Trauma is an Experience, Not an Event

-Santiago Delboy, MBA, MSW, LSW, S-PSB

It seems like “trauma” has become one of those household terms everyone talks about. I took a look at the number of average monthly Google searches for “trauma” in the U.S., and found that it has grown 22% in only one year. As with other terms that became mainstream (for instance “addiction” or “narcissism”), I suspect the price of increased awareness is a diluted understanding of what they really mean.

After hearing my patients talk about their experiences, reflecting on my own upbringing, and studying some of the literature on trauma, I believe the following can be a useful working definition:

Trauma is an experience that overwhelms our capacity to regulate our emotions and results in fragmentation and dissociation.

While this may not be a comprehensive or final definition, I think it captures a few ideas that are important:

  • Trauma impairs our capacity to regulate our emotions. We feel worried, irritated, anxious or afraid, consciously or not, and we cannot self-soothe or seek support from others.
  • Trauma creates fragmentation and dissociation. Whether we understand this as an unconscious defense mechanism (e.g., splitting, projection or repression), as a neurological issue (e.g., thalamus gone offline, hypersensitive amygdala), or both, dissociation is a key trait of trauma.

However, in this post I want to expand on the idea that trauma is not about a past event, but about a present experience.

I think the idea of trauma as a present experience is captured dramatically and beautifully in a 1930 painting by Belgian artist René Magritte.

The Titanic Days

I have liked Magritte since I was a little boy, but I saw “The Titanic Days” (Les jours gigantesques) for the first time a couple of years ago, at a special exhibition at the Art Institute of Chicago.

I was stunned by the power and the violence of this piece. What I see is not a rape attempt happening now, but how a past experience is stored in the woman’s body and felt in the present moment. I see the terror of her frozen expression, reminiscent of the so-called “thousand-yard stare,” the tension of her entire body and the desperate attempt to push back an attacker from a real or imagined past.

I notice the stark contrast of colors in the woman’s body and I see the traumatic struggle between life and death, and the need to keep part of her in the shadows. No words are required to convey the drama, and no words could probably do justice to the horror; trauma, in fact, impairs our capacity to develop a cohesive narrative.

The experience is overwhelming and occupies most of the space on the canvas, yet the atmosphere feels completely desolate: we know nobody will come to her help. Is the blue background a wall, keeping this woman cornered against the attacker living in her body and in her mind or does it suggest an abyss, making the woman one step away from oblivion?

We can only imagine the details of what actually happened in this woman’s past. Was she sexually abused as an adult by a coworker? Was she touched in uncomfortable ways as a young girl by a family friend? Was she somehow sexualized when she was a toddler by her father? How much of what happened was real and how much a creation of her mind?

These are important questions to consider, but not as important as the terror, the isolation, an the helplessness she is experiencing in the present moment. When I stand in front of this painting, much like when I sit across from my patients in therapy, what I see is this woman’s suffering in the here and now.

I don’t need to know all the actual details of her story, but I am curious about the meaning she assigned to it, about how it feels in her body, her mind and her spirit, and about the ways it might be getting in the way of being her full self.

Trauma is Like a Splinter

I remembered Magritte’s painting some months ago, when I read Bessel van der Kolk, a leading trauma researcher, suggesting the metaphor of trauma as a splinter (Van der Kolk, 2014): it is the body’s response to the foreign object that becomes the problem, more than the object itself.

This idea has been around for some time. Almost twenty years ago Peter Lavine, developer of the somatic experiencing approach for trauma treatment, wrote:

Traumatic symptoms are not caused by the triggering event itself. They stem from the frozen residue of energy that has not been resolved and discharged; this residue remains trapped in the nervous system where it can wreak havoc on our bodies and spirits.” – Peter Levine (1997)

It is worth noting that this notion is even older. Not to make the point that everything goes back to Sigmund Freud, but over a hundred years earlier he and his colleague Josef Breuer advanced a similar idea in “Studies on Hysteria:”

Psychical trauma – or more precisely the memory of the trauma – acts like a foreign body which long after its entry must continue to be regarded as the agent that still is at work.” – Josef Breuer and Sigmund Freud (1895)

I think there is value in talking about “traumatic events,” but I believe that it is critical to shift our focus toward the ways in which trauma stays with us. Trauma is not remembered, but reenacted. It is not about something that happened in the past, but about its consequences in the present, about the conscious or unconscious meaning we give to our experience, and how that experience defines how it feels to be in our body and in our mind.

