Substance abuse and mental health issues are often linked, underlying the fact that good health requires people to take care of both their physical and emotional needs, according to Angela Fileccia, a licensed clinical social worker with Summer Street Health Center in Bangor.

With one session left to go in our advocate training, my class of Rape Response Services trainees delved into the issue of mental health and how it affects our response to a trauma. It’s an unfortunate situation we’re likely to face: Not only are people with mental health issues more likely to be victimized, Maine’s per capita substance abuse rate is higher than the national average, Fileccia said.

The majority of recipients of mental health and substance abuse services in Maine have experienced either sexual or physical abuse, according to study materials provided by the Maine Coalition to End Sexual Assault. In fact, a study by the Maine Trauma Advisory Group in 1997 showed that 70-80 percent of people diagnosed with mental illness who have been treated in psychiatric facilities have a history of sexual trauma, physical abuse or both.

Often times our perceptions of mental health and substance abuse come from our experiences. My classmates share a range of connections to addiction and mental health disorders, some from childhood, others from professional experiences. Fileccia made it clear though that even if we didn’t directly experience mental health issues, we all have experienced stress in varying degrees.

That stress serves a purpose. In our “caveman days,” Fileccia said, the limbic system in our brain, which controls stress reactions, warned us when we were in danger.

Nowadays, however, that same limbic system is set to trigger during much different circumstances, such as dealing with a traffic jam. In more extreme situations, the limbic system reacts to trauma such as sexual assault. But the response is generally the same in both scenarios: We are programmed to fight, flee or freeze.

Memories are stored in two ways — as facts and realities or as interpretations and assumptions. Such interpretations could include thoughts similar to, “the man who raped me had black hair, so all men with black hair are dangerous.” It’s not a rational thought but is entirely reasonable in the mind of someone who has been violated.

In addition, most of us are more apt to remember negative memories rather than positive ones. It’s a survival mechanism that ensures we learn from past experiences.

Unfortunately, this means many victims will store the memory of an assault in a way that blames themselves. Maybe she thinks she shouldn’t have worn a short skirt; maybe he feels he should have had less to drink.

But no matter the memory interpretation, victims should never blame themselves. As it has been reported here in the BDN and taught time and time again in my class, the victim is never at fault for the crime.

These self-blaming expressions about what the victim feels he or she could or should have done differently to prevent the assault are what Fileccia called “automatic negative thoughts.” We as advocates should listen to these but not validate them. Instead, we may want to offer counter statements or initiate a conversation about how to approach the situation differently.

We have to, as always, make sure we leave our own baggage at the door as well. We must leave behind stereotypes, stigmas and disregard feelings of disbelief. We should think about the symptoms we are seeing, rather than trying to diagnose a victim or label him or her with a specific illness.

Symptoms of mental health issues and trauma look very similar. They can include an increase or decrease in sleep or appetite, irritability, a lack of concentration or motivation, an increase in distracting activities or a loss of interest in things once enjoyed. Physical symptoms can include but may not be limited to: shortness of breath, a racing heart, muscle tension or aches in the stomach or head.

In addition to the emotional and physical symptoms, many victims, both those with mental health issues and those without, will often question their reaction to the crime as it is occurring. Whatever the response, this, too, is controlled by the ever-powerful limbic system.

None of the common reactions — fight, flight or freeze — is a better choice than the other. In fact, freezing is not only more common than we think, but in some situations it may be the safest option.

So what do we tell someone who questions why they didn’t fight back?

Simple. “Your brain is trying to save your life,” Fileccia said.

Natalie Feulner is the BDN’s newsroom administrator.