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In 2018, Hannah Gadsby created a sensation through her stand-up show Nanette. In it she shocked audiences by telling her hard-hitting trauma narrative, revealing the impact of sexual abuse, male violence, and homophobia on her mental health. Controversially, Gadsby also claimed that stand-up as a form and the mainstream stand-up industry itself were significant agents in deepening her psychological harm. This chapter examines Gadsby’s dramaturgical strategies and struggles in attempting to construct a means of speaking about the pain of her lived experience and seeking a therapeutic means of addressing her trauma through stand-up. Luckhurst analyses Gadsby’s interest in ethical story-telling and her notion of educating audiences about laughter and political complicity. Finally, Luckhurst argues that Gadsby draws on therapy models to transform her trauma narrative into a story of healing for herself and her audiences.
The study of infant, child, and adolescent remains (non-adult remains) is a topic of growing interest within the fields of archaeology and bioarchaeology. Many published volumes and articles delve into the experiences of childhood and what these small remains may tell us about life, more broadly, in the past. For those interested in exploring infant and child remains, it is an exciting period as more methods and approaches are constantly being incorporated into the archaeological toolkit. This Element introduces the reader to the topic and to common methodological approaches used to consider non-adult remains from archaeological contexts. With this toolkit in hand, readers will be able to begin their own explorations and analyses of non-adult human remains within archaeological contexts.
The presence of children in eighteenth-century English voluntary hospitals is an area of increasing interest and attention. The Northampton Infirmary admission records detail inpatient and outpatient ages from 1744 to 1804, allowing for longitudinal investigations of children in the institution. The most common distempers affecting children were surgical infections, infectious diseases, and skin diseases; fifty-six per cent of the child patients were male and 43.3 per cent were female. Nearly seventy-five per cent of children left the hospital ‘cured’. This article outlines the Northampton Infirmary Eighteenth Century Child Admission Database, and demonstrates how the patterning of distempers within and among children provides insight into the health journeys of eighteenth-century children through the lens of their bodies, their parents, and their institutional recommenders.
Trauma plays a critical role in psychosis, but the nature of the relationship between specific symptoms and trauma history remains unclear.
Aims
The aim of the study was to explore the experience of positive symptoms and their association with trauma and life events from the perspective of patients with first-episode psychosis (FEP).
Method
Seventeen participants who were enrolled in an FEP programme participated in a qualitative interview examining their life and trauma events, the onset of their symptoms, their experience of positive symptoms and their perceived associations between symptoms and life and trauma events. The interview was based on a semi-structured interview of six main questions and follow-up questions. Participants also completed the Trauma and Life Experiences Checklist (TALE), and were asked about the relevance of the whole interview. Thematic content analysis, exploratory cluster analysis and matrix queries coding were performed.
Results
Fifteen participants described the experience of psychotic symptoms as distressing or traumatic. Eleven participants attributed the onset of positive psychotic symptoms to trauma and life events. Ten participants described explicit thematic associations between their symptoms and trauma and life events. Twelve participants evaluated the interview as relevant and helpful.
Conclusions
Our findings give insight into the lived experience of positive symptoms and potential psychological interventions valuing causal theories of participants and the association with life and trauma events.
This chapter explores how the term ‘Chernobyl child’ expanded over time to encompass nearly all children from Belarus and Ukraine, categorized based on their perceived suffering and need for help. This classification, while useful for securing aid, often led to ethical dilemmas about who deserved assistance. Through specific examples, the chapter illustrates how this categorization not only shaped their experiences abroad but also influenced how they and others understood their identities. The chapter also delves into how these trips abroad served as a means for the children to cope with the trauma of the Chernobyl disaster. While these journeys opened their eyes to different cultures, they often involved significant emotional challenges, such as adjusting to unfamiliar environments and confronting the reality of their situation. These experiences, though difficult, played a crucial role in how the children processed their pasts and envisioned their futures. The chapter shows that, despite the challenges, the trips sometimes led to lasting relationships with host families, providing a complex blend of support and difficulty in dealing with their traumatic histories.
The inglorious twelfth Battle of the Isonzo (autumn 1917), came to be an icon of catastrophe in the national awareness. It has remained one of the most persistent memory sites in Italian culture. However, many of the revolutionary myths proved in time to be little more than legend or false reports of war. There was no betrayal, no organized subversive plot, no attempt to ‘do a Russia’, yet Caporetto still has evocative power over the collective memory, outweighing the ‘splendid recovery’ on the Piave. Not only is it the most written about (and debated) battle in the history of unified Italy, it is also the only one whose name has entered common parlance to conjure up moral and material disaster. This more than explains why it was also the culminating experience in the life of Luigi Cadorna. Not only did it end his career, it turned him into a reprobate. He who even days before had been an untouchable idol, was now tarred with the brush of incompetence, even treason, and put through the public disgrace of a court of enquiry vetting his every act of command. Unsurprisingly, Caporetto was a ghost which Cadorna tried to shake off for the rest of his days.
Core premenstrual disorders (PMDs), including premenstrual syndrome (PMS) and premenstrual dysphoric disorder, can cause significant impairment. Despite evidence linking stress and premenstrual symptoms, a systematic synthesis is lacking.
Aims
To systematically review the literature and meta-analyse evidence on the relationship between premenstrual symptoms and stress.
Method
Four databases (Web of Science, PubMed, PsycINFO, Scopus) and Google Scholar were searched for studies indexed before 27 August 2024 (no language/year restrictions) assessing the relationship between self-reported stress and premenstrual symptoms in regularly menstruating individuals (PROSPERO: CRD42021244503). Three multilevel meta-analyses estimated (a) the correlation between stress and premenstrual symptom severity, (b) stress differences between individuals with and without core PMD across the menstrual cycle and (c) the impact of traumatic experiences on the occurrence of premenstrual symptoms. Study quality and publication bias were assessed.
Results
We synthesised 188 effect sizes from 66 studies (N = 38 344), indicating (a) a positive correlation (r = 0.29, 95% CI 0.23–0.36); (b) higher stress levels in participants with core PMD (d = 0.79, 95% CI 0.32–1.26), particularly during the luteal phase (dlut = 1.01, 95% CI 0.46–1.57); and (c) over twofold higher odds (odds ratio 2.45, 95% CI 1.87–3.23) of PMS in individuals with a history of trauma. Heterogeneity was high (I2 = 84.64–91.38%); one meta-analysis (c) showed evidence of publication bias.
Conclusions
The results indicate an association between stress and premenstrual symptoms, an effect of cycle phase and trauma as a risk factor for PMS. Future research should explore underlying biopsychosocial mechanisms.
Chapter 6 discusses the representation of memory in trauma narratives. Accounts of victims of childhood trauma are contrasted with the testimony of Holocaust survivors. I argue that that the distinctive qualities of trauma narratives can also be understood as differences in the culturally constructed landscapes of memory that shapes the distance and effort to remember affectively charged and socially defined events. Landscapes of memory draw from implicit models of memory that influence what can be recalled and warranted as accurate. Trauma narratives involve cultural models and metaphors of personal and historical memory. For them to function as personal and collective history, there must be public places for them to be told, acknowledged, and retold. The political recognition of collective identity and history can help create such a place. Individuals’ stories, in turn, can serve as testimony to ground collective history and call for further moral and political response. Understanding the personal, social, and political meanings of trauma in theory and practice requires tracing the systemic loops that link memory, symptom, and response with a landscape of cultural affordances.
Chapter 7 explores some ways in which metaphors trauma shape the experience of the self and temporality through examples from refugees and Holocaust survivors. A key function of narrative is organizing the experience of time. Narratives of the self have consequences for the experience time. The discussion distinguishes two meta-narratives of the self in terms of their implicit root metaphors and associated temporalities: the adamantine self, characterized by endurance, integrity, coherence, autonomy, self-definition, self-determination, and self-control; and the relational self, characterized by flexibility, fluidity, sensitivity to context, multivocality, interdependence, and responsiveness. These models of the self are associated with different ideologies and forms of social life that shape trauma memory and experience. They also influence the ways that trauma experience is narrated through personal and collective stories. This occurs in settings that require an attentive listener. The ethics of storytelling has an essential counterpart in the ethics of listening, which involves particular forms of temporality and ways of participating in a cultural community.
Fall from height is common in all age groups. In 2020 alone, over 6000 people in Canada died from fall-related injuries. Most of the published literature investigating fall-related injuries are often focused on fracture patterns, survival and recovery. Fatal falls are not well studied. The objective of this study is to characterize the demographics and craniocerebral and vertebrospinal injury patterns related to fatal falls within Southwestern Ontario.
Methods:
A retrospective case review was conducted at the Department of Pathology, London Health Sciences Centre, for deaths attributed to falls from 2000 to 2020. Only cases with complete autopsy and detailed neuropathology reports were included. Demographic data, comorbidity profiles and craniocerebral and vertebrospinal injuries, along with scene details, were collected and analyzed.
Results:
45 cases were included, with a male sex predominance and a mean age of 60.3 ± 18.1 years. The most common head injuries were hematoma, cerebral contusions and skull base fractures. Falls from stairs were the most common. Low fall (<3 m) was associated with subfalcine herniation and was more commonly seen in older individuals (>65 years). Younger individuals were more prone to falls from a high height (>3 m), with frontotemporal lobe contusions as the most common finding.
Discussion:
This study provides a detailed depiction of craniocerebral and vertebrospinal injury patterns of the fatal falls in Southwestern Ontario. Our findings show low falls are a more common cause of fatalities in individuals 65 years and older, and age is a significant predictor of frontal contusions and subdural hematomas.
Patients with posttraumatic stress disorder (PTSD) exhibit smaller regional brain volumes in commonly reported regions including the amygdala and hippocampus, regions associated with fear and memory processing. In the current study, we have conducted a voxel-based morphometry (VBM) meta-analysis using whole-brain statistical maps with neuroimaging data from the ENIGMA-PGC PTSD working group.
Methods
T1-weighted structural neuroimaging scans from 36 cohorts (PTSD n = 1309; controls n = 2198) were processed using a standardized VBM pipeline (ENIGMA-VBM tool). We meta-analyzed the resulting statistical maps for voxel-wise differences in gray matter (GM) and white matter (WM) volumes between PTSD patients and controls, performed subgroup analyses considering the trauma exposure of the controls, and examined associations between regional brain volumes and clinical variables including PTSD (CAPS-4/5, PCL-5) and depression severity (BDI-II, PHQ-9).
Results
PTSD patients exhibited smaller GM volumes across the frontal and temporal lobes, and cerebellum, with the most significant effect in the left cerebellum (Hedges’ g = 0.22, pcorrected = .001), and smaller cerebellar WM volume (peak Hedges’ g = 0.14, pcorrected = .008). We observed similar regional differences when comparing patients to trauma-exposed controls, suggesting these structural abnormalities may be specific to PTSD. Regression analyses revealed PTSD severity was negatively associated with GM volumes within the cerebellum (pcorrected = .003), while depression severity was negatively associated with GM volumes within the cerebellum and superior frontal gyrus in patients (pcorrected = .001).
Conclusions
PTSD patients exhibited widespread, regional differences in brain volumes where greater regional deficits appeared to reflect more severe symptoms. Our findings add to the growing literature implicating the cerebellum in PTSD psychopathology.
The DSM-5 recognized that the separation anxiety disorder (SEPAD) may span the entire life course or have an adult-onset. Epidemiological data indicated a 23%–69% prevalence of SEPAD in clinical settings and a high comorbidity with both prolonged grief disorder (PGD) and post-traumatic stress disorder (PTSD). Some authors hypothesize that while life threat represents the key trigger of PTSD, disruptions or threats to interpersonal bonds lead to PGD and SEPAD. This study aims to test the hypothesis that adult-onset SEPAD might be a trauma-related disorder, triggered by events threatening to interpersonal bonds.
Methods
The sample included 106 consecutive adult outpatients with anxiety and/or mood disorders. SEPAD was diagnosed according to DSM-5 criteria by means of the Structured Clinical Interview for Separation Anxiety Symptoms (SCI-SAS). The Adult Separation Anxiety Checklist (ASA-27) was used to assess symptoms severity. To assess exposure to trauma, the SCID-5 criterion A form for PTSD was administered. Traumatic events were coded as directly experienced (self) or involving close ones (others). Lifetime exposure to separation events was also assessed.
Results
60.4% of participants were categorized as not having SEPAD in adulthood or in childhood (NO-SEPAD), 18.9% as childhood-onset SEPAD, and 20.8% as adult-onset SEPAD. Controlling for comorbid disorders, lifetime traumatic events involving self and separation events, traumatic events involving others significantly predicted adult-onset SEPAD. A significant correlation between the age at trauma exposure and the age of SEPAD onset was found.
Conclusions
Our results are consistent with the hypothesis that adult-onset SEPAD may represent an event-related disorder.
The plays of Sean O’Casey are filled with aches and pains, debilitating diseases, and traumatic wounds. He was himself a disabled writer. Furthermore, his presentation of disease and disability is inseparable from his critique of class, militarism, and masculinist ideology. This chapter shows how O’Casey’s depictions of disability are more nuanced than they may at first appear. He does demonstrate an essentialist tendency to see female resilience as a triumph over the failures of male impairment, yet, in plays such as Juno and the Paycock and The Silver Tassie, O’Casey allows space for contrary readings that speak with relevance to contemporary understandings of disability.
On February 6, 2023, 7.7 and 7.6 magnitude earthquakes struck southeastern Türkiye, affecting 11 provinces and causing significant losses. This study aims to assess the mental health status of survivors in the twelfth month after the earthquake.
Methods
A cross-sectional study was conducted using an online survey with the virtual snowball sampling method. The survey included sociodemographic data, previous traumas, earthquake-related experiences, and the Post-Earthquake Trauma Level Determining Scale (PETLDS) and Hospital Anxiety and Depression Scale.
Results
The study included 2544 participants. The mean PETLDS score was 58.14±18.18, indicating that the participants were highly traumatized. Among them, 59.5% had high levels of post-traumatic symptoms, 44.2% had high anxiety, and 61% had high depression symptoms. 35.77% of participants displayed a co-occurrence of post-traumatic stress along with anxiety and depression. Female gender was the strongest predictor of high-level trauma and anxiety, while a history of psychiatric disorder was the strongest predictor of depression. Multiple logistic regression analysis indicated that symptoms were predicted by low income, low education level, smoking, comorbid chronic diseases, past traumatic experiences, the loss or injury of a loved one due to the earthquake, personal injury, temporary displacement, and damage to homes and workplaces.
Conclusions
The findings suggest that one year after the earthquake, mental health problems are prevalent among survivors, highlighting the need for urgent psychiatric interventions.
This study aimed to investigate the relationship between pre-earthquake and earthquake-related characteristics and post-earthquake trauma levels of individuals affected by the February 6, 2023 Kahramanmaraş earthquakes.
Methods
The study is in survey design, one of the quantitative research methods. The participants consist of individuals affected by the earthquake and staying in temporary accommodation centers (student dormitories) in Konya province. A survey including a personal information form and a scale for determining the Post-Earthquake Trauma Levels was administered face to face to 334 volunteer participants.
Results
Adults aged 30-46, those trapped under debris, those injured in the earthquake, those who lost a family member, a relative, a neighbour or a friend, and those who received psychological support after the earthquake are in the risk group in terms of high post-earthquake trauma levels.
Conclusions
The findings reveal the groups in which the traumatic effects of earthquakes on adults are high. It is important to prepare intervention programs by considering the needs of these groups in psychosocial interventions to be carried out after the earthquake.
Trauma is one of the leading global causes of mortality. In spite of more liberal use of CT scans, some patients will still have occult injuries and require a short period of observation and may need treatment of pain, etc. Emergency department observation units (ED OUs) have been used for the short-term management of trauma patients since the 1980s. OUs have proven to be a cost effective and safe alternative to inpatient admission for patients who need short-term management of their injury. OUs were found to decrease length of stay, increase efficiency, and decrease the utilization of resources.
Trauma refers to an event or series of events that overwhelms the capacities of the person. Trauma disrupts all developing systems from brain to self. Trauma is especially devastating in the early years because of the nature of development. Development is cumulative and follows the principle of differentiation. Basic forms are laid down and then refined; therefore, there is a lasting impact of early disruption. Trauma can be especially devasting with regard to meaning making, because the major impact of trauma is to compromise integration. Integration is precisely what meaning making is. When early integration is compromised, gaps in the mind in the form of dissociation will result.
William Fawcett, Royal Surrey County Hospital, Guildford and University of Surrey,Olivia Dow, Guy's and St Thomas' NHS Foundation Trust, London,Judith Dinsmore, St George's Hospital, London
Perioperative cardiac arrest occurs in about 1 in 3,000 anaesthetics. The majority occur in older, frailer patients (1 in 1,200), and in high-risk or emergency surgery. The cause may be the result of underlying medical disease – usually cardiac, secondary to surgery – usually due to haemorrhage or secondary to an anaesthetic cause – usually due to hypoxia and hypercapnia, typically resulting from airway problems.
The Resuscitation Council has issued algorithms to guide management of basic and advanced life support in both adults and children. Advanced life support secures the airway and supports the circulation using drugs with the aim of the return of spontaneous circulation. Two main types of arrhythmia occur in a cardiac arrest:
Non-shockable: pulseless electrical activity (PEA) – a QRS complex without a palpable pulse and asystole
Shockable: ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT)
Potentially reversible causes of cardiac arrest should be actively sought and treated. There are special circumstances after 28 weeks of pregnancy which require attention and are described. A traumatic cardiac arrest resuscitation algorithm is discussed.