From Traumatic Experience to Healing Experience

The notion of trauma as an experience is valid for traditional PTSD trauma (e.g., when there is a specific event or situation that triggers the traumatic experience, such as sexual abuse, a war or a natural disaster), and for complex developmental trauma, which is more insidious.

Complex trauma is characterized by an upbringing defined by patterns of inconsistency, neglect or abuse. Emotions are not expressed, not allowed, or even punished. A specific “big” event is not necessary; repeated and chronic interpersonal wounds can overwhelm the child’s capacity to regulate emotions, and create fragmentation and dissociation.

Most people I have seen in therapy have experienced some form of developmental trauma. They felt unseen and unheard by physically or emotionally absent parents. They did not feel taken care of, taken seriously, or taken into account. They believed their needs were not important and would ever be met.

They had to carry within, in silence, destructive family secrets. They had to be parents to their parents from a very early age. They needed to constantly perform or pretend to be someone else, in order to feel accepted or loved. They had to learn to soothe themselves. They lived feeling that nothing they did would ever be enough.

All these experiences from the past are re-enacted and experienced in the present, keeping them from feeling safe, loved, worthy and trusting in others or themselves. They get in the way of becoming self-aware, of letting go of control, of developing vulnerable and intimate relationships. They make them feel either in high alert or depleted. These experiences keep them from being fully alive.

The most important thing therapists can do to work through traumatic experiences of this kind, is to offer the opportunity for a healing experience.

The essence of that healing experience is not a matter of technique, approach or theory and goes beyond the promise of providing a safe, calm and reliable environment. I believe the question is about love, authenticity and curiosity.

For me, the question is about being self-aware and curious about my own reactions, about how I think of, feel with, and relate to the person in front of me. It is about being a human being first and a psychotherapist second, which is a difficult task.

Often times I get caught up in the need to make sure that I am saying the right words, giving the best feedback, offering the most insightful interpretation, or providing a useful perspective. Instead, I can trust that my presence, my curiosity, my compassion and my humanity, with its flaws and imperfections, is the first thing that matters.

Do my patients feel heard and seen by me? Would they tell me if they didn’t? Do they feel there is room for their feelings toward me, whether they come from a place of anger, hurt, sadness, joy, love or desire? Can they express them trusting that our relationship will survive? Can they count on me, and trust that I will provide safe boundaries? Can they feel that every part of themselves is acknowledged, accepted and valued?

I believe these are the types of questions that define a healing therapeutic experience. They matter not only because they allow patients to recognize current dysfunctional relationship patterns in their lives, but mainly because they have the potential to provide an experience that was not available to our patients when they were growing up.

We cannot change the past, but we can offer them the opportunity to experience and develop self-awareness, acceptance and unconditional love.

How to Recognize the Signs of Posttraumatic Stress (PTSD)

Posttraumatic stressPerson sits on sofa in dark room, covering eyes with one hand, or PTSD as it is more commonly referred to, is a serious condition that affects many people worldwide. As June is PTSD Awareness Month, learning more about this condition can be helpful in order to gain a better understanding of the struggles that many individuals deal with on a daily basis.

Although PTSD affects numerous people, military service members tend to be more often affected by this condition than others due to the nature of their jobs. They are frequently exposed to traumatic events on a routine basis, especially during tours of duty in combat zones. The peace we take for granted in our country can be shattered in an instant through the life-and-death situations they encounter every day. Even if they are not physically wounded in battle, their psychological wounds can be deep and long-lasting. Trying to pick up the pieces after their return to “normal” life can be difficult, both for themselves as well as their friends and loved ones, who often have trouble understanding what they have gone through and the ways in which they have changed.

A study conducted by the U.S. Department of Veterans Affairs between 1999 to 2010 revealed that about 22 veterans lost their lives to suicide every day—a higher number than those who die on the battlefield (Kemp, J., and Bossart, R., 2012). With statistics this alarming, learning to look for warning signs of PTSD can be an important first step toward addressing it.

Although being exposed to a war zone is a common cause of PTSD, many other situations can cause ongoing trauma. Other experiences that commonly lead to symptoms of posttraumatic stress include both natural and man-made disasters, abuse or assault, and serious accidents. Individuals who have learned about a traumatic situation involving a loved one can also experience PTSD, as can people who are exposed to many other types of experiences.

