Trauma and Recovery

 

 

TRAUMA and RECOVERY:

The aftermath of violence – from domestic abuse to political terror

 

By Dr. Judith Herman

 

 

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. 176-181)

 
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.”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.

 

As the survivor attempts to resolve these questions, she often comes into conflict with important people in her life. There is a rupture in her sense of belonging within a shared system of belief. Thus she faces a double task: not only must she rebuild her own “shattered assumptions” about meaning, order, and justice in the world, but she must also find a way to resolve her differences with those whose beliefs she can no longer share.9  Not only must she restore her own sense of worth but she must also be prepared to sustain it in the face of the critical judgments of others.

 

The moral stance of the therapist is therefore of enormous importance. It is not enough for the therapist to be “neutral” or “nonjudgmental.” The patient challenges the therapist to share her own struggles with these immense philosophical questions. The therapist’s role is not to provide ready-made answers, which would be impossible in any case, but rather to affirm a position of moral solidarity with the survivor.

 

Throughout the exploration of the trauma story, the therapist is called upon to provide a context that is at once cognitive, emotional, and moral. The therapist normalizes the patient’s responses, facilitates naming and the use of language, and shares the emotional burden of the trauma. She also contributes to constructing a new interpretation of the traumatic experience that affirms the dignity and value of the survivor. When asked what advice they would give to therapists, survivors most commonly cite the importance of the therapist’s validating role. An incest survivor counsels therapists: “Keep encouraging people to talk even if it’s very painful to watch them. It takes a long time to believe. The more I talk about it, the more I have confidence that it happened, the more I can integrate it. Constant reassurance is very imporant—anything that keeps me from feeling I was one isolated terrible little girl.”10

 

As the therapist listens, she must constantly remind herself to make no assumptions about either the facts or the meaning of the trauma to the patient. If she fails to ask detailed questions, she risks superimposing her own feelings and her own interpretation onto the patient’s story. What seems like a minor detail to the therapist may be the most important aspect of the story to the patient. Conversely, an aspect of the story that the therapist finds intolerable may be of lesser significance to the patient. Clarifying these discrepant points of view can enhance the mutual understanding of the trauma story. The case of Stephanie, an 18-year-old college freshman who was gang-raped at a fraternity party, illustrates the importance of clarifying each detail of the story:

 

When Stephanie first told her story, her therapist was horrified by the sheer brutality of the rape, which had gone on for over two hours. To Stephanie, however, the worst part of the ordeal had occurred after the assault was over, when the rapists pressured her to say that it was the “best sex she ever had.” Numbly and automatically, she had obeyed. She then felt ashamed and disgusted with herself.

    The therapist named this a mind rape. She explained the numbing response to terror and asked whether Stephanie had been aware of feeling afraid. Stephanie then remembered more of the story: The rapists had threatened that they “just might have to give it to her again” if she did not say that she was “completely satisfied.” With this additional information, she came to understand her compliance as a strategy that hastened her escape rather than simply as a form of self-abasement.

 

Both patient and therapist must develop tolerance for some degree of uncertainty, even regarding the basic facts of the story. In the course of reconstruction, the story may change as missing pieces are recovered. This is particularly true in situations where the patient has experienced significant gaps in memory. Thus, both patient and therapist must accept the fact that they do not have complete knowledge, and they must learn to live with ambiguity while exploring at a tolerable pace.

