definitely been sitting on this one too long…..

I was recently asked to write a little something about trauma and the recovery therefrom so I thought I would give it a go like this. The back at the office format is a handy one to use but it does require a bit of the creativejuices to pull off, of course assuming that I am pulling that off, and right now I have those juices being utilizedon another project.

That does remind me that I have not reminded you, my faithful readers, that I have an open call for topics here.If there is something you would like more information about, or want to hear a psychologist’s perspective on it,maybe the internet answer isn’t sitting right, or whatever–drop me a line or a message or a whatever and I notonly will I give it a go with my two cents but I promise to utilize not just my opinion and experience but the latest available research on the subject as well.

now back to trauma…

The question I was specifically asked is not altogether dissimilar to others I have been asked and addressed inthis little corner of the interweb–will I ever recover from this, or am I doomed to struggle with this forever?

While it seems an easy enough question to answer it is a bit more complicated than that.

As I have said before there is no such thing as “getting over” complicated emotions, there is only getting through them.  I suppose the answer to part of the question is no, you will never get over your trauma,because no one ever really gets over anything.

I suppose I could just end it there but then that is not a very SouldDoc-y way to do things, now is it?

The reason no one gets over anything is partly because of the way people are made up psychologically and partly because of the way people tend to process (or not process) complex emotional experiences.

I think the second part of that is easier to explain: people tend to not consciously or actively process theiremotional experience and worse they tend to actively avoid doing so.

Why? Well because it is a difficult and often painful process to undertake and human beings will go toextraordinary lengths to avoid experiencing discomfort let alone actual pain.

that is a fundamental piece of what fuels the process of developing an addiction, pain sucks and no one wantsto experience it, and what better way to avoid the pain that to get good and numb from some chemical, eitherinternal or externally applied? (I would go into this more, but I am writing a book on this subject, or at least will be once some of my other projects get to a state a bit more wrapped up, and don’t want to spoil the surprise).

In essence, people don’t process their trauma because they actively avoid it and that is one reason why theydon’t get over their traumatic experience.

The other part is equal measures of how people are made up of both conscious (which believes it is in charge and alone in making up the Self) and unconscious (which is in charge but doesn’t communicate in language)parts and the complex nature of traumatic emotional experiences.

I have spoken at length about the conscious and the unconscious so I won’t go into too much more detail here,but I will say that the process of these two parts interacting is something like a reverse tug of war. The conscious, or Ego, will attempt to convince the Self (that is the unification of both parts) that whatever occurred was no big deal or doesn’t matter because it took place long ago or was something you deserved to have happened because you are in some way responsible for the trauma taking place. This process, called suppression, is the conscious act of pushing materials down into the unconscious (so the Ego can pretend the event was “gotten over” or worse never took place at all) and is opposed to repression which is an unconscious act of pulling something out of consciousness. Repression is a healthy survival or adaptive technique whereas suppression is an unhealthy (in the long term) act of ignoring something and in that way, it is very much a form of denial.

While the conscious is attempting to suppress the emotions and processing, and in a very real way the veryknowledge of the experience by pushing it down into the unconscious, the unconscious is, at the same time,attempting to push these materials up into consciousness so they can be more fully processed and integratedinto the Self. This process is very energy-demanding and will utilize a large portion of a person’s libidinal (orpsychological) energy and in that way is a contributing process toward the development of depression.

In other words, while your ego and psyche are arm wrestling over who will get stuck with the emotions of thisexperience you will get tired because of the demand on your energy resources.  You, like most people, willequate the resulting tiredness (which is often described by