T&R Intro

 

 

 

TRAUMA and RECOVERY

 

The aftermath of violence – from domestic abuse to political terror © 1992

 

By Judith Lewis Herman, MD

 

 

 

INTRODUCTION

 

 

THE ORDINARY RESPONSE TO ATROCITIES is to ban­ish them from consciousness. Certain violations of the social compact are too terrible to utter aloud: this is the meaning of the word unspeakable.

 

Atrocities, however, refuse to be buried. Equally as powerful as the desire to deny atrocities is the conviction that denial does not work. Folk wisdom is filled with ghosts who refuse to rest in their graves until their stories are told. Murder will out. Remembering and telling the truth about terrible events are prerequisites both for the restoration of the social order and for the healing of individual victims.

 

The conflict between the will to deny horrible events and the will to proclaim them aloud is the central dialectic of psychological trauma. People who have survived atrocities often tell their stories in a highly emotional, contradictory, and fragmented manner which undermines their credibility and thereby serves the twin imperatives of truth-telling and secrecy. When the truth is finally recognized, survivors can begin their recovery. But far too often secrecy prevails, and the story of the traumatic event surfaces not as a verbal narrative but as a symptom.

 

The psychological distress symptoms of traumatized people simulta­neously call attention to the existence of an unspeakable secret and deflect attention from it. This is most apparent in the way traumatized people alternate between feeling numb and reliving the event. The dialectic of trauma gives rise to complicated, sometimes uncanny alterations of con­sciousness, which George Orwell, one of the committed truth-tellers of our century, called “doublethink,” and which mental health professionals, searching for a calm, precise language, call “dissociation.” It results in the protean, dramatic, and often bizarre symptoms of hysteria which Freud recognized a century ago as disguised communications about sexual abuse in childhood.

 

Witnesses as well as victims are subject to the dialectic of trauma. It is difficult for an observer to remain clearheaded and calm, to see more than a few fragments of the picture at one time, to retain all the pieces, and to fit them together. It is even more difficult to find a language that conveys fully and persuasively what one has seen. Those who attempt to describe the atrocities that they have witnessed also risk their own credi­bility. To speak publicly about one’s knowledge of atrocities is to invite the stigma that attaches to victims.

 

The knowledge of horrible events periodically intrudes into public awareness but is rarely retained for long. Denial, repression, and dissocia­tion operate on a social as well as an individual level. The study of psychological trauma has an “underground” history. Like traumatized people, we have been cut off from the knowledge of our past. Like traumatized people, we need to understand the past in order to reclaim the present and the future. Therefore, an understanding of psychological trauma begins with rediscovering history.

 

Clinicians know the privileged moment of insight when repressed ideas, feelings, and memories surface into consciousness. These moments occur in the history of societies as well as in the history of individuals. In the 1970s, the speakouts of the women’s liberation movement brought to public awareness the widespread crimes of violence against women.  Vic­tims who had been silenced began to reveal their secrets. As a psychiatric resident, I heard numerous stories of sexual and domestic violence from my patients. Because of my involvement in the women’s movement, I was able to speak out against the denial of women’s real experiences in my own profession and testify to what I had witnessed. My first paper on incest, written with Lisa Hirschman in 1976, circulated “underground,” in manuscript, for a year before it was published. We began to receive letters from all over the country from women who had never before told their stories. Through them, we realized the power of speaking the unspeak­able and witnessed firsthand the creative energy that is released when the barriers of denial and repression are lifted.

 

Trauma and Recovery represents the fruits of two decades of research and clinical work with victims of sexual and domestic violence. It also reflects a growing body of experience with many other traumatized people, particularly combat veterans and the victims of political terror.  This is a book about restoring connections: between the public and private worlds, between the individual and community, between men and women. It is a book about commonalities: between rape survivors and combat veter­ans, between battered women and political prisoners, between the survi­vors of vast concentration camps created by tyrants who rule nations and the survivors of small, hidden concentration camps created by tyrants who rule their homes.