Some of the most common symptoms of PTSD in a person include (American Psychiatric Association, 2013):

  1. Recurrent intrusive thoughts and memories of the traumatic event and/or difficulties remembering some aspects of the event.
  2. Insomnia and difficulties sleeping, which often includes having frequent nightmares about the event.
  3. Flashbacks and hallucinations that lead the individual to believe the event is recurring.
  4. Feelings of panic or extreme distress whenever something reminds them of the event.
  5. Increased irritability or anger.
  6. Hypervigilance and preoccupation with the possibility of the event happening again.
  7. Avoidance of anything or anyone that reminds the individual of the traumatic event.
  8. A sense of isolation from other people, including family and loved ones.
  9. An inability to enjoy activities that used to be significant to them.
  10. Feelings of numbness and detachment from their emotions.

Any of the above may be warning signs that should be taken seriously. As mentioned earlier, individuals who have experienced traumatic events are at greater risk than the general population of dying by suicide. They may also have a greater likelihood of self-medicating through the use of alcohol or drugs, if they do not receive treatment.

Although trauma can have devastating effects on many, receiving appropriate treatment can help to alleviate many of the symptoms experienced and assist individuals with returning to happy and productive lives. Recognizing there is a problem and assisting the individual with obtaining help are the first steps in the healing process.

-Wendy Salazar, MFT

Talking Out Military Sexual Trauma

Sexual abuse led one vet to a VA career counseling other MSA victims.

            Jennifer Sluga,  six-year veteran of the Wisconsin National Guard, originally participated in the VA’s new oral history program to help her caregivers understand her military sexual trauma, but her ordeal made her a strong advocate for others who had been assaulted.

“In the beginning, telling about my story helped me heal,” she told me recently. “But now I want everyone else who has ever experienced sexual trauma to know that they are not alone. By talking about it, we can get back the power that was taken from us.”

Now a psychotherapist at the Vet Center in Madison, Sluga estimates that 90 percent of her patient caseload also suffers from MST.

Sluga spent 17 months with the National Guard in Kosovo, but she told Thor Ringler, the “poet-in-residence” who runs the VA’s pilot “My Life, My Story” program in Madison, that her PTSD probably started well before her deployment from her military sexual trauma during her military training. (For more about the oral history program, see my previous blog, “An Oral History Program to Tell Veterans’ Stories.”)

“When he started that program, I told him it was the most amazing program ever,” she said. “Talking this trauma out of my system and using it to help others is just an amazing and powerful experience. It’s important for medical personnel to know that when I’m in those situations, I’m gonna be a little uptight, that I wonder whether I can trust that person, and that I’d prefer work with female doctor.”

Her ordeal started in boot camp when she and her “battle buddy” both reported to sick call. Her buddy was sent to the hospital, and that left her alone with the doctor.

“He had lot of rank on his chest and expected me do anything he said,” Sluga said. “He wanted me get undressed, then he began touching me and it became pretty obvious that this was nothing in the realm of anything medical.”

Sluga finally managed to push him away and ran to her barracks, only partially dressed.

“I ran to our barracks because I wanted to shower and cry, but another woman saw the marks on my body, asked about them, and then called the drill sergeant,” she said. “He ran over to sick call, and I thought he was going to kill the medic. It was really cool to be validated like that.”

But it didn’t stop there.

Several members of Sluga’s unit reported also sexual abuse during their deployment, and she began advocating for them.

Finally, the medic was charged with sexually assaulting his patients, and Sluga, her battle buddy and her drill sergeant were all required to testify at his court martial. “He finally admitted to sexually assaulting more than 70 soldiers and excused it by saying he had been raped as a child,” she said.

No wonder Sluga was severely traumatized. But she didn’t realize it until after she had left the National Guard and returned to college.

“I didn’t recognize that I wasn’t doing well until I went from an A student and I was failing all my classes, not attending classes, sleeping 20 hours a day,” she said. “I just wanted to go hide.”

Her breaking point came after she and her classmates got an exam back, and one of the girls was complaining about a bad grade.

“She said, ‘It really raped me,’” Sluga remembered.  “And I just wanted to jump over the chairs and scream at her: ‘Did it really rape you? Did it make you feel completely out of control?  Did it actually hurt you?’”

