinking, and cutting before assaulted as a teen...diagnosed PTSD after a suicide attempt in response to the assault. The therapist creeped me out and I never went back. My avoidance was really deep and I just kept starving for years. Now my therapist frames it all as "complex trauma", which makes enough sense. It accounts for all of it, and she understands there is a very early trauma component and what that looks like. My "avoidance" and "re-experiencing" are deep patterns but don't look quite like adult PTSD. If there was just PTSD and CPTSD (that could account for developmental or multiple traumas, or captivity), that's probably good enough...but still requiring therapists who understand how child development corresponds to the ages of traumas.

We are stuck with this mess in a good way...we are starting to recognize the deep and global impacts of trauma. But that doesn't mean we're figuring it out very quickly. There was support from a team of top trauma specialists compiling hundreds of profile, yet Van Der Kolk's "DTD" did not make it into the DSM. There was not, supposedly, enough clinical evidence. Van Der Kolk states that childhood trauma is "radically different" from trauma to fully formed adults. DTD would have encompassed the large range of symptoms for many children who go without treatment (later struggle in school, and a portion of traumatized children end up later incarcerated). Instead, the DSM V has what Van Der Kolk calls a "smorgasbord" of "diagnoses" associated with early-life trauma, including some new ones like "Disruptive Mood Regulation Disorder, Non-suicidal Self Injury, Intermittent Explosive Disorder, Dysregulated Social Engagement Disorder, and Disruptive Impulse Control Disorder" ("The Body Keeps the Score", p. 164). :sour::meh: WTF? Basically, these kids get labels as their symptoms, and treated with whack-a-mole behavioral and Special Education approaches (the emotional-behavioral disorder subset within American SpEd), versus being helped from a trauma-informed perspective.

In response to the DSM V, the director of the National Institute for Mental Health, Thomas Insel, announced that the NIMH could no longer support the DSM's "symptom-based diagnosis." (Van Der Kolk, p. 165)

So, that's where we're at with that...

 

[lostforgottensoul]

Now im getting the 2 thread confused lol. Sorry.

 

[lostforgottensoul]

neither of which would include the torture victim that doesn't have severe, permanent injury but does have severe, permanent psychological injury.

This couldnt be more right. The issue I have was referencing the inabilty to work. Just because i have awesome abilty to numb myself to be able to work doesnt mean i didnt have injury, possible permant (though I hope not) psycholoically.

 

[Anarchy]

A child's perception of the threat of death may be entirely different from an adults perception...

Children and especially very young children (going right back to around 6 months after conception, when the limbic brain becomes active in an unborn child and begins to learn), have no way to understand what is being done to them.

Add to that, the fallacious belief amongst medical personnel that babies are unable to feel pain, and even if they could feel pain, they wouldn't be able to remember it. Hence surgery was carried out on babies, without pain control, and without anaesthesia or sedation. :inpain:

The child has no idea what is about to happen or why - then finds itself either physically restrained or paralysed by drugs, and subjected to the pain of surgery, carried out by complete strangers.

I was lucky enough to have the relationship T who I was seeing when I was in my forties, spot that I was showing signs of PTSD.

At that time, I would not have been able to identify a memory of a trauma. Therefore if I had been seeing a T who wasn't good at spotting PTSD, It would never have been identified.

I could not relate to the idea of having PTSD and didn't accept the idea until several years later.

 

[Chava]

Add to that, the fallacious belief amongst medical personnel that babies are unable to feel pain, and even if they could feel pain, they wouldn't be able to remember it. Hence surgery was carried out on babies, without pain control, and without anaesthesia or sedation.

Such hell! As if we "feel" pain with our frontal cortex. :shifty: To add to your bits, the amygdala is fully formed at birth. :wideeyed::wideeyed::wideeyed: That's a fact and it's major. I do have early body memories but it has taken a very long time to sort out and understand WTF happens with my triggers around these situations. I'm also deeply pissed off at humans, in general, and distrustful. I'm mostly friendly, I do well as a colleague, but I'm a hermit beyond that :ninja: (I do like you guys here though :)). I find it nearly impossible to ask for help before going to the ER. Asking for help makes almost no sense to me, the way foreign languages make no sense to me. Glad you found an understanding therapist @Anarchy

Alright, sorry to derail a bit here. I'm off to shopping. Thanks for letting me chime in though.

 

[Sideways]

I'm coming to this late, but I'm struggling to see where the complication is...

If someone detains you against your will and subjects you to torture, even if that torture inflicts no serious physical injury, there seems to me to be a very real and immediate threat of death or catastrophic injury. That's the threat of torture and confinement - you're powerless, & they're demonstrating that they can and will hurt you and deprive you of basic survival necessities. You don't know if or when you'll be released, or how far the torture will go, all you know is you're powerless.

I think it would be fairly unusual for a captor to say to a detainee, "Keep your head up, we're not going to hurt you really, and the detainment is just a pointless exercise that won't last longer than a couple of minutes".

Yes, your 'will to survive' kicks in, but it kicks in because your brain is concerned that maybe you won't survive...maybe I've missed the point??