 

People who have endured horrible events suffer predictable psycholog­ical harm. There is a spectrum of traumatic disorders, ranging from the effects of a single overwhelming event to the more complicated effects of prolonged and repeated abuse. Established diagnostic concepts, especially the severe personality disorders commonly diagnosed in women, have generally failed to recognize the impact of victimization. The first part of this book delineates the spectrum of human adaptation to traumatic events and gives a new diagnostic name to the psychological disorder found in survivors of prolonged, repeated abuse.

 

Because the traumatic syndromes have basic features in common, the recovery process also follows a common pathway. The fundamental stages of recovery are establishing safety, reconstructing the trauma story, and restoring the connection between survivors and their community. The second part of the book develops an overview of the healing process and offers a new conceptual framework for psychotherapy with trauma­tized people. Both the characteristics of the traumatic disorders and the principles of treatment are illustrated with the testimony of survivors and with case examples drawn from a diverse literature.

 

The research sources for this book include my own earlier studies of incest survivors and my more recent study of the role of childhood trauma in the condition known as borderline personality disorder. The clinical sources of this book are my twenty years of practice at a feminist mental health clinic and ten years as a teacher and supervisor in a univer­sity teaching hospital.

 

The testimony of trauma survivors is at the heart of the book. To preserve confidentiality, I have identified all of my informants by pseudo­nyms, with two exceptions. First, I have identified therapists and clini­cians who were interviewed about their work, and second, I have identi­fied survivors who have already made themselves known publicly. The case vignettes that appear here are fictitious; each one is a composite, based on the experiences of many different patients, not of an individual.

 

Survivors challenge us to reconnect fragments, to reconstruct history, to make meaning of their present symptoms in the light of past events. I have attempted to integrate clinical and social perspectives on trauma without sacrificing either the complexity of individual experience or the breadth of political context. I have tried to unify an apparently divergent body of knowledge and to develop concepts that apply equally to the experiences of domestic and sexual life, the traditional sphere of women, and to the experiences of war and political life, the traditional sphere of men.

 

This book appears at a time when public discussion of the common atrocities of sexual and domestic life has been made possible by the women’s movement, and when public discussion of the common atrocities of political life has been made possible by the movement for human rights. I expect the book to be controversial—first, because it is written from a feminist perspective; second, because it challenges established diagnostic concepts; but third and perhaps most importantly, because it speaks about horrible things, things that no one really wants to hear about. I have tried to communicate my ideas in a language that preserves connections, a language that is faithful both to the dispassionate, rea­soned traditions of my profession and to the passionate claims of people who have been violated and outraged. I have tried to find a language that can withstand the imperatives of doublethink and allows all of us to come a little closer to facing the unspeakable.

 

 

CHAPTER  9

____________________________

 

Remembrance and Mourning pp. 175-76

 

IN THE SECOND STAGE OF RECOVERY, the survivor tells the story of the trauma. She tells it completely, in depth and in detail. This work of reconstruction actually transforms the traumatic memory so that it can be integrated into the survivor’s life story. Janet described normal memory as “the action of telling a story.” Traumatic memory, by contrast, is wordless and static. The survivor’s initial account of the event may be repetitious, stereotyped, and emotionless. One observer describes the trauma story in its untransformed state as a “prenarrative.” It does not develop or progress in time, and it does not reveal the storyteller’s feelings or interpretation of events.Another therapist describes traumatic memory as a series of still snapshots or a silent movie; the role of therapy is to provide the music and words.2

 