That led to counseling and therapy. It led to Ringler and the “My Life, My Story” program, which has now spread to six other VA facilities across the country. And it led Sluga to a career helping others as a psychotherapist.

More men than women are sexually assaulted in the military, she said.

“One of four women reports she has been sexually assaulted,” said Sluga. “The rate for men is one in ten, but since there are so many more men than women, the number of male victims is greater. Females are assaulted by men and other females, and males are assaulted by males and females as well.”

Rape and sexual assault are not about sexual gratification, she added. It’s all about power and control.

“In the military, you have no control over much of anything, so if you can find an area you can control, you take it,” Sluga explained. “A lot of people bully up and take advantage of other people—it’s almost like a sport.”

Now look at Sluga’s ordeal in light of our previous discussions on moral injury. She was betrayed by virtually everyone in her chain of command: the medical officer who sexually assaulted her, the officers who let such conduct go unchecked.  Those fellow soldiers who are supposed to save your life if necessary and have your back should be the last individuals anyone should need to protect themselves against.

VA psychologist Jonathan Shay argues that moral injury is present when there has been a betrayal of what is right by a person in a position of legitimate authority in a high-stakes situation. “Moral injury impairs the capacity for trust and elevates despair, suicidality and interpersonal violence,” he wrote in an article, “Moral Injury,” published last year in the journal of Psychoanalytic Psychology.

Sluga would agree that military sexual trauma can lead to PTSD.

When you lose your sense of self, especially from someone who’s supposed to be helping you, and they take your power and use it against you, to me that’s combat,” she said. And we all know that combat trauma leads to PTSD.

-Eric Newhouse

Why Are Some Soldiers With Combat Stress More Resilient ?

Genetic differences may explain the difference, two new studies find.

Scientists in San Diego, Calif., think they have at least one of the answers to a question that has puzzled psychologists for years: why some soldiers are more resilient to combat stress than others.

They believe the answer is in their genes.

After studying the DNA of 13,000 American soldiers, researchers have found two genetic variants that they believe may explain why some combat vets are afflicted with PTSD, but others are not.

“The first, in samples from African-American soldiers with PTSD, was in a gene (ANKRD55) on chromosome 5,” said Dr. Murray Stein, Distinguished Professor of Psychiatry at the University of California-San Diego. “In prior research, this gene has been found to be associated with various autoimmune and inflammatory diseases, including multiple sclerosis, type II diabetes, celiac disease, and rheumatoid arthritis. The other variant was found on chromosome 19 in European-American samples.”

A team from the UC-San Diego School of Medicine, the VA San Diego Healthcare System, and the Uniformed Services University compared the genomes of 3,167 combat vets diagnosed with PTSD and another 4,607 combat vets who had not been diagnosed with PTSD.  A second study involved 947 diagnosed vets compared with 4,969 combat vets without PTSD.

“We compared the two groups in all markers for all genes and found differences that were distinctly different between the two groups,” Dr. Stein told me. “But it wasn’t a 100 percent difference. The group with the variant was about 60 percent more likely to develop PTSD.”

Their hope is that one day in the future a DNA test during basic training will tell commanders which soldier will be more able to withstand combat stress and which might be better suited for an administrative role.

“In theory, that is how this could be used, but we’re nowhere near there yet,” Dr. Stein said. “We have a lot of work yet to do to be sure of these findings. But we may be able in the future to analyze this data and say someone would be very good at combat, while someone else might be better as a supply sergeant – or may need additional training to boost his resilience.”

In addition, further testing is needed to determine whether other racial groups – Asian Americans or American Indians, for example – express the same difference with different genes.

-Eric Newhouse

Sexual Effects of Sexual Abuse

It is now known that sexual abuse is a primary risk factor in sexual health, dysfunction, and intimacy problems. Some of the more common sexual problems linked to sexual abuse are:

* low sexual desire

* chronic sexual pain

* sexually transmitted infections

* unwanted pregnancy

* compulsive sexual behavior

* hi-risk sexual activity

* erection and orgasm problems

-Talkspace

If You Don’t Have a Father Today…

Maybe you don’t have a dad to meet with today. It’s your day, too.

