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    When there is dissociation of various degrees both aspects of the dissociation are brought together in the safety of the therapeutic alliance. This is easier said than done because the fear and anger of the memories defended against may be gargantuan and the safety of everyday capable functioning is under jeopardy.

    It is important to know that protracted grief and PTSD can both overwhelm the mother’s psyche, especially if they are together.

    The word ‘decompensation’ is used when the overwhelming brings about ‘breakdown’. The overwhelming feelings are usually followed by depression. Sometimes depression of other types occur such as the depression of being alienated called ‘anomie’, that is associated with bleak circumstances and loneliness. Sometimes there is a more acute depression because there is no really close other there. The decompensation depression when they don’t lift by themselves will mostly be helped by medications such as fluoxetine and sertraline in relatively small doses.
    Follow up studies have often found however a huge amount of secondary disability when drugs are used to cover grief, or when the causes of the depression are multiple. Some depressions of hereditary origin sometimes need medication early. But in many instances there is treatment with benzodiazepines or major tranquillisers that produce secondary problems including addiction. Self-medication with recreational drugs and alcohol are responsible for many serious admissions to both types of hospital and are large in bad outcome statistics.

    Family therapy is often indicated when an overview gives indications that their PTSD and grief are misunderstood by their immediate family. When a family member does not understand the strange nature of PTSD at times, and particularly that many of the features have become hard-wired into the nervous system from the beginning, their tolerance of living with it can be quite limited. The sufferer of PTSD has often been loath to burden their family with the details of what they experienced subjectively, and don’t realise that their family may be able to follow the therapists lead in
    reshaping these experiences to take away the high emotional energy invested in them. There are some instances where the family is suitable where such enlisting family members in the therapy may short cut what is often a long individual work to a much shorter process.
    This is not always possible and if mistakes about the ‘suitability’ of the family for this are made it can even backfire.

    Above all in such treatment experience, kindness, and the development of a functional therapeutic relationship is what is required to advance healing where this is possible. And you don’t really know until you try it.


    Dr Geoff Rickarby Consultant Psychiatrist
    November 2014