The basic principle of empowerment continues to apply during the second stage of recovery. The choice to confront the horrors of the past rests with the survivor. The therapist plays the role of a witness and ally, in whose presence the survivor can speak of the unspeakable. The reconstruction of trauma places great demands on the courage of both patient and therapist. It requires that both be clear in their purpose and secure in their alliance. Freud provides an eloquent description of the patient’s approach to uncovering work in psychotherapy: “[The patient] must find the courage to direct his attention to the phenomena of his illness. His illness must no longer seem to him contemptible, but must become an enemy worthy of his mettle, a piece of his personality, which has solid ground for its existence, and out of which things of value for his future life have to be derived. The way is thus paved . . . for a reconciliation with the repressed material which is coming to expression in his symptoms, while at the same time place is found for a certain tolerance for the state of being ill.” 3

 

As the survivor summons her memories, the need to preserve safety must be balanced constantly against the need to face the past. The patient and therapist together must learn to negotiate a safe passage between the twin dangers of constriction and intrusion. Avoiding the traumatic memories leads to stagnation in the recovery process, while approaching them too precipitately leads to a fruitless and damaging reliving of the trauma. Decisions regarding pacing and timing need meticulous attention and frequent review by patient and therapist in concert. There is room for honest disagreement between patient and therapist on these matters, and differences of opinion should be aired freely and resolved before the work of reconstruction proceeds.

 

The patient’s intrusive symptoms should be monitored carefully so that the uncovering work remains within the realm of what is bearable. If symptoms worsen dramatically during active exploration of the trauma, this should be a signal to slow down and to reconsider the course of the therapy. The patient should also expect that she will not be able to function at the highest level of her ability, or even at her usual level, during this time. Reconstructing the trauma is ambitious work. It requires some slackening of ordinary life demands, some “tolerance for the state of being ill.” Most often the uncovering work can proceed within the ordinary social framework of the patient’s life. Occasionally the demands of the therapeutic work may require a protective setting, such as a planned hospital stay. Active uncovering work should not be undertaken at times when immediate life crises claim the patient’s attention or when other important goals take priority.

 

 

RECONSTRUCTING THE STORY – pp. 176-78

 
Reconstructing of the trauma story begins with a review of the patient’s life before the trauma and the circumstances that led up to the event. Yael Danieli speaks of the importance of reclaiming the patient’s earlier history in order to “re-create the flow” of the patient’s life and restore a sense of continuity with the past.4 The patient should be encouraged to talk about her important relationships, her ideals and dreams, and her struggles and conflicts prior to the traumatic event. This exploration provides a context within which the particular meaning of the trauma can be understood.

 

The next step is to reconstruct the traumatic event as a recitation of fact. Out of the fragmented components of frozen imagery and sensation, patient and therapist slowly reassemble an organized, detailed, verbal account, oriented in time and historical context. The narrative includes not only the event itself but also the survivor’s response to it and the responses of the important people in her life. As the narrative closes in on the most unbearable moments, the patient finds it more and more difficult to use words. At times the patient may spontaneously switch to nonverbal methods of communication, such as drawing or painting.  Given the “iconic,” visual nature of traumatic memories, creating pictures may represent the most effective initial approach to these “indelible images.” The completed narrative must include a full and vivid description of the traumatic imagery. Jessica Wolfe describes her approach to the trauma narrative with combat veterans: “We have them reel it off in great detail, as though they were watching a movie, and with all the senses included.  We ask them what they are seeing, what they are hearing, what they are smelling, what they are feeling, and what they are thinking.” Terence Keane stresses the importance of bodily sensations in reconstructing a complete memory: “If you don’t ask specifically about the smells, the heart racing, the muscle tension, the weakness in their legs, they will avoid going through that because it’s so aversive.” 5

 

A narrative that does not include the traumatic imagery and bodily sensations is barren and incomplete.6 The ultimate goal, however, is to put the story, including its imagery, into words. The patient’s first attempts to develop a narrative language may be partially dissociated. She may write down her story in an altered state of consciousness and then disavow it. She may throw it away, hide it, or forget she has written it. Or she may give it to the therapist, with a request that it be read outside the therapy session. The therapist should beware of developing a sequestered “back channel” of communication, reminding the patient that their mutual goal is to bring the story into the room, where it can be spoken and heard.  Written communications should be read together.

