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Someone’s Gotta Say it- Insights from 30 Years at the Forefront of Medical Care for Victims of Sexual Harms

by Susan Nerenbaum in Professional Insights & Experiences, Uncategorized

Someone’s Gotta Say It

 

Insights from 30 Years at the Forefront of Medical Care for Victims of Sexual Harms

 

By Marina Sampanes Peed
Executive Director of Mosaic Georgia

We are thrilled to celebrate a significant milestone at Mosaic Georgia – 30 years of providing exceptional medical care for victims of sexual harms. Since July 1993, we have been at the forefront of delivering trauma-informed forensic medical services, setting a new standard of care in Georgia. As we reflect on our journey, we want to share some valuable insights and observations with you. 

Our mission began when the Gwinnett Rape Crisis Center was founded by a dedicated hospital volunteer named Ann Smiley. Our volunteer advocates would respond to calls from the hospital to provide support to survivors who disclosed sexual assault. However, we realized that there were opportunities to improve the process. By shifting the response away from hospitals and establishing a center focused on advocacy support and medical forensic care, we could ensure quicker, more private care for survivors while enabling law enforcement to investigate promptly. 

Our specially-trained Sexual Assault Nurse/Forensic Examiners (SANEs) have conducted over 6,000 sexual assault exams, catering to patients of all ages and genders. By offering specialized care, including prevention of sexually transmitted infections or pregnancy resulting from rape, we ensure that every survivor has access to the support they need. Witnessing the relief in survivors’ eyes when they realize they won’t have to worry about these additional costs is truly heartwarming. 

This community-based approach benefits everyone involved. All our services are provided at no charge to the victims or local law enforcement. We believe that access to quality care should never be hindered by financial constraints. However, we face sustainability challenges as crime victim services funding decreases while the costs of delivering 24/7 response increase. The work we do at Mosaic Georgia sits at the intersection of public safety, healthcare, and addressing the long-term harms caused by sexual violence. 

Looking at the larger picture, we see our work is far from done. Despite the #metoo movement and numerous media reports of high-profile cases, fewer victims are coming forward to report these crimes to the police (2021 estimate is only 25% of sexual assaults for people age 12 and older are reported to police). Myths and misunderstandings surrounding sexual violence persist. Our culture is inundated with sexualized images of girls and women and harmful definitions of masculinity. Additionally, instances of child sexual abuse, incest, and commercial sexual exploitation of children and youth are on the rise. 

The expansion of high-speed internet and the world wide web has facilitated predators in exploiting vulnerable individuals. Arrests and prosecution of perpetrators also remain lower compared to other violent crimes. It is clear that there is still much work to be done to address these pressing issues. 

At Mosaic Georgia, we are committed to making a difference through education and training. Our SANE Success Institute offers comprehensive programs that equip Sexual Assault Nurse Examiners (SANEs) with the knowledge, clinical skills, and court testimony preparation they need. In response to the pandemic, we launched PRO/SANE, an online peer review platform that allows SANEs to learn from one another and discuss unique situations they encounter in their practice. Through these initiatives, we foster shared learning, skill development, and a supportive community of professionals across Georgia. 

Combating sexual harms requires a collective effort from our community. It is crucial that we support survivors, hold perpetrators accountable, and ensure that consent and boundaries are understood by all. Together, let us break the silence and create a world where every individual is safe, respected, and free from the devastating impacts of sexual violence. 

Thank you for being a part of the Mosaic Georgia community. Your support and involvement are instrumental in our continued efforts to make a lasting difference. 

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SANE Spotlight: Remember the SANEs during National Nurses Week

by brian in HEALTH, Professional Insights & Experiences

SANE Spotlight: Remember the SANEs during National Nurses Week

By Marina Sampanes Peed
Executive Director of Mosaic Georgia

Mosaic Georgia SANEs in action. From left to right: Melissa Drinkard, Kathy Carter, Teresa Bullard

As National Nurses Week is upon us, we call attention to a small but mighty forensic nursing specialty: Sexual Assault Nurse Examiners (SANEs). SANEs are specially trained registered nurses who provide compassionate care to survivors of sexual violence including assault, abuse, and sex trafficking.

The SANE practice is at the intersection of health care and criminal investigation. Their patients are both people and evidence. They collect evidence, document injuries, and provide treatment and support to survivors in a way that is trauma-informed and respectful. When cases proceed to court, SANEs are often called to testify in proceedings.

Kathy Carter, director of Forensic Medical Services, is often asked why she chose to practice as a nurse in such a difficult specialty. Kathy shares her Why: “While I cannot end sexualized violence, I can offer trauma informed care to patients after an assault or on-going abuse which promotes a feeling of safety, empowerment and healing. This level of care can make a HUGE difference in the trajectory of the patient’s journey.”

Victims of sex crimes are more likely to report the assaults and participate in investigations after receiving trauma-informed care from SANE and advocates. Like all people who seek medical care, the experience is more effective when the care providers lead with listening and believing.