Maybe you don’t have a father anymore, or feel like you never did. Maybe you never knew him, or maybe he was never around enough to know – emotionally, mentally, or spiritually – even if he was often physically in the same room. Maybe you, yourself, are also a father, or will be soon, would like to be one someday, are married to one, have a child with one, or already have a fatherly role toward others as a teacher, advisor, mentor or boss. While we celebrate and honor the great fathers who are here with us today, many millions of us don’t have one, and this day is for you too.

What can you do today, and how is it that you have made it this far without a dad to reach out to through the years?

Volumes of research on human resilience exist that explain your current success and healthy adjustment. Whether you are a man or woman, taking note of the fact that you do have a good life right now at this very moment is proof that you have everything in you that you ever needed to survive the loss of a father, the absence of a father, the need for a father, and thrive anyway. As someone who lost a father at a young age – and for over a decade has specialized in helping men and women overcome the effects of that absence on their dating, relationship, and career lives – I’d like to share a bit of that research, and some things I’ve learned along the way.

Fathers not only make us more resilient people, but our own natural resilience also assists us in finding the fathering we need. Human resilience has been defined as:

a. a positive outcome despite the experience of adversity;
b. continued positive or effective functioning in adverse circumstances; or
c. recovery after a significant trauma (Masten et al., 1999).

My own dad died when I was twenty-two, in the midst of medical school, and had just broken up with a fiancée. My little brothers were eighteen and about to enter college, and twelve and about to enter puberty. I could safely say that the particular week my dad died was also probably the week I had most needed him, ever. And while my brothers and I dealt with the loss at different developmental stages, with different challenges and gifts, and in unique ways amongst us, there were most certainly universal effects to overcome and actions to take to adapt and heal.

I called my brothers today to ask what they are doing. One informed me that he is going to connect with his former rugby coaches, his former priest, and our father’s best friend from childhood. The second is going to church with his new wife and her parents. I am going to spend time writing about fathers, assisting some of my clients on the matter, and then will meet with some good male friends whose fathers aren’t going to be in the city for the weekend.

I’m also thinking about personal heroes such as an old friend and journalist who passed on many years ago – Starr Wright. He was one of many fatherly people who stepped in to help me along when I needed it. He saw a glimmer of passion for writing in me long ago, encouraged it and nurtured it. With a chuckle thumbing through my earliest clumsy attempts at writing, Starr would put out his cigarette, cough, clear his throat, and regardless of my lack of inborn talent, stoke the pure interest and passion for it, saying, “You’re doing good, kid. Keep at it and don’t let anyone tell you what it’s worth but you. Get to work.”

In all of these personal examples, there is a common thread about resilient humans – men and women both. When we can’t get what we need from a single source, we adapt and get it anyway from diverse sources past, present, and future. We find fathering in our mentors and coaches, our spiritual leaders or the spiritual experience itself, from looking at our father’s life and his past, those who shaped him, indirectly from the fathers of our friends and loved ones, and even from our makeshift families called “circles of friends” – what have also been called “urban tribes” that can substitute for nontraditional or broken families.

We can even look to the future with guidance from men we have never even met, and will never likely meet – our heroes. Feeling fathered, the gifts fathers bestow, life skills they teach, and guidance they provide from a masculine worldview do not have to come from a single source. They can be collected and refined from our life’s experience in the social arena itself, the “school of hard knocks,” and the kind and competent men we meet along the way.

I’m particularly proud of my brothers’ abilities to have graduated college, found excellence in careers, and a solid role in marriage and family with no resources or guidance to begin with.

The absence of a dad is certainly known to affect the young in different ways depending on what their level of psychological development is, but it’s not just what’s in you that matters – how you will do with your life is also dependent on what you surround yourself with, and what you do with the circumstances you are in, to adapt. To take your “lemons and make lemonade.”

Glen Elder in Children of the Great Depression (1974), identified the profound effects of historical change on human development. By comparing the experiences of children born in Berkeley and parts of Oakland, California, in the early and late 1920s, he could show that children born at the beginning of the 1920s were not as susceptible to the effects of family disruption and hardship caused by the Great Depression as children born in the late 1920s (Elder, 1974/1999). The findings illustrate that developmental processes should be viewed not only in relation to individually lived time, but also in relation to the socio-historical context in which they take place.

We live in a time of history right now that has been compared to the Great Depression. And while many of the statistics show job losses taking a heavy toll on men’s health and welfare even more than on women currently, we have different resources at our disposal in the form of social networking and technology, behavioral science and education. The need men and women have for a father hasn’t changed, but the pressures on fathers, and our means of accessing their gifts, have.