 

The recitation of facts without the accompanying emotions is a sterile exercise, without therapeutic effect. As Breurer and Freud noted a century ago, “recollection without affect almost invariably produces no result.”7 At each point in the narrative, therefore, the patient must reconstruct not only what happened but also what she felt. The description of emotional states must be as painstakingly detailed as the description of facts. As the patient explores her feelings, she may become either agitated or withdrawn. She is not simply describing what she felt in the past but is reliving those feelings in the present. The therapist must help the patient move back and forth in time, from her protected anchorage in the present to immersion in the past, so that she can simultaneously re-experience the feelings in all their intensity while holding on to the sense of safe connection that was destroyed in the traumatic moment.8

 

Reconstructing the trauma story also includes a systematic review of the meaning of the event, both to the patient and to the important people in her life. The traumatic event challenges an ordinary person to become a theologian, a philosopher, and a jurist. The survivor is called upon to articulate the values and beliefs that she once held and that the trauma destroyed. She stands mute before the emptiness of evil, feeling the insufficiency of any known system of explanation. Survivors of atrocity of every age and every culture come to a point in their testimony where all questions are reduced to one, spoken more in bewilderment than in outrage: Why? The answer is beyond human understanding.

 

Beyond this unfathomable question, the survivor confronts another, equally incomprehensible question: Why me? The arbitrary, random quality of her fate defies the basic human faith in a just or even predictable world order. In order to develop a full understanding of the trauma story, the survivor must examine the moral questions of guilt and responsibility and reconstruct a system of belief that makes sense of her undeserved suffering. Finally, the survivor cannot reconstruct a sense of meaning by the exercise of thought alone. The remedy for injustice also requires action. The survivor must decide what is to be done.