 

In order to resolve her own doubts or conflicting feelings, the patient may sometimes try to reach premature closure on the facts of the story. She may insist that the therapist validate a partial and incomplete version of events without further exploration, or she may push for more aggressive pursuit of additional memories before she has dealt with the emotional impact of the facts already known. The case of Paul, a 23-year-old man with a history of childhood abuse, illustrates one therapist’s response to a patient’s premature demand for certainty:

 

After gradually disclosing his involvement in a pedophilic sex ring, Paul suddenly announced that he had fabricated the entire story. He threatened to quit therapy immediately unless the therapist professed to believe that he had been lying all along. Up until this moment, of course, he had wanted the therapist to believe he was telling the truth. The therapist admitted that she was puzzled by this turn of events. She added: “I wasn’t there when you were a child, so I can’t pretend to know what happened. I do know that it is important to understand your story fully, and we don’t understand it yet. I think we should keep an open mind until we do.” Paul grudgingly accepted this premise. In the course of the next year of therapy, it became clear that his recantation was a last-ditch attempt to maintain his loyalty to his abusers.

 

Therapists, too, sometimes fall prey to the desire for certainty. Zealous conviction can all too easily replace an open, inquiring attitude. In the past, this desire for certainty generally led therapists to discount or minimize their patents’ traumatic experiences. Though this may still be the therapist’s most frequent type of error, the recent rediscovery of psychological trauma has led to errors of the opposite kind. Therapists have been known to tell patients, merely on the basis of a suggestive history or “symptom profile,” that they definitely have had a traumatic experience. Some therapists even seem to specialize in “diagnosing” a particular type of traumatic event, such as ritual abuse. Any expression of doubt can be dismissed as “denial.” In some cases patients with only vague, nonspecific symptoms have been informed after a single consultation that they have undoubtedly been the victims of a Satanic cult. The therapist has to remember that she is not a fact-finder and that the reconstruction of the trauma story is not a criminal investigation. Her role is to be an open-minded, compassionate witness, not a detective.

 

Because the truth is so difficult to face, survivors often vacillate in recontructing their stories. Denial of reality makes them feel crazy, but acceptance of the full reality seems beyond what any human being can bear. The survivor’s ambivalence about truth-telling is also reflected in conflicting therapeutic approaches to the trauma story. Janet sometimes attempted in his work with hysterical patients to erase traumatic memories or even to alter their content with the aid of hypnosis.11  Similarly, the early “abreactive” treatment of combat veterans attempted essentially to get rid of traumatic memories. This image of catharsis, or exorcism, is also an implicit fantasy in many traumatized people who seek treatment.

 

It is understandable for both patient and therapist to wish for a magic transformation, a purging of the evil of the trauma.12  Psychotherapy, however, does not get rid of the trauma. The goal of recounting the trauma story is integration, not exorcism. In the process of reconstruction, the trauma story does undergo a transformation, but only in the sense of becoming more present and more real. The fundamental premise of the psychotherapeutic work is a belief in the restorative power of truth-telling.

 

In the telling, the trauma story becomes a testimony. Inger Agger and Soren Jensen, in their work with refugee survivors of political persecution, note the universality of testimony as a ritual of healing. Testimony has both a private dimension, which is confessional and spiritual, and a public aspect, which is political and judicial. The use of the word testimony links both meanings, giving a new and larger dimension to the patient’s individual experience.13  Richard Mollica describes the transformed trauma story as simply a “new story,” which is “no longer about shame and humiliation” but rather “about dignity and virtue.” Through their storytelling, his refugee patients “regain the world they have lost.”14

 

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

 

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. Strachey (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.

 

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.

 

9.  The term is from R. Janoff-Bulman, “The Aftermath of Victimization: Rebuilding Shattered Assumptions,” in Trauma and Its Wake, ed. C. Figley (New York: Brunner/Mazel, 1985), 135.

 

10.  Interview, Karen, 1986.

 

11.  O. van der Hart, P. Brown, and B. van der Kolk, “Pierre Janet’s Treatment of Post-Traumatic Stress,” Journal of Traumatic Stress 2 (1989): 379-96.

 

12.  S. Hill and J. M. Goodwin, Freud’s Notes on a Seventeeth Century Case of Demonic Possession: Understanding the Uses of Exorcism (unpublished ms., Department of Psychiatry, Medical College of Wisconsin, Milwaukee, 1991).

