ABUSER IDENTIFICATION SCREENING TOOL
Trauma Informed Care
The Center for PTSD firmly believes that all persons seen for mental health or psychological/emotional presentations deemed non-normative should be screened for emotionally or psychologically harmful dynamics in their relationships and resultant trauma, before diagnosing a mental illness.
Providers often diagnose any and all mental health symptoms as mental health disorders. Taking a pause to view a mental health symptomatology, prior to diagnosis, and assess for psychological/emotional trauma is the how trauma informed care is practiced.
Trauma is defined as a "physical injury", however, even our dictionary definitions differentiate between "1. a deeply distressing or disturbing experience - and - 2. physical injury." This shows how disconnected mental health is from the medical community. The brain is an organ, and deeply distressing or disturbing experiences cause physical injury to the brain, measurable by medical examination tests (MRI/CT). Suicidal patients especially should be screened for ongoing impacts to their emotional centers by distressing experiences in their social environment.
To my current view with what I would consider a CPTSD trauma: The complexity is a series of lesser identifiable or minor injuries that are sustained and through time result in a severe damage to the organ, in this case, the emotion centers of the brain. I am sure this could relate to cirrhosis or something of that nature to another organ, where responses are overproduced from an external stimuli or intrusion and the organ is left damaged, in pain, and malfunctioning to an extent.
Our current system is the equivalent of diagnosing every person with a broken bone as having a birth defect. Additionally, traditional treatment has a presupposed context that the failures of treatment or the responsibility of care is on the injured patient. Imagine breaking your leg in a fall, the doctor diagnosing you as disabled due to genealogy, treating you as disabled, and then blaming your inability to walk on non-compliance with treatment; which may have not even involved a cast.
To sum this up: assume your patient or client is possibly injured in their emotion centers when they present as any of the following: suicidal, anxious, depressed, OCD, dissociative symptoms (including attention). Dissociation and other mental health symptoms may result from a severe physical external impact to the brain, called a Traumatic Brain Injury, and I would argue that most of "mental health" may in fact just be traumatic brain injuries of a different type. I also have noticed abusive personalities tend to differ from traditional "metal health" and they are delineated from this in the DSM, however, they may mimic mental health (trauma) symptoms at times, especially when it suits their individual goals, to the detriment of those around them, and they are typically heavily traumatized at a very young age.
Attention deficits, amongst other dissociative symptoms, are what I will begin to describe below to re-understand the context of mental health treatment, should you happen to utilize this screen and catch an appropriate person considered for treatment.
Fight/Flight/Freeze
Clients who were considered to have diagnoses including prior diagnoses of OCD, ADHD, Depression, Bipolar, amongst others were caught within the screen. I was unable to rule out a single case and in some was able to directly trace a suicidal ideation rumination emergency call to a single sentence in a larger contextual traumatic conversation.
To be considered:
Fight - Anger, outbursts, violence, shouting, property destruction, "oppositional behavior", ODD, Bipolar 1, and others.
Flight - ADHD, social anxiety, anxiety, ODD, Bipolar 1 and 2, and others.
Freeze - Panic, ADD, Dissociations, Depression, and others
Meet the SCREEN
MJDNR + Markers
The MJDNR screen is the most simplistic form of screening found by this practitioner thus far. The screen was later used to develop a treatment for CPTSD. The treatment in talk therapy treatment for CPTSD is a reversal process via identifying the statements made in an MJDNR abuse conversation, then strongly and directly contradicting those statements. This helps to reverse the inoculation to sense esteem degradation and to repair a narcistic trauma.
MJDNR - Minimization, Justification, Denial, Negation, Reversal.
This grim acronym can be easily memorized as MJ-DNR (marijuana use, suicidal ideation - a common course for an emotional abuse victim)
The screen has the added "markers" - which are standard relational patterns seen in narcissistic relationships that permeate throughout most families seen by the wirter, in varieties and at differing levels. The levels appeared to match the same level of symptomatology and severity of diagnosis (i.e. schizoaffective disorder disabled to no work or driving as an adult with family who rarely displays empathy during sessions and who express extreme lack of empathy outside of sessions, alongside MJDNR communication)..
MJDNR communication is communication which coincides with an overall power dynamic. This is a non-negotiable.
It is certainly true that MJDNR can take place in a lower power, however, the emotional tie, especially with unconscious parental or societal representations, is not present with low to high MJDNR. Two people both experiencing MJDNR simultaneously is where boundaries are found, built, and consent is made. Respect for boundaries during MJDNR are differing levels of narcissism.
Certain individuals seem to be unable to step outside of MJDNR communication, or if they do, are only able to stay "picture perfect", often with crutch/prompt, before lapsing back into emotionally injuring others for personal gain.