Mosaic Georgia was the first Sexual Assault Center in Georgia to develop the community-based SANE/medical forensic program. In 1993 (then Gwinnett Rape Crisis), we treated our first patient/victim of rape in our center. Over the last 30 years, our SANEs have provided more than 6,000 medical forensic exams to people ranging in age from 3 months to 90 years. The medical care is enhanced with victim and family advocacy, mental health services, and other supports in one location.

To respond to calls 24/7, the community relies on committed SANEs who go on-call after hours and weekends and respond to our center when needed. These are special people. If you meet a SANE, let them know you appreciate their dedication.

Mosaic Georgia’s SANE Success Institute professional education, peer review, and an online community for SANE practitioners. It is a lively forum of support and connection for SANEs across Georgia and nearby states. For more information, https://www.mosaicgeorgia.org/education-training/

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A Day in the Life of a Counselor at a Child Advocacy Center

by brian in Professional Insights & Experiences, SAFETY

A Day in the Life of a Counselor at a Child Advocacy Center

Kendall Circle Headshot

By Kendall Wolz
Mental Health and Wellness Manager at Mosaic Georgia

When I was in graduate school, I regularly heard my peers talk about their dreams of owning a private counseling practice, working in a school system with students, or working on a behavioral health unit of a hospital. I do not recall anyone talking about opportunities to work as a therapist/counselor at a Child Advocacy Center.

A Child Advocacy Center (CAC) is a child-friendly, safe and neutral location where law enforcement and other investigators conduct and observe forensic interviews with children who are victims of crimes. The center is also a place where children and non-offending caregivers receive support, crisis intervention, and referrals.

Working as a therapist/counselor at a Child Advocacy Center is a unique opportunity that requires dedication, patience, and a willingness to walk with people through their significant traumatic experiences. Some days are filled with sadness for the child who has been hurt, outrage at systems and policies that still fail children, and anger towards perpetrators that have grossly harmed little ones. Amid the hard days, there are many glimmers of hope and celebrations. Our “why” reignites when we hear how a child effectively managed a trauma trigger using coping skills practiced in session. Our hearts are filled with joy when a child completes their trauma narrative signifying, they are ready to graduate from therapy. Each time a child shows up to session, willing to do the work of therapy, we are reminded of the resilience and strength children possess.

So, what is a day like for a therapist/counselor at Mosaic Georgia?

We rarely have two days that look the same in a given week at Mosaic Georgia. Our therapists manage a caseload of individual clients and schedule weekly sessions with each of them. We also facilitate various support groups during the week for non-offending caregivers and adult survivors of sexual trauma.

We participate once a month in multi-disciplinary team (MDT) meetings which allow us to interact with our partner agencies to ensure the clients we serve are receiving the assistance they need. Child Advocacy Centers work within a multi-disciplinary team of law enforcement, child protection agencies, district attorney’s offices, and other organizations involved in cases where child maltreatment has been disclosed. Multidisciplinary teams are integral for trauma-informed responses to children and their families. One way the MDT serves children and their families is that the intergroup communication prevents a child from having to tell their story multiple times to each agency involved in the response.

Our team of therapists/counselors also provide crisis counseling intervention when a child or adult comes to the center and needs immediate mental health support. Between sessions with clients, leading support groups, and meeting with the rest of the Mosaic Georgia staff and partner organizations, our team is busy building treatment plans for clients, attending trainings to increase awareness of best practices, and building resources for clients and the community.

Did you know that there are 47 Child Advocacy Centers in Georgia?

Throughout the United States there are Children’s Advocacy Centers providing critical services to children and families after outcries of abuse. If you know someone pursuing a career in the mental health field, I encourage you to share with them and make sure they are aware of the opportunity to provide therapy/counseling to children at a Child Advocacy Center.

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National Suicide Prevention Month: The Impact of Sexual Violence on Mental Health

by brian in Mental Health & Trauma, SAFETY

National Suicide Prevention Month: The Impact of Sexual Violence on Mental Health

Kendall Circle Headshot

By Kendall Wolz
Mental Health and Wellness Manager at Mosaic Georgia

“I feel hopeless.”
“I just don’t know how I can continue with this pain.”
“Sometimes I think dying is the only way.”
“I don’t really want to die, but I think about it all the time.” 
 

It is common for therapists to hear phrases like these when sitting with clients in the aftermath of sexual violence. The phrases reveal the depth of the pain that sexual trauma creates. Many clients who share these words struggle with post-traumatic stress disorder (PTSD) symptoms such as nightmares, intrusive thoughts, hypervigilance, avoidance of reminders of the trauma, anxiety, and depression. The psychological impacts of sexual violence disrupt survivor’s daily lives.  

Real-World Aftereffects of Trauma

Take a moment to remember the last time you went grocery shopping. You probably got in your car, turned on the radio, drove to the store, picked up the items you needed, checked out, drove home, and unloaded the groceries.  

