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February 3 - May 9, 2020
Trauma, whether it is the result of something done to you or something you yourself have done, almost always makes it difficult to engage in intimate relationships. After you have experienced something so unspeakable, how do you learn to trust yourself or anyone else again? Or, conversely, how can you surrender to an intimate relationship after you have been brutally violated?
Somehow the very event that caused them so much pain had also become their sole source of meaning. They felt fully alive only when they were revisiting their traumatic past.
Trauma results in a fundamental reorganization of the way mind and brain manage perceptions. It changes not only how we think and what we think about, but also our very capacity to think.
I remember asking him once: “What would you call this patient—schizophrenic or schizoaffective?” He paused and stroked his chin, apparently in deep thought. “I think I’d call him Michael McIntyre,” he replied.
Healing, he told us, depends on experiential knowledge: You can be fully in charge of your life only if you can acknowledge the reality of your body, in all its visceral dimensions.
Scared animals return home, regardless of whether home is safe or frightening. I thought about my patients with abusive families who kept going back to be hurt again. Are traumatized people condemned to seek refuge in what is familiar?
Being a patient, rather than a participant in one’s healing process, separates suffering people from their community and alienates them from an inner sense of self.
Our most surprising finding was a white spot in the left frontal lobe of the cortex, in a region called Broca’s area. In this case the change in color meant that there was a significant decrease in that part of the brain. Broca’s area is one of the speech centers of the brain, which is often affected in stroke patients when the blood supply to that region is cut off. Without a functioning Broca’s area, you cannot put your thoughts and feelings into words. Our scans showed that Broca’s area went offline whenever a flashback was triggered. In other words, we had visual proof that the effects of
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No matter how much insight and understanding we develop, the rational brain is basically impotent to talk the emotional brain out of its own reality.
Being able to move and do something to protect oneself is a critical factor in determining whether or not a horrible experience will leave long-lasting scars.
For now I want to emphasize that emotion is not opposed to reason; our emotions assign value to experiences and thus are the foundation of reason. Our self-experience is the product of the balance between our rational and our emotional brains.
Flashbacks and reliving are in some ways worse than the trauma itself. A traumatic event has a beginning and an end—at some point it is over. But for people with PTSD a flashback can occur at any time, whether they are awake or asleep.
Feeling numb during birthday parties for your kids or in response to the death of loved ones makes people feel like monsters. As a result, shame becomes the dominant emotion and hiding the truth the central preoccupation.
The opposite is also true—situations become intolerable if they feel interminable. Most of us know from sad personal experience that terrible grief is typically accompanied by the sense that this wretched state will last forever, and that we will never get over our loss. Trauma is the ultimate experience of “this will last forever.”
Depersonalization is one symptom of the massive dissociation created by trauma.
Research Dissociation vs depersonaliztion
When you can’t be fully here, you go to the places where you did feel alive—even if those places are filled with horror and misery.
We’ll do anything to make these awful visceral sensations go away, whether it is clinging desperately to another human being, rendering ourselves insensible with drugs or alcohol, or taking a knife to the skin to replace overwhelming emotions with definable sensations.
the solution requires finding ways to help people alter the inner sensory landscape of their bodies.
Our brains are built to help us function as members of a tribe.
Being able to feel safe with other people is probably the single most important aspect of mental health; safe connections are fundamental to meaningful and satisfying lives.
You don’t need a history of trauma to feel self-conscious and even panicked at a party with strangers—but trauma can turn the whole world into a gathering of aliens.
What we witnessed here was a tragic adaptation: In an effort to shut off terrifying sensations, they also deadened their capacity to feel fully alive.
This research confirms what our patients tell us: that the self can be detached from the body and live a phantom existence on its own.
for abused children, the whole world is filled with triggers.
If you cannot tolerate what you know or feel what you feel, the only option is denial and dissociation.
This means that the imprint of past trauma does not consist only of distorted perceptions of information coming from the outside; the organism itself also has a problem knowing how to feel safe.
Children have no choice but to organize themselves to survive within the families they have.
Rage that has nowhere to go is redirected against the self, in the form of depression, self-hatred, and self-destructive actions.
Psychiatry, as a subspecialty of medicine, aspires to define mental illness as precisely as, let’s say, cancer of the pancreas, or streptococcal infection of the lungs. However, given the complexity of mind, brain, and human attachment systems, we have not come even close to achieving that sort of precision.
Sroufe informally told me that he thought that resilience in adulthood could be predicted by how lovable mothers rated their kids at age two.
When there’s no relationship between diagnosis and cure, a mislabeled patient is bound to be a mistreated patient.
Mental illness, however, is not at all like cancer: Humans are social animals, and mental problems involve not being able to get along with other people, not fitting in, not belonging, and in general not being able to get on the same wavelength.
Social support is a biological necessity, not an option, and this reality should be the backbone of all prevention and treatment.
As a therapist treating people with a legacy of trauma, my primary concern is not to determine exactly what happened to them but to help them tolerate the sensations, emotions, and reactions they experience without being constantly hijacked by them.
autobiographical memories are not precise reflections of reality; they are stories we tell to convey our personal take on our experience.
These early researchers referred to traumatic memories as “pathogenic secrets”9 or “mental parasites,”10 because as much as the sufferers wanted to forget whatever had happened, their memories kept forcing themselves into consciousness, trapping them in an ever-renewing present of existential horror.11
Traumatized people simultaneously remember too little and too much.
If the problem with PTSD is dissociation, the goal of treatment would be association: integrating the cut-off elements of the trauma into the ongoing narrative of life,
Doctors shape how their patients communicate their distress: When a patient complains about terrifying nightmares and his doctor orders a chest X-ray, the patient realizes that he’ll get better care if he focuses on his physical problems.
The mind cannot help but make meaning out of what it knows, and the meaning we make of our lives changes how and what we remember.
Trauma robs you of the feeling that you are in charge of yourself, of what I will call self-leadership in the chapters to come.1 The challenge of recovery is to reestablish ownership of your body and your mind—of your self.
avoiding feeling these sensations in our bodies increases our vulnerability to being overwhelmed by them.
Learning to observe and tolerate your physical reactions is a prerequisite for safely revisiting the past. If you cannot tolerate what you are feeling right now, opening up the past will only compound the misery and retraumatize you further.
Becoming aware of how your body organizes particular emotions or memories opens up the possibility of releasing sensations and impulses you once blocked in order to survive.
Therapy is a collaborative process—a mutual exploration of your self.
We are a hopeful species. Working with trauma is as much about remembering how we survived as it is about what is broken.
Being traumatized is not just an issue of being stuck in the past; it is just as much a problem of not being fully alive in the present.
Silence about trauma also leads to death—the death of the soul.
The critical issue is allowing yourself to know what you know. That takes an enormous amount of courage.
Communicating fully is the opposite of being traumatized.