 

~~~~~~~~~~~~~

 

1.  R Mollica, “The Trauma Story: The Psychiatric Care of Refugee Survivors of Violence and Torture,” in Post-Traumatic Therapy and Victims of Violence, ed. F. Ochberg (New York: Brunner/Mazel, 1988), 295-314

 

2.  F. Snider, Presentation at Boston Area Trauma Study Group (1986)

 

3.  S. Freud, “Remembering, Repeating, and Working-Through (Further Recommendations on the Technique of Psycho-Analysis, II,” [1914]) in Standard Edition, vol, 12, trans. J. Strachery (London: Hogarth Press, 1958), 145-56.  This paper also contains the first mention of the concept of a repetition-compulsion, which Freud later elaborated in “Beyond the Pleasure Principle.”

 

4.  Y. Danieli, “Treating Survivors and Children of Survivors of the Nazi Holocaust,” in Post-Traumatic Therapy, ed. F. Ochberg, 278-94, quote on 286. Interview. J. Wolfe and T. Keane, January 1991.

 

5.  Interview, J. Wolfe and T. Keane, January 1991.

 

6.  L. McCann and L. Pearlman, Psychological Trauma and the Adult Survivor: Theory, Therapy, and Transformation (New York: Brunner/Mazel, 1990).

 

7.  Breurer and Freud, “Studies on Hysteria,” [1893-95] in Standard Edition, vol. 2, trans. J. Strachey (London: Hogarth Press, 1955), 6.

 

8.  This simultaneous present and past orientation is well described in V. Rozynko and H. E. Dondershine, “Trauma Focus Group Therapy for Vietnam Veterans with PTSD,” Psychotherapy 28 (1991): 157-61.

 


 

Trauma and Recovery (cult, brainwashing)
 

cult recovery 101.com

 


 

The Roots of the Self

 

Unraveling the Mystery of Who We Are © 1993

 

By Dr. Robert Ornstein

 

 

From CHAPTER 15 – pp. 188-92

 

Of Monkey Brains, Fish Hierarchy,

Tame and Wild Cats, Missing Limbs, and the

Amazing Possibility of Growth in the Brain

 

 

 

Human beings are not born once and for all
on the day their mothers give birth to them. . .
Life obliges them over and over again to give
birth to themselves. — Gabriel Garcia Marquez
 
 

 

Cultural Differences in Reponse to Pain

 

To see in detail how extreme are the changes that can occur in human brains, we need to consider extraordinary events.  It is impossible to measure what might go on deep inside the brain of a middle-aged person when he or she learns the guitar.  We also can’t duplicate in the laboratory the effects of the extremes of war on individuals.  Yet changes in the brain provoked by life experiences can sometimes happen quite rapidly, with effects as dramatic as might be expected from a physical blow to the head.  Combat veterans, hostages, and victims of rape, child abuse, assault, or natural disasters frequently suffer long-lasting symptoms, referred to as posttraumatic stress disorder (PTSD).

 

Posttraumatic Stress Disorder

People with PTSD are hyperreactive to the world around them.  Minor startling events can trigger reexperiences of the trauma, such as hallucinations of being back in the combat zone. Victims frequently explode in aggressive outbursts and cannot keep thoughts of danger out of their minds.  They have recurring nightmares.  PTSD sufferers retreat from social and emotional commitments, become irresponsible at work, show little emotional expression outside of outbursts, may find themselves in legal troubles, and experience little life pleasure.  These difficulties can last for decades.  One Vietnam veteran, quoted in the 1985 report of a study by Bessel van der Kolk and colleagues, described his state:

 

After a certain moment you just keep running the 100-yard dash. I spend all my energy on holding it back. I have to isolate myself to keep myself from exploding. It all comes back all the time. The nightmares come two, three times a week for a while…. You can never get angry, because there is no way of controlling it. You can never feel just a little bit. It is all or nothing. I am constantly and totally preoccupied with not getting out of control.

 

PTSD patients live in a constant state of preparedness to defend themselves against the danger that originally caused the problem.  For this lasting damage to occur, a person must experience a truly terrifying event with the sense of having no control over it.  Scientists studying anxiety disorders have induced in laboratory animals a condition similar to PTSD by subjecting them to painful shocks from which they cannot escape.  Drugs that deplete certain brain messenger chemicals produce animal behaviors like those evoked by the inescapable shocks.

 

Clues like this have led researchers to look for unusual features in the brain chemistry of people with PTSD.  The chemicals the brain uses to initiate the “fight-or-flight” response to danger are chronically present at high levels in PTSD patients.  One of these chemicals, norepinephrine, has far-ranging influences: it diminishes the ability to sleep, increases alertness, elevates heart rate and blood pressure, promotes the release of hormones that mediate the body-wide response to stress, and possibly causes “flashbacks” and nightmares duplicating the traumatic events.

 

Some parts of the brain and body adapt to the high levels of hormones by reducing sensitivity to them, while others do not, causing disorder in the nervous system, tipping it toward constant anxiety and overreaction.  The outpouring of these chemicals may lead to their absence in some parts of the brain following periods of anxiety, and this absence can lead to such behavioral symptoms as low emotional reactivity, shaky hands, jerky movement, exaggerated startle responses, and speaking difficulties.

 