 

13.  I. Agger and S. B. Jensen, “Testimony as Ritual and Evidence in Psychotherapy for Political Refugees,” Journal of Traumatic Stress 3 (1990): 115-30.

 

14.  Mollica, “The Trauma Story,” quote on 312.

 


 

The Roots of the Self:

Unraveling the Mystery of Who We Are 

 

By Dr. Robert Ornstein

1993

 

From Chapter 15

(pp. 188-192)

 

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.

 

Gabrial Garcia Marquez

 

 

Cultural Differences in Response 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 post-traumatic stress disorder (PTSD).

 

Post-traumatic 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 post-traumatic 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.

 


 

cult recovery 101

 

Cult Recovery, cult counseling, cult professionals,

mental health professionals with cult recovery experience,

former cult member counseling, cult recovery therapists,

experienced cult recovery counseling

 

 

Trauma and Recovery (cult, brainwashing)

 

By Judith Lewis Herman, M.D.

 

Naming the syndrome of complex post-traumatic stress disorder represents an essential step toward granting those who have endured prolonged exploitation a measure of the recognition they deserve. It is an attempt to find a language that is at once faithful to the traditions of accurate psychological observations and to the moral demands of traumatized people. It is an attempt to learn from survivors, who understand, more profoundly than any investigator, the effects of captivity.

 

Complex Post-Traumatic Stress Disorder

 

  1. A history of subjection to totalitarian control over a prolonged period (months to years). Examples include hostages, prisoners of war, concentration-camp survivors and survivors of some religious cults. Examples also include those subjected to totalitarian systems in sexual and domestic life, including survivors of domestic battering, childhood physical or sexual abuse, and organized sexual exploitation.

 

  1. Alterations in affect regulation, including
  • persistent dysphoria (a state of anxiety, dissatisfaction, restlessness or fidgeting)
  • chronic suicidal preoccupation
  • self-injury
  • explosive or extremely inhibited anger (may alternate)
  • compulsive or extremely inhibited sexuality (may alternate)

 

  1. Alterations in consciousness, including
  • amnesia or hyperamnesia for traumatic events
  • transient dissociative episodes
  • depersonalization/derealization (depersonalization – an alteration in the perception or experience of the self so that the usual sense of one’s own reality is temporarily lost or changed; derealization – an alteration in the perception of one’s surroundings so that a sense of the reality of the external world is lost)
  • reliving experiences, either in the form of intrusive post-traumatic stress disorder symptoms or in the form of ruminative preoccupation

 

  1. Alterations in self-perception, including
  • sense of helplessness or paralysis of initiative
  • shame, guilt, and self-blame
  • sense of defilement or stigma
  • sense of complete difference from others (may include sense of specialness, utter aloneness, belief no other person can understand, or nonhuman identity)

 

  1. Alterations in perception of perpetrator, including
  • preoccupations with relationship with perpetrator (includes preoccupation with revenge)
  • unrealistic attribution of total power to perpetrator (caution: victim’s assessment of power realities may be more realistic than clinician’s)
  • idealization or paradoxical gratitude
  • sense of special or supernatural relationship
  • acceptance of belief system or rationalizations of perpetrator

 

  1. Alterations in relations with others, including
  • isolation and withdrawal
  • disruption in intimate relationships
  • repeated search for rescuer (may alternate with isolation and withdrawal)
  • persistent distrust
  • repeated failures of self-protection

 

  1. Alterations in systems of meaning
  • loss of sustaining faith
  • sense of hopelessness and despair

 


 

Post-Traumatic Therapy and Victims of Violence, edited by Frank M. Ochberg, M.D., 1988

 

From Chapter 3: The Role of Medication in Post-Traumatic Therapy, by Walton T. Roth

 

THE IMMEDIATE POST-TRAUMATIC PERIOD (p. 46)

 

    Dissociative or somatic “conversion” reactions may occur shortly after a trauma. Dissociation is a trancelike state in which the sense of personal identity or voluntary control is suppressed. Losses of memory usually accompany dissociation, ranging from minor gaps in recall of the traumatic event to not knowing one’s own name or personal history. Sometimes the old “I” is replaced by a new personality, coming either from within the person or from an outside source. Somatic conversion reactions include perceptual alterations – anesthesias and paresthesias – and motor alterations – paralysis or weaknesses. Less often hallucinations appear, usually visual, but sometimes auditory or in another sensory modality.