It’s a different and more challenging social world for men to contend with than it was a generation ago.

For about a decade I have contributed to teaching an online community of men who – on the surface – seek out information with which to better their dating, relationship, social and romantic lives in general. What I found in that time was something deeper than just a public need for more accessible dating tips for men. I met men of all ages, some single, some divorced, some fathers themselves and all struggling to find a role, a place, and social satisfaction in our changing society. The universal need underneath their diversity ends up clearly being a need for a father – they all identify an absent father, a neglectful one, an abusive one, a father confused over his own role in a marriage, community, or society, or at the very least, the absence of enough practical, genuine, fatherly advice from our media to the degree and breadth of social and romantic guidance that women have enjoyed for decades in that same media.

For the past several years, men haven’t been flocking to the internet “men’s dating community” to learn how to date. They’re looking for a father.

Fathers teach us “how to use our bodies” – which is to say, how to take action out there in the world – to take our resources and use them, face our challenges with courage, adapt, innovate, and solve our problems with our own two hands.

They teach their sons about women, and competition with other men. They don’t just lecture, but literally show their sons how to play sports or fix cars, or get a job that’s meaningful. By example they show sons how to grow a character maturity which will lead to someday having a satisfying marriage, career, and a legacy to give back to the world (as he will have done for us.)

Fathers teach their daughters about men, both through their stories, and through personal example – being the very first man she has ever encountered and “fallen in love with.” Fathers show their daughters they are valuable and precious, and will always, always be protected and safe, but that they have guts and strength and resolve no less than a man. If he can see to it, he will always be there for you to help, to remind you of who you are when you are confused or stressed, and that you are not just any girl or woman, a statistic in today’s confusing social and romantic arenas, or a cog in a corporate wheel, but his daughter.

No matter who you are, a man or woman, or whether your father is alive or available to meet today, you come from a long line of fathers – generation after generation over centuries and ages have led up to making you who you are right now. You are a resilient person from a long line of resilient people. You have the right to celebrate today with all the joy you can muster, honoring those who have fathered you – mentors, advisors, teachers, spiritual leaders, friends, bosses and partners – whether they had one minute to spare which would impact you for a lifetime, or years of devoted concern to give.

It is a day to do – to take action the way fathers are so good at helping us with, rather than just to think or ponder our lives. Here, then, are some actions you can take:

• Contact those mentors, teachers, spiritual leaders, advisors, coaches, and elder friends from your past – to thank them for their impact.

• Be with the friends, supporters, and confidantes of your present life who are your examples of good fathering, and with whom you are striving to go out into the world to make an impact.

• Remember who your heroes have been and who they are now, noticing that their own best features are always aspects of yourself – perhaps qualities you haven’t yet cultivated, matured, and brought to bear in the world around you. Join one new activity that your heroes are gifted at.

• Look to the future and enjoy it now instead of waiting for it to be provided to you. The actions you will take while being your own best counsel – fathering yourself – will lead there.

• Look to the future and wonder who you will provide fathering to, the impact you will make, and the legacy you will leave behind when you’re gone. Start now, and offer to help someone less skilled than you, today.

Regardless of the reasons your father is not around – whether there is unfinished business, anger at him, remorse over what went unsaid or undone , loneliness and missing him, or in a time of stress for which you really wish he was around to provide the answer – you are still here and there are real things that need to get done. You don’t have to impress his memory because you never could get his attention, or vow to be his opposite because he let you down. You are resilient, and can forgive his failings while enjoying the skills for building a life you inherited anyway, if only in his DNA.

Get to work.

Father’s Day is your day too, and in every courageous act in which you do what is right, even if it is difficult or uncomfortable, every ambition in which you fail and pick yourself up anyway for another go at it, you’re living a genuine Father’s Day. Every time you pass on what you know, assisting someone with less competence, less experience or skill than your own, you are honoring yourself, and fathers everywhere. You’re honoring fatherhood itself.

You’re doing good, kid. Keep at it, and don’t let anyone tell you what you’re worth but you.

Paul Dobransky, MD

Helping a Partner, Relative or Child who is Recovering from Trauma

Trauma can be described as a mental injury that is stored in the body and the brain. It’s an experience that overwhelms our natural ability to cope effectively. Managing the symptoms and daily experience of trauma recovery can be a constant battle, for both the survivor and those around them. Here are some information about the traumatized brain and tips for supporting your loved one in an effective way and creating an environment for healing and connection after trauma.

  • Trauma changes to way that neurons fire, the connections made, and chemical and electrical signals sent through the body. Repetition of care, safety, and regular sensory input in a positive environment, through a positive relationship leads to changes in the brain.
  • All learning is experiential and in the context of relationships, be flexible and adaptable to retraining the traumatized person’s responses, triggers and sense of safety
  • Structure, routine, and providing a sense of control can ease some of the daily symptoms. Set the individual up for success through these tools and involve them in creating it.
  • The positive neural effects of a relational reward (hug, positive comment, supportive activity) lasts about 8 minutes for a child, 30-60 minutes for an adult. How can you add more to support change?
  • Brain growth and new neural connections (neuroplasticity) can occur at anytime over the lifespan. But it can only occur only when the child or adult feels safe and secure, able to relax hyperarousal and/or dissociative (vigilance or numbness) in order to create new neural pathways. Trauma most impact lower brain functioning including self regulation, fight/ flight/ freeze responses, heart rate, breathing, temperature control, and emergency response. You can access this part of the brain, and help healing and growth happen, by using sensory interventions including rhythmic repetitive movement, patterned breathing, exercise, bouncing a ball or squeezing a toy, massage, jumping etc.

-Angie Gunn, LCSW

Margaret Cho Wants You to Embrace Your Darkness

Using creativity to cope and connect

Margaret Cho has been finding ways to entertain us for decades. From her stand-up routines, such as The Notorious C.H.O.; to her books, such as I’m The One That I Want; to her roles in films such as Face/Off, Cho continues to come up with new ways to explore and share her artistry.

A major reason why Cho continues to be so prolific is the same reason why she is so beloved by her fans — she is willing to tackle and speak out on difficult issues. Cho has been an advocate for LGBT rights, has opened up about her having experienced sexual abuse, and about her sexuality, as well as her consequent struggles with an eating disorder, addiction, depression and suicide. In doing so, Cho has given voice to people who feel alone and invisible in their struggles with social and emotional issues.

And with her new album, American Myth, Cho is continuing her message: Don’t run away from your darkness — embrace it.

Cho explains how this is a central approach to her life and art. She told me, “People should be conscious that pain and suffering are essential to living. We need it as much as we need happiness and joy and pleasure. There would be no contrast in your existence if the bad and dark parts didn’t exist.”

For Cho, this stance is personal. One of the painful issues with which she has struggled over the years is depression. People who struggle with depression — even only sub-clinical depressive symptoms — may experience significant loss of physical, social and role functioning. And the loss of functioning associated with depression appears to be comparable to or worse than that of other chronic medical issues.

“I think I’ve always had it. It’s something that sounds familiar when people talk about their experience of depression,” Cho explained. “But I’ve never been diagnosed or medicated or anything. It’s not weeks; it’s more just like it’s parts of days.”

Cho describes her depression as feeling like existential dread, also referred to as existential angst. “There’s always been this existential dread that I’ve had, not knowing what the future is going to bring,” Cho explained. “And not knowing how you may have done something in the past that’s upsetting, or regret something that you’ve done.”

Like many others who experience depression, Cho also experiences rumination, which is to compulsively and repeatedly think about something. Rumination can be useful if one is attempting to deliberate over possible solutions to a problem. But it can also take the form of obsessing and amplifying a problem without arriving at a solution.

“It becomes something amplified in your mind to obsess over. The tiny slights that build up – like someone doesn’t email or text you back,” she explained. “Something that you obsess on, and then you realize that the other person has no idea that you’re going through this crazy thing. And it’s just strange how certain facts or details about your life become amplified.”

Managing one’s negative experience can be difficult enough, but Cho felt that while she was growing up there were many social signals that she and her feelings didn’t matter. This first came with observing the underrepresentation of Asian-Americans in popular culture. Research suggests that even subtle forms of racism can result in negative psychological consequences.

In Cho’s case, she described the feeling of invisibility — like she was not there and she didn’t matter — that can arise from these forms of racism.  “I think you feel betrayed and shocked when you realize that you’re not what’s being represented or you don’t feel included. It’s just this strong feeling of invisibility. And it can be very hard to explain to other people.”

-Michael Friedman, PhD, Brick By Brick