Another brain system linked to stress and disrupted in PTSD is the endogenous opiate pain-reducing circuit.  Intense fear or pain releases floods of substances, including opiates, in the brain and body to reduce unpleasant sensations, presumably to permit the person or animal to function and fight in order to escape harm.  One study found that combat veterans with PTSD had reduced sensitivity to pain after they watched a segment of the movie Platoon (about the Vietnam war), which simulated combat.  The PTSD patients reported that viewing the film was extremely unpleasant.  Participants in this study who did not have PTSD found the scene distressing but showed no subsequent increase in their pain thresholds.  The pain sensitivity of those with PTSD was reduced as much as if they had received an injection of eight milligrams of morphine.

 

Essentially, the combat veterans with PTSD responded to the clip as if they were in a life-threatening situation. PTSD researcher Bessel van der Kolk suggested that because PTSD sufferers pour so much natural pain-killer into their systems at so little provocation, the victims become addicted to their own internal narcotics.  There’s a similarity between the systems of opiate (such as heroin) withdrawal and PTSD; both are characterized by anxiety, irritability, unpredictable rage, insomnia, and hyperalertness.  Also, the opioid system in the brain is closely linked to the norepinephrine (adrenaline) system, both of which participate in responding to danger.  These two systems, disordered in PTSD, probably act together to produce the unpleasant symptoms.

 

Some people exposed to catastrophes spend the rest of their lives seeking out further traumatic events, bringing themselves into emergency situations or taking up dangerous careers as soldiers, firefighters, or police officers.  These people may be addicted to the flow of internal opiates, requiring frequent fear to prevent the occurrence of withdrawal symptoms.  They may need to seek continuous excitement through horror movies, dangerous sports like white-water rafting, or fast driving.  These sensation seekers need the stimulation required to produce their own internal opiates, not the RAS stimulation sought by extroverts.

 

These changes in the brains of those exposed to catastrophes can happen through a process known as neural kindling, which has been studied in rats.  Electrical stimulation of the amygdala of rats eventually leads to a permanent “heating up” of the responsiveness.  If one gives a rat thirty to sixty days of daily one-second repeated stimulation bursts, the animal begins to have spontaneous convulsions that emanate from the limbic system even after the electrical stimulation has ceased.  If inhibited children have a more excitable circuit leading from their amygdala to the hypothalamus, a frightening environmental event might function as a similar kindling stimulus.  The trauma that causes posttraumatic stress disorder may also have a kindling effect in the brain, ensuring that future activities will pass along an already “warm” pathway.  This is what may lead PTSD sufferers to be irritable and extrasensitive to glitches in the world.

 

PTSD shows that if an experience is intense enough, it can change the way the brain works even in adulthood.  At the time of World War I, some believed postcombat trauma symptoms to be “shell shock,” caused by physical concussion to the brain.  We now know that the actual effect is on the neurons of the brain, but it has an equally overwhelming impact on the life of the trauma survivors, affecting almost every aspect of their ability to function in human society.  It is not easy for these people to recover normal functions because of the widespread unbalancing of their nervous systems, which have become programmed to deal only with terrible threats.  Behavior therapy and treatment with drugs that restore balance to brain chemicals are now being developed and becoming available to help PTSD patients live normal, productive lives.

 

Our brains are constantly in flux, adapting to serve our lives.  Of course, changes in adulthood are not usually as dramatic as those in childhood, when we learn language and the ways of our local world, but change is possible at any time through the selection and deselection of neural pathways.  It isn’t that one has to have an experience as dramatic as a major trauma in order to change; it’s simply that right now these dramatic changes are easier to study.

 

There’s no point in life at which we can’t grow and develop, even if that growth is related to one of the roots of the self.  We can’t change much about how we amplify the world nor much of our basic mood predispositions, but we can change our experienced mood by doing things that make us happy and concentrating on optimistic interpretations.

 

I know this sounds a little simplistic, yet there is a lot of research that backs it up: even silently repeating things like “Every day in every way I am getting better and better” does have longlasting results, as does learning to interpret the events of our life in a more positive manner, as does cognitive therapy.  Optimists live longer, are freer from disease, and recover from surgery faster.  Is this just innate?  No, for people who obtain training to become more optimistic also increase their immunity to disease!  This is why taking up new challenges throughout life is most often associated with increased health; it also indicates that if we make minor changes, the major changes in life will also be possible.  In the final chapter, we’ll briefly discuss some of the ways in which we can manage change, taking into account what we now know about our basic nature.