 

    Rarely, the psychotic symptoms of what DSM-III calls brief reactive psychosis appear within hours or days of a trauma or during the stress of a prolonged traumatic event. If a victim shows signs of psychotic thinking, antipsychotic medication such as haloperidol may be indicated, as well as hospitalization. Examples of psychotic thinking are loose associations (trains of thought jump in irrelevant or bizarre directions), paranoid ideas (unreal ideas of persecution or of self–importance), delusions (idiosyncratic, fixed, false ideas), and ideas of reference (thinking that irrelevant environmental events are relevant). Hallucinations may accompany psychotic thinking, most often voices talking about the person in the third person, or to him.

 


 

NYC Mayor’s Office of Community Mental Health

 

Understanding Psychosis

 

This video provides information on psychosis and available resources to help.

 


 

SCIENTIFIC AMERICAN

 

NEUROSCIENCE

April 6, 2021

 

Forgotten Memories of Traumatic
Events Get Some Backing from
Brain-Imaging Studies

 

 
A new wave of research seeks neurological signatures for a type of amnesia

 

 

By Joshua Kendal

 
 
When adults claim to have suddenly recalled painful events from their childhood, are those memories likely to be accurate? This question is the basis of the “memory wars” that have roiled psychology for decades. And the validity of buried trauma turns up as a point of contention in court cases and in television and movie story lines.

 

Warnings about the reliability of a forgotten traumatic event that is later recalled—known formally as a delayed memory—have been endorsed by leading mental health organizations such as the American Psychiatric Association (APA). The skepticism is based on a body of research showing that memory is unreliable and that simple manipulations in the lab can make people believe they had an experience that never happened. Some prominent cases of recovered memory of child abuse have turned out to be false, elicited by overzealous therapists.

 

But psychotherapists who specialize in treating adult survivors of childhood trauma argue that laboratory experiments do not rule out the possibility that some delayed memories recalled by adults are factual. Trauma therapists assert that abuse experienced early in life can overwhelm the central nervous system, causing children to split off a painful memory from conscious awareness. They maintain that this psychological defense mechanism—known as dissociative amnesia—turns up routinely in the patients they encounter.

 

Tensions between the two positions have often been framed as a debate between hard-core scientists on the false-memory side and therapists in clinical practice in the delayed-memory camp. But clinicians who also do research have been publishing peer-reviewed studies of dissociative amnesia in leading journals for decades. A study published in February in the American Journal of Psychiatry, the flagship journal of the APA, highlights the considerable scientific evidence that bolsters the arguments of trauma therapists.

 

The new paper uses magnetic resonance imaging (MRI) to study amnesia, along with various other dissociative experiences that are often said to occur in the wake of severe child abuse, such as feelings of unreality and depersonalization. In an editorial published in the same issue of the journal, Vinod Menon, a professor of psychiatry and behavioral sciences at the Stanford University School of Medicine, praised the researchers for “[uncovering] a potential brain circuit mechanism underlying individual differences in dissociative symptoms in adults with early-life trauma and PTSD [post-traumatic stress disorder].”

 


 

Psychotherapy

  N  E  T  W  O  R  K  E  R

 

March/April 2022

 

 

Treating Trauma From the Top Down

 

A Cognitive Path to Healing

 

By Kathleen Chard

 

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Healing in the Outback

 

An Outdoor Therapist Reconceives His Role 

 

By Will Dobud