A typical MJDNR example may be the following:
(Aunt who offered to babysit and called police for parental abandonment during the vacation offered by the aunt)
child: (goes to get food/water at night when waking up thirsty)
aunt: ("what are you doing up? you have school in the morning!)
child: "I'm just getting a drink of water"
aunt: "you did not ask and it is past 9pm, you are not allowed out of that bedroom. go to the bathroom and drink your water before bed! we told you this. You do not need to drink the rest of that, dump it out and go to bed. I am tired and you're making me stressed. You don't need water you are only seeking attention, You always do this and wake up the whole house!"
(many would consider that a totally normal household interaction, at least in my region of the world, SE Mass)
the next morning the niece may be greeted this way
aunt: "good morning."
child: (tired and silent)
aunt: "I said good morning, you kids are so disrespectful, you are so ungrateful, how about you don't eat breakfast this morning if you feel like you cant say hello to the household members. I'm calling your therapist and telling her that you were acting up again and not saying hi to me. I am tired of being treated this way by you. I care so much about you- I do everything around here, I didn't even eat today. Maybe you need to give me your phone, talking to your friends keep you from saying hi to your family, who loves you, and they don't. You know, you do this to yourself.
The MJDNR + markers screen would have caught the following:
MARKERS
1. bathroom restriction/control
2. water restriction
3. repeated discomfort of child despite no actual problem identified
4. blame of child with term "attention seeking"
5. blanket statements
6. high regard for respect despite not being disrespected and having power
7. control of person's healthcare and narratives within helping services
8. social restriction
9. consequence for existing
10. intentional psychosocial self esteem breaking with peers
MJDNR
Minimizations are when people minimize our personal needs, to paramount their own. Justifications are when people justify a boundary violation which hurt someone's feelings and was unprovoked initially. Denials are when people deny the right or correctness of someone's ability to feel any way about any topic. Negations often get mixed with denials, however, this practitioner views them as part of the narcissistic = feeding process which is particularly pronounced in harsh narcissistic dynamics - as either outright statements denying realty of events and often mixed with social layering. Reversals are when narcissistic people make the victim feel that they are actually the perpetrator. This appears to often be done intentionally by study of the victim and access through the unconscious and subconscious trauma related neuropathways and egodystonic/syntonic responses I have coined "trauma kays."
Minimizations: need for water, need for empathy, need for space, need for silence, need for respect, etc.
Justifications: 'making them stressed', 'haven't eaten', etc.
Denials: You need not have needs past 9pm, you don't have a voice in therapy unless the therapist does what I tell them to.
Reversals: You are making me stressed, you woke up the whole house, you are doing this to yourself, etc.
How to utilize MJDNR in reverse to "stitch" a narcissistic trauma the psycho/social mechanisms (and I'd be interested in brain scans)
Markers should be found and dealt with. This mean by any means necessary if you are that type of social worker or provider. There are times for example that a teen may want to withhold information about an abusive person who they identify as a boyfriend in lucidity begging for help. The trauma keys tended to be caught through reversal process in which the victim is left in a emotion loop unprocessed and feeling as if they themselves are the abuser.
This practice focuses heavily on reprocessing the reversals. The first step of which is the identification. Narcissism has several layers and sublayers. The context beneath layers is so potent it can be buried under several sub surface layers. The deeper the narrative the stronger it is for the victim experience invalidation or other brain scramble.
example that come to mind on a video I made long ago - "cash me outside" girl, severe abuse by Dr. Phil, mom, grandma, audience, and entire nation. We all owe her an amends to hopefully facilitate trauma healing.
Identified in MJDNR + Markers:
Danelle Bregoli - mom trigger word "mouth" several times until explosion on stage. The term seemed innocuous and benign in conversation - was likely buried in subconscious layers since birth and used as a button the possible NPD mom displayed. This was a basic layer found only in infantile narcissistic family control patterns but may be repeated into adulthood as both adults seemingly are immature, instead, both are injured in their own capacity, but mom in this practice would be solely responsible to complete screen. The power dynamic ensures parent always must be responsible unless guardian ad litem type circumstance is present. The unconscious power of a parent even in every socially relevant way is paramount to that of the parent's need in the child/parent relationship.
MJDNR repair in practice with Danielle: I am sorry Danielle, you didn't deserve that or the way any of those people treated you. You deserved to be treated with kindness, patience, and respect. No *child should ever be treated by a parent like your mom treated you. Your mom should have been nurturing and understanding, not degrading and hitting you. You are the strongest *young adult I've seen for standing up to the entire world and massive audience right in front of you. You are intelligent, strong, and there is no reason why all of society wont want you to be part of their family, you will bring a great family into the world who will advance us by carrying your intelligence, strength, and beauty.
Notice I use the word "young adult". I do this to avoid degradation of self esteem and to show respect as is required during repair. The word "child" implicates a degradation of self esteem in most contexts. Danielle was not 5 and playing on playgrounds, in less than a year she would be eligible for her first legal W2 job, so 'young adult' facilitates self esteem growth rather than emotional injury by external signaled regression. For younger people (7-11) I say 'older kid' and people in the middle (12-17) I say 'young adult'. In certain contexts I may say "child" but only in parent/child repair as you are 40 and still the child in the parent/child relationship.
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