Fabrication of Trauma Rebecca Wilkinson
Workshop aims to increase awareness on identification of fabrication within the ex - service population and to facilitate reflection and discussion on the possible reasons people fabricate and underlying personality processes.
Outline Brief overview of the service I work in and how I came across the issue of fabrication How prevalent is the issue How is fabrication defined How can you identify it within the ex military/ military population. Memory and PTSD The 7 sins of memory
Personality Disorder How we assess for PD Its relevance to fabrication The different types of PD Relate to Case study examples How do you then address this as part of client assessments and interventions? What might you begin to think about? Feedback and main group discussion Questions and close
Fabrication
Humber Traumatic Stress Service PTSD Service piloted 1996-98 Provide specialist assessment, formulation and intervention for ex-military personnel affected by exposure to trauma Psychological intervention, Occupational Therapy, Dual Diagnosis work Nurse with experience working for the MOD. links with national and local military. Work alongside other agencies Service expanded in 2009 in Hull
Who do we see? Mainly Complex (multiple or prolonged) type II trauma On occasions Type I trauma when accompanied with others factors e.g. self harm, previous treatment ineffective Comorbidity – alcohol and substance misuse, anxiety and depression, obsessive traits, personality traits Mainly army, majority male, late 20’s early 30’s NI, Falklands, Bosnia, Kosovo, Iraq, Afghanistan
Service Model Referrer Military Records Family/ Partner Assessment Dual diagnosis Team discussion Stabilisation Processing Integration
Veterans Outreach Pilot Project Recognition that group of veterans not being reached PTSD not most common mental health problem in veterans Evidence shows veterans generally happy with NHS services once accessed them, problem is getting into services Potential need to develop different approach to engaging veterans in mental health services Pilot to scope need and trial different routes of access
Structure and Staffing Humber Host Trust Administrator Band 3 0.8wte Hull, ER,N Lincs, Leeds, Bradford, Sheffield, Barnsley, York and Wakefield Doncaster, Rotherham North Yorkshire Veterans Outreach Veterans Outreach Veterans Outreach Post Band 7 Post Band 7 Post Band 7 Humber NHS Leeds Partnerships Sheffield Health and Foundation Trust NHS Foundation Trust SC Foundation Trust
Outreach pilot further Highlighted fabrication and its co morbidity with disorders of the self and addictions Of 31 cases seen within the outreach service pilot 17 were fabricating their military history Of those who fabricated in this population all had served, but less than the time they stated for example 3 only completed basic training but reported they had been on operational deployment, many of the cases reported they had been to on ‘black (secret) ops’; reported they were members of SAS or Parachute Regiment or had been on operational tour when they had not..
6 pilot projects: Stafford, Camden & Islington, Cardiff, Tyne Esk & Wear, St Austell, Lothian. Most have estimated 50%-70% embellished or fabricated in some way. Why Fabricate ? Do Veterans think they need to have PTSD to access treatment? Or is it a badge of honour? Or is It something else ? In general the fabrication for the outreach cases was an exaggeration and embellishment of the truth in many cases it appeared to be a way to feel they had achieved something, in others it became a reason for not achieving significantly where they had sought to find a family in the army structure that had been lacking previously the army appeared to become the scapegoat and cause of everything wrong in their life.
“It is rare to find a psychiatric diagnosis that anyone wants to have, but PTSD seems to be one of them” (Andreasen, 1995, p. 963).
“Some individuals who never even served in military combat have successfully acquired service-connected benefits for PTSD (Burkett & Whitely, 1998). A valuable procedure to support or refute an account of combat experiences is the collection of collateral data.”
“ Those malingering PTSD may state that their records do not reflect their covert missions or ‘black ops’; hence no evidence of their experiences exists. If there is no written record of one of these events, look for the special training required for these missions. The terms Selection, specialist courses passed, classified training/mission will appear with dates (Burkett & Whitely, 1998). “
“ Although fabricated stories that are as vivid and horrifying as the experiences of true combat veterans (Burkett & Whitely, 1998; Hamilton, 1985) they may reveal their fabrication by incorrectly identifying certain details, including geography and culture of the area, military terminology used at the time and dates related to specific events” (Burkett & Whitely, 1998)
Genuine PTSD Malingered PTSD Minimise relationship of symptoms to Emphasize relationship of symptoms to combat combat Blame themselves Blame others Dream themes of helplessness Dream themes of grandiosity or power “Act out” alleged feelings Deny emotional impact of combat “Relish telling combat memories Are reluctant to tell combat memories Have survivor guilt related to specific incidents Have generalized guilt over surviving the war Avoid environments that resemble combat Do not avoid environments that resemble combat Show anger at helplessness Show anger at authority
Case Study Client referred by GP showing symptoms of PTSD, Client reports that he was a Chef in the RLC. He reports to have witnessed been exposed to various contacts with the Taliban when he was selected to go out on operations with special forces.
Investigations of records and Confidential reports show that this client is telling the truth – born in the UK with heritage from Pakistan he was fluent in Pashto and Dari (amongst other languages) and he was able to act as an interpreter when operational circumstances meant normal channels broke down, he was reliable and given positive reports for his adaptability. Be Aware sometimes it may not sound real but is true and other times it sounds very real but is fabricated!
Memory
Memory The 7 sins (D.Schacter 2001) There are genuine mistakes in memory recollection. It is worth considering these possibilities in our assessment of authenticity or fabrication
Omission: (Involves forgetting) the result is a failure to recall an idea, fact, or event 1. Transcience - the general deterioration of a specific memory over time. 2. Absent mindedness - memory breakdown involves problems at the point where attention and memory interface 3. Blocking - when the brain tries to retrieve or encode information, but another memory interferes with it
Commission: (Distorted or unwanted recollections) there is a form of memory present, but it is the desired fact, event, or ideas 4. Misattribution Misattribution entails correct recollection of information with incorrect recollection of the source of that information. Example: A soldier who witnessed a shooting just after attending a training course may blame the shooting on someone who was at the training course.
5. Suggestibility Memories of the past are often influenced by the manner in which they are recalled, and when subtle emphasis is placed on certain aspects of the event those emphasized aspects are sometimes incorporated into the recollection, whether or not they actually occurred. Example: A sergeant witnesses three hostages being kidnapped, a woman and two men. He later reads in the newspaper that two women and one man were kidnapped and he remembers it as two women and one man.
6. Bias One's current feelings and worldview distort remembrance of past events. This can pertain to specific incidences and the general conception one has of a certain period in one's life. This occurs partly because memories encoded while a person was feeling a certain level of arousal and a certain type of emotion, come to mind more quickly when a person is in a similar mood. Example: An ex-army officer, retired from the service is getting married and really enjoying the experience. He get’s into conversation with some members of his squadron at the wedding and talks about his experiences in Iraq with enjoyment and pleasure. This is not representative of the actual experience in which he witnessed a great deal of death and destruction. His colleagues who are not in the same present state of mind may feel confused at his response.
7. Persistence (A thought you can’t get rid of) This failure of the memory system involves the unwanted recall of information that is disturbing. The remembrance can range from a blunder on the job to a truly traumatic experience, and the persistent recall can lead to formation of phobias, post-traumatic stress disorder, and even suicide in especially disturbing and intrusive instances. (The body remembers) For example: The body physically reacts to a loud bang in the present in the same way it would have been on alert to explosions etc in the war zone.
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