A survivor with PTSD symptoms may have a very different experience. A survivor may choose to go to a grocery store across town to avoid the possibility of running into their abuser at the local store. They may find themselves constantly looking in the review mirror for any indication that danger is nearby. If a vehicle matching that of their perpetrator pulls near them, they may experience a surge of anxiety and panic that lasts long after they realize it is just a similar vehicle not the abuser. As they browse the aisles in the store, they may find themselves frozen for an unknown amount of time when they see the type of chips they ate prior to being assaulted. When they finally return home, they barely have the energy to unload the groceries. This was a single shopping trip. While completing the shopping trip is a success for that survivor, they may also feel defeated because the previously simple tasks now require more than they feel they can sustain.

The Troubling Links Between Sexual Violence, PTSD, and Suicide Risk 

Research illustrates the significant link between sexual assault and PTSD. One study found that 94% of women who were raped experienced PTSD symptoms during the two weeks immediately following the rape. About 30% of the women reported continued symptoms nine months later. The National Women’s Study reported that almost one-third of all rape victims develop PTSD sometime during their lives and 11% of rape victims currently suffer from the disorder (1). 

The effects of PTSD can be unrelenting.  

Psychological distress, difficulty with activities of daily living, and disrupted sleep patterns often result in an increased risk of suicidal ideation and suicidal attempts. 

Left untreated, the symptoms of PTSD will often result in feelings of hopelessness which places someone at a significant risk of suicide. Eapen and Cifu (2020) found that among people who have been diagnosed with PTSD at some point in their lifetime, approximately 27% have attempted suicide. A body of research (2) provides evidence that traumatic events such as childhood abuse may increase a person’s suicide risk.  

When a client discloses in session one of the phrases above, the first response as clinicians often involves normalizing their feelings. It makes sense in the aftermath of sexual trauma that a person would not want to endure the pain that seems like it will last forever. It makes sense that they would experience feelings of hopelessness when their entire world has been changed. Clinicians strive to instill hope for their clients that with consistent therapy, the establishment of safety and a support system, and the regular use of coping skills, the symptoms that currently wreak havoc in their lives will decrease.  

Healing can and does happen following sexual violence. 

What to Do If You or a Friend are Experiencing Suicidal Thoughts

If you are experiencing suicidal ideation and are thinking about ending your life, know that you are not alone and there is help available. There are likely people you know, love, and trust who have also experienced suicidal thoughts. This moment of pain, despair, and feeling like there is no other way will not last forever. If you feel like your life is in immediate danger, please call 911 right away. If you are in Georgia, you can call the Georgia Crisis Access Line 1-800-715-4225. If there is a person in your life that you love and trust, reach out to them and let them know you are having these thoughts. If possible, avoid being alone. You can also call or text the Suicide and Crisis Line at 988. Reach out and let someone support you in this time of need. It does not have to be the end. 

If someone you know is experiencing suicidal ideation or is talking about ending their life, the same resources listed above are available. If they have shared their thoughts and pain with you, acknowledge the courage it took for them to voice their need. Remind them how important they are and how much you care for them. If they are unwilling to call the resources listed above, you can take the step and call for them. Trained crisis counselors can guide you in supporting your friend. If they are in immediate danger, call 911 right away. 

References

  1. U.S. Department of Veterans Affairs and National Center for PTSD
    https://www.ptsd.va.gov/professional/treat/type/sexual_assault_female.asp

     2. U.S. Department of Veterans Affairs and National Center for PTSD https://www.ptsd.va.gov/professional/treat/cooccurring/suicide_ptsd.asp

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How Trauma Shakes Up the ‘Puzzle Pieces’ of the Brain

by brian in HEALTH, Mental Health & Trauma

How Trauma Shakes Up the ‘Puzzle Pieces’ of the Brain

Kendall Circle Headshot

By Kendall Wolz
Mental Health and Wellness Manager at Mosaic Georgia

A transcript of an interview Mosaic Georgia’s Director of Mental Health & Wellness, Kendall Wolz

Can you tell us a little about your background?

My name is Kendall, and I am the director of mental health and wellness services here at Mosaic, Georgia. I hold a LPC, which means I’m a licensed professional counselor. So I get to not only oversee our program, but also provide direct services to clients.

 

How long have you been in this field?

I would say I’ve been in the helping profession since 2010, so gosh, 14 years. But specifically as a counselor, I’ve been seeing clients since 2018. I’ve been with Mosaic Georgia for a year and a half. It’ll be two years in October. I joined the staff and helped launch the Mental Health and Wellness Services in October of 2022.

 

So that launches us right into what is now upon us – Mental Health Awareness Month, which is of course the big topic. Let’s talk how trauma affects the brain. People tend to forget that the brain is an organ that has its own way of acting, the way any other organ would in the body. There are some scientific elements in terms of how the brain might react, or behaviors that might show up, that people who have not experienced significant trauma may not understand. Can you talk a little bit about how the brain typically records memories and then how that process could change when the body is in a mode of fight or flight?

I always talk about the brain as an organ of our body that is designed to protect us, to keep us safe, to keep us alive. Many of our organs have that role. And when they’re not threatened, when they’re not sick, when they’re not facing challenges, they usually work properly and do just that. However, when we experience something like a traumatic event, it sort of rattles our systems and they don’t function as they do in other circumstances.

If we think about the brain in its neutral or baseline state where everything is fine, memories are encoded using all parts of our brain. There’s the sensory pieces of memories that get recorded so we can recall how we felt when certain events happened, what something may have smelled like or tasted like or felt like to touch; we can recall maybe what thoughts we had. We can also recall those narrative portions of that event. We can tell the story of ‘this is what happened’ and ‘that is what happened’. So I compare it [the brain] to a puzzle. In that neutral state, we have access to all the puzzle pieces and that memory is getting stored as a complete puzzle.

However, when trauma happens or a traumatic event occurs, those memories don’t get stored as a full puzzle. Instead, it’s like someone shook that puzzle up or tossed all the pieces up in the air. And that memory is getting stored with some of the puzzle pieces and maybe not all of them. And the way that that typically looks is that when a person has experienced a trauma, they have difficulty accessing some pieces of that memory.

 

How does this show up when someone discloses abuse?

It may mean they can’t tell us that narrative portion of ‘I did this, and ‘then I did this, and then this happened’, or give us that complete storyline that we desire. Instead, what they may recall is what was playing on the TV in the background for example. There’s a very strong sensory aspect of the memory. They may recall how something smelled and can tell you in great detail what that was like, but it wouldn’t be fair for us to expect them to be able to give us the full puzzle of that memory, because that’s just not how the brain stores what has occurred.

Very rarely when a trauma occurs is a person going to think about, let me jot down, let me remind myself what time it is when this happened or what day it occurred. And especially when there’s chronic or long-term trauma events that occur multiple times in multiple settings, it’s difficult. The brain isn’t thinking, ‘what time is it, what day is it?’ Instead, the brain is thinking, ‘I’ve got to survive’.

People unfortunately can tend to question why someone would wait a long period of time to disclose abuse. Can you talk a little about how common that is and how it affects the healing process?

Some studies have shown and some organizations have stated that the average age of disclosure for childhood sexual abuse is the age of 55. And so if that length of time has passed since a trauma occurs, what we typically see is that – let’s say a person never received any form of treatment for a trauma and many years have passed – it is challenging.

Typically that trauma, that may have been a single event, becomes more complex because of the symptoms they experience, the ways that they may try to self-soothe or to cope, and the way that other people respond to them. Often we see that there’s this pattern of multiple hurts and harms over their lifetime,

but it’s never too late to begin therapy and it’s never too late to heal.

We have many, many studies and I have a lot of personal experience from my work where I’ve seen people who didn’t disclose as kids and are now adults, they work through their trauma and are able to find that joy in life again that was stolen when the trauma occurred.

 

The Hand Model of the Brain

I’ll sometimes use Dr. Dan Siegel’s hand model of the brain. The way that that works is you ball up your fist and think of it as your brain. The front part of our brains behind our forehead is our prefrontal cortex. Not only is it the last thing to develop – our executive functioning–decision making, reasoning, higher level thoughts – but it’s also the least important when our lives feel threatened, or a traumatic event is occurring.

If you open your hand and lift up the four fingers, then you would see your lower brain and your midbrain. For survival, we need all the energy in this part of our brain. This is where our stress hormones are released. This is where our body goes into that fight or flight response which is what keeps us alive and keeps us going.

Sometimes we’ll talk about when a kid gets dysregulated, their ‘lid is flipped’. They can’t access the front part – the executive functioning piece, the thought process, the reasoning. It’s the same way when a trauma occurs, we’re not going to have time to think about ‘what am I going to do?’ Instead, we just go into the automatic responses.

It’s just really what our brain does. It’s what it was designed to do, But it’s not exactly what society wants from people.

 

Is access to the more episodic information, like dates, times and locations gone forever?

A lot of times people are expected to give that full puzzle memory quickly–right away. But really their bodies are still in that hyperarousal state, that fight or flight response. If we just give them some time to be able to regulate and feel safe again, then sometimes they are able to access more of those pieces of the puzzle.

I think the expectation or the hope is that they can provide that information right away. And sometimes it’s just not reasonable for us to expect that.

Do you think that most responders who are dealing with those types of situations and listening to disclosures understand the challenges in recalling information, or do you think there’s a lot of work that needs to be done in creating more awareness around it?

I think there’s definitely room for more awareness. However, we have come a long way from where we were a decade ago and definitely, for example, three decades ago. There has been improvement. There is more awareness and understanding from a science perspective of what happens with our brain. But I think it takes a while to shift attitudes and long held beliefs about expectations of how a survivor should act after trauma.

An eye-opening animated video using a real-life scenario, effectively illustrates how trauma affects the brain.

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Other Helpful and Informative Resources

Mosaic Georgia 24/7 FREE Crisis Line: 866-900-6019

Watch as Dr. Seigel explains his hand model of the brain

Read more from Kendall Wolz about trauma and the brain

Read about the trauma brain in Psychology Today.

Ready to heal?
Our Wholeness Collective offerings help facilitate a mind-body connection that encourages personal growth, healing, and resilience.

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Making Room for Grief After Trauma

by Susan Nerenbaum in HEALTH, Mental Health & Trauma, Uncategorized

Making Room for Grief After Trauma

Kendall Circle Headshot

By Kendall Wolz
Mental Health and Wellness Manager at Mosaic Georgia

One of the often-overlooked responses following a trauma like child sexual abuse or sexual assault is the pervasive grief. For many survivors of sexual violence, their life looks different after an outcry or disclosure of their experiences. It is vital in our care for survivors and their families, that we make room for grief and provide a safe space where the losses are acknowledged. 

When a child discloses childhood sexual abuse, that outcry is not usually accompanied by an understanding of what will happen after they tell someone. Many times, children are only questioning if the perpetrator will follow through on their threat of what would happen if they did tell. If I had known what losses I would endure in the aftermath of my disclosure at 13 years old, I’m not sure I would have had the same courage to tell. Not only are there personal losses, but media has revealed how negligently disclosures are handled.  

Disclosures are costly, but they are worth it. The response to a disclosure is very important as it makes a significant difference in the experience of the survivor.  

What are the losses a survivor may need space to grieve?
 

Relationships

RAINN estimates that 93% of juvenile victims of sexual violence know their perpetrator.1 Many perpetrators do not act “all bad” within the family unit. In fact, they are often loved and trusted by family members. Following many disclosures in which law enforcement and child protective services become involved, the perpetrator and other family members are separated. In my family, my mom, siblings, and I moved from the home we shared with my abuser into a bedroom at our grandparents’ home. Despite the horrific crimes my abuser committed, he had been a constant in our lives for over seven years. My siblings and I loved our cousins/aunts/uncles/grandma on that side of the family. In what seemed like an instant, those relationships were irreparably damaged. While the relational loss to my abuser was absolutely necessary and what we needed, its rationality did not squelch the pain of losing family.
 

Environment 

In situations where the offender is a member of the household, the victim and their non-offending family member may not be able to return to the place they once called home. On November 10, 2004, my siblings and I went to school in the morning, and we never returned to the place we had called home with our stepdad for years. We moved away from a very rural area with plenty of land to run around on and pets, including a potbelly pig. We moved into a bedroom in our grandparents’ home in a neighborhood and were unable to bring them with us. We never saw our pets again after we went to school that morning. We were incredibly grateful to remain together and live in a home full of love; however, it was a major adjustment for us during a very stressful time.
 

Financial 

Financial losses occur when the perpetrator is a contributor to the household’s income. Not only might families experience the loss of an income, but they also incur new expenses including mental health treatment, absenteeism from work due to appointments, housing expenses for relocation, and civil court expenses in addition to others. Families may no longer be able to engage in previously normal leisure activities like eating at a restaurant or going to the movies. The increased financial burden creates additional stress and leaves families grieving the life they once had.
 

How Mosaic Georgia Helps 

At Mosaic Georgia we recognize the long-lasting impacts of sexualized violence and strive to provide meaningful support by acknowledging the losses and alleviating some of the burdens. When any person walks through the doors at Mosaic, we seek to build safety and trust, and to be a positive force in that person’s life. We provide opportunities for survivors to build their support system with others in the community through our Wholeness Collective offerings. While we are not able to reclaim homes, we purposefully create warm environments in our offices that we hope promote safety and comfort. To alleviate the financial burden our clients face, we provide free supportive services including advocacy, counseling/therapy, and legal services.  

Grief after trauma encompasses much more than the loss of relationships and people in our lives. It is vital that anyone who works with trauma survivors creates a space for grief as part of the healing process. 

My abuser was someone I loved, trusted, and wanted to know and be known by. He was someone I saw every single day. My family accepted him and welcomed him.

If you’ve followed my blog or read previous posts, you know the excitement I expressed for the popular television show, Who Wants to Be A Millionaire. I literally could not wait for the show to air in 1999. We only had antennas and two televisions in the trailer where I could watch the show. One television was in the living room but that is where my siblings often did their homework in the evening. The other television was in my mom and stepdad’s bedroom. When my stepdad invited me to watch the show, it seemed like the best of both worlds. Time with the person I trusted and loved AND I got to watch what I believed would be the best show ever.

It seems strange to label sexual abuse as gentle, but from a physical perspective, it was, in the beginning. I didn’t leave the room that first night in any kind of pain. But emotionally, I was filled with ambivalence.

I LOVED the show, Who Wants to be a Millionaire.

I ENJOYED getting the undivided attention of my stepdad.

I TRUSTED my stepdad would never do anything to harm me.

I was DISGUSTED by the evidence of the abuse on me.

I was CONFUSED by the passive threat he made before I left the room.

I FEARED someone would find out about our new secret.

At eight years old, these were strong, complex emotions that totally overwhelmed my system. I could not assess what was true, right, or healthy. As a result of the ambivalence, I had to rest on my default belief which was based on a general trust of people older than me. I needed those people to survive. If I could not trust them, how would I make it in the world?

Kids should be able to long for and love quality time with a parent. It is normal and healthy for a child to desire those things. My need for that perception of love was normal. I chose what was normal over and over- quality time with my stepdad and getting to watch my favorite show. Though it came with other hard feelings, the desire for love and acceptance won, over and over again.
So, ambivalence kept me quiet for a long time. And it keeps a lot of kids quiet.

When you hear a child disclose abuse, please know they have likely fought through the power of ambivalence. It is an incredible step of courage and bravery to go against the defaults to tell their story. Please accept that the ambivalence will not disappear overnight. Healing takes time.

Kendall Wolz heads up the Mental Health and Wellness team that provides individual, family, and group therapy to those seeking care at Mosaic Georgia. As a survivor herself, she has a unique insight into the challenges of living with past trauma, how it impacts lives daily, and what the process of healing truly looks like. Her personal website, Brave Girl, Speak unpacks some of the complex issues that come along with being a survivor of sexual violence. Visit Kendall’s site to read more about her personal journey healing from trauma and peeling the layers to reclaim her true self.

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Trauma and the Brain: A Look at How Traumatic Events Shape Memory and Perception

by brian in HEALTH, Mental Health & Trauma

Trauma and the Brain: A Look at How Traumatic Events Shape Memory and Perception

By Kendall Wolz
Mental Health and Wellness Manager at Mosaic Georgia

At the age of 13, I disclosed years of sexual abuse by my stepfather. Unfortunately, the rural area I lived in did not yet follow the robust Child Advocacy Center model that is the protocol today. This meant that I had multiple interviews by various investigative parties. I can recall extreme frustration when I was asked “when did the abuse start, how old were you, how many times did it happen?”

I felt intense fear that people would not believe me because I could not give the answers to those seemingly simple questions. The reality is that my brain did not file the memory of the first incident, or subsequent incidents of abuse as a biographical memory where the date and incident number were important.

Instead, what I could tell investigators included: the show, Who Wants to Be a Millionaire, was playing in the background, what my favorite pair of pajamas I wore most frequently looked like, what the abuse felt like to my body, and the fear that swept over me.

This is an example of how trauma memories are often stored.

Let’s explore how this happens.

The Brain: One Fascinating Organ

Weighing on average 3 pounds, the brain is the most complex organ within the body. It processes every piece of information received through the five senses and communicates with the rest of the body to keep us safe and alive.

How do experiences impact our brains?
Decades of research have shown that trauma has a significant negative impact on various structures within the brain. Before discussing those impacts, here is a look at the healthy brain functions that are harmed by trauma.

  • Brain Stem: Responsible for our survival instincts and functions such as heart rate, respiration, blood pressure, consciousness, and sleep.
  • Midbrain: Stores memory, processes emotions, and serves as a connection between our cortex and our brain stem.
  • Cortex: The most highly evolved structure of the brain, responsible for cognitive processing, decision making, and controlling thoughts and emotions.

Fight or Flight Leads the Way

When a person experiences an actual or perceived threat to their safety or wellbeing, the lower part of the brain, the brain stem, becomes highly activated to ensure survival. It may respond to the threat in a variety of ways.

An event like seeing a bear on a hike, witnessing a crime, or experiencing a sexual assault may elicit a desire to either fight with intensity, get away from the situation as quickly as possible, become frozen or paralyzed, fawn (go along with what is happening), or faint.

If the traumatic or threatening event is survived through a fight/flight/freeze/fawn/faint response, the brain has performed its job well.

How our brain responds to trauma is not a cognitive choice.

Temporarily Turning Off the Lights

Decision making happens in the prefrontal cortex, near the forehead – sometimes referred to as the “thinking area” of the brain. When a threat is perceived and the body goes into survival mode, the cortex essentially goes offline, halting its ability to communicate with other parts of the brain. This conserves energy and allows the body to focus on survival, until the perceived threat is gone. For example, during a traumatic event the brain would not have the ability to think through and solve a word problem, or the body would not put effort into digesting food. Until the threat subsides, the brain and body direct their many resources strictly towards survival.

The Brain’s Megaphone

What alerts the body to go into fight or flight mode? A small, almond shaped structure deep within the midbrain called the amygdala is responsible for sounding the alarm. The amygdala sends messages to other parts of the brain that activate various elements of the fight or flight response when a potential threat is present. Functions like increased heart rate and the release of stress hormones allow the body to get itself to safety.

It is in this part of the brain where memories are attached to emotion. Traumatic memories get stuck in the emotional memory of the amygdala rather than reaching the hippocampus, the area of the brain that records the details – like the what, when and where of an event.

So for survivors the “memory” of a trauma often emerges as a strong emotional or sensory experience. Unfortunately, trauma shuts down our ability to integrate events episodically which creates a barrier to recalling things like dates and locations.

This is why trauma survivors often keenly remember a smell, like the smoke of a house burning or the cologne of a rapist, but not what time it was when the trauma occurred.

The Trauma of Disclosing Trauma

Without understanding what happens within the brain during a trauma, there exists a risk of doing more harm to people who have experienced horrific events. When survivors are expected to recall the traumatic event in an episodic manner (the when, where, why), they become set up for judgement, disappointment, frustration, and even disbelief despite the reality that the memory is not consolidated and stored in a way that can be recollected.

However, opportunities for people to disclose their memory of what occurred can be provided by eliciting the information they can recall – how they felt, what their senses noticed – while assessing whether they can also access any of the biographical data.

As this information becomes more accessible and understood by the general population, an opportunity presents to move away from some of the stigmas and widespread misconceptions that plague survivors.

Helpful and Informative Sources

A video illustrating how trauma affects the brain can be seen here. 

The Body Keeps the Score by Bessel van der Kolk 

Dr. Seigel’s hand model of the brain: https://www.youtube.com/watch?v=f-m2YcdMdFw 

https://www.verywellmind.com/the-effect-of-ptsd-on-the-brain-2797643 

https://www.psychologytoday.com/us/blog/the-mindful-self-express/202106/understanding-the-trauma-brain 

At the age of 13, I disclosed years of sexual abuse by my stepfather. Unfortunately, the rural area I lived in did not yet follow the robust Child Advocacy Center model that is the protocol today. This meant that I had multiple interviews by various investigative parties. I can recall extreme frustration when I was asked “when did the abuse start, how old were you, how many times did it happen?”

I felt intense fear that people would not believe me because I could not give the answers to those seemingly simple questions. The reality is that my brain did not file the memory of the first incident, or subsequent incidents of abuse as a biographical memory where the date and incident number were important.

Instead, what I could tell investigators included: the show, Who Wants to Be a Millionaire, was playing in the background, what my favorite pair of pajamas I wore most frequently looked like, what the abuse felt like to my body, and the fear that swept over me.

This is an example of how trauma memories are often stored.

Let’s explore how this happens.

The Brain: One Fascinating Organ

Weighing on average 3 pounds, the brain is the most complex organ within the body. It processes every piece of information received through the five senses and communicates with the rest of the body to keep us safe and alive.

How do experiences impact our brains?
Decades of research have shown that trauma has a significant negative impact on various structures within the brain. Before discussing those impacts, here is a look at the healthy brain functions that are harmed by trauma.

  • Brain Stem: Responsible for our survival instincts and functions such as heart rate, respiration, blood pressure, consciousness, and sleep.
  • Midbrain: Stores memory, processes emotions, and serves as a connection between our cortex and our brain stem.
  • Cortex: The most highly evolved structure of the brain, responsible for cognitive processing, decision making, and controlling thoughts and emotions.

Fight or Flight Leads the Way

When a person experiences an actual or perceived threat to their safety or wellbeing, the lower part of the brain, the brain stem, becomes highly activated to ensure survival. It may respond to the threat in a variety of ways.

An event like seeing a bear on a hike, witnessing a crime, or experiencing a sexual assault may elicit a desire to either fight with intensity, get away from the situation as quickly as possible, become frozen or paralyzed, fawn (go along with what is happening), or faint.

If the traumatic or threatening event is survived through a fight/flight/freeze/fawn/faint response, the brain has performed its job well.

How our brain responds to trauma is not a cognitive choice.

Temporarily Turning Off the Lights

Decision making happens in the prefrontal cortex, near the forehead – sometimes referred to as the “thinking area” of the brain. When a threat is perceived and the body goes into survival mode, the cortex essentially goes offline, halting its ability to communicate with other parts of the brain. This conserves energy and allows the body to focus on survival, until the perceived threat is gone. For example, during a traumatic event the brain would not have the ability to think through and solve a word problem, or the body would not put effort into digesting food. Until the threat subsides, the brain and body direct their many resources strictly towards survival.

The Brain’s Megaphone

What alerts the body to go into fight or flight mode? A small, almond shaped structure deep within the midbrain called the amygdala is responsible for sounding the alarm. The amygdala sends messages to other parts of the brain that activate various elements of the fight or flight response when a potential threat is present. Functions like increased heart rate and the release of stress hormones allow the body to get itself to safety.

It is in this part of the brain where memories are attached to emotion. Traumatic memories get stuck in the emotional memory of the amygdala rather than reaching the hippocampus, the area of the brain that records the details – like the what, when and where of an event.

So for survivors the “memory” of a trauma often emerges as a strong emotional or sensory experience. Unfortunately, trauma shuts down our ability to integrate events episodically which creates a barrier to recalling things like dates and locations.

This is why trauma survivors often keenly remember a smell, like the smoke of a house burning or the cologne of a rapist, but not what time it was when the trauma occurred.

The Trauma of Disclosing Trauma

Without understanding what happens within the brain during a trauma, there exists a risk of doing more harm to people who have experienced horrific events. When survivors are expected to recall the traumatic event in an episodic manner (the when, where, why), they become set up for judgement, disappointment, frustration, and even disbelief despite the reality that the memory is not consolidated and stored in a way that can be recollected.

However, opportunities for people to disclose their memory of what occurred can be provided by eliciting the information they can recall – how they felt, what their senses noticed – while assessing whether they can also access any of the biographical data.

As this information becomes more accessible and understood by the general population, an opportunity presents to move away from some of the stigmas and widespread misconceptions that plague survivors.

Helpful and Informative Sources

A video illustrating how trauma affects the brain can be seen here. 

The Body Keeps the Score by Bessel van der Kolk 

Dr. Seigel’s hand model of the brain: https://www.youtube.com/watch?v=f-m2YcdMdFw 

https://www.verywellmind.com/the-effect-of-ptsd-on-the-brain-2797643 

https://www.psychologytoday.com/us/blog/the-mindful-self-express/202106/understanding-the-trauma-brain 

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Solutions for Survivors/Victims of Crimes: the Criminal Justice System, Civil Legal Remedies, and Non-legal Assistance

by miguelm in JUSTICE, Legal & Justice System

Solutions for Survivors/Victims of Crimes: the Criminal Justice System, Civil Legal Remedies, and Non-legal Assistance

 

Helpful responses to sexual assault and sexual abuse can take many forms. The criminal justice system is an important part of the puzzle for many victims of crimes, but sometimes a lack of corroborating evidence and other factors prevent cases from ending in arrest and eventual conviction. For a reported perpetrator to be found guilty, prosecutors must be able to prove beyond a reasonable doubt (See the chart below) that the crime occurred and that the reported perpetrator is the one who committed the crime. This is an extremely high burden of proof.  Additionally, adult victims of crimes may choose not to report their assault to law enforcement, and as a result, the criminal justice process may never begin. If the criminal justice system doesn’t lead to the conviction of the perpetrator, are there other options for victims of crimes?

In some cases, people who experience sex-based crimes are helped most by advocacy and support services that don’t involve the legal system. Mosaic Georgia has a talented team of victim advocates on staff to assist these clients with support and non-legal resources.

In other cases, civil legal remedies may provide helpful safety options and can assist victims of crimes with protections for their privacy, solutions for housing issues, help with immigration needs, answers to custody or divorce issues associated with the assault or abuse, resolutions to education problems stemming from the assault or abuse, and other creative remedies. Mosaic Georgia’s legal team is available to provide information, resources, referrals, and/or legal representation for victims of crime who need assistance in qualifying matters, as resources allow. Call Mosaic Georgia today (or speak with an attorney of your choosing) to discuss whether (and which!) civil legal remedies may be helpful to you.

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Why Don’t They Report?

by mosaicga in JUSTICE, Legal & Justice System

Some people who have not experienced personal violence wonder aloud “Why don’t they report it?” A careful look at how society reacts to reported sex crimes may provide some clues. In the majority of assaults, the victim and perpetrator are acquaintances or in same social circles. Because the persons are known, relationships are called into question. Social media provides space for people to declare judgments as facts on cases where they have no direct knowledge. Recent cases show:

  • The perpetrator’s potential innocence is often valued higher than the victim’s experience.
  • The potential impact of punishment on the perpetrator’s life is weighted more than the impact of the crime on the victim.

Here are some of the most common reasons victims of sexual assaults do not report:

1. Fear of reprisal: Social stigma, bullying from peers. Parents/School punishment for being out, drinking, etc.
2. Fear of stress on the family and loss of relationship, housing, transportation, economic support.
3. Fear of losing job, education, children, economic support.
4. Not important enough to report. “I was drunk and I shouldn’t have been there.” “He kissed me/apologized after.”
5. Reputational risk: “Don’t want people to think I’m a drunk / loose / not a virgin.”
6. Incident was a personal matter. “Don’t want the police at my house.”
7. Fear of being exposed (e.g., gender identity, sexual orientation, immigration status)

Sexual violence operates in plain sight.

Perhaps the better question is:

How can we make community safer so reporting a sexual assault is as safe as reporting a stolen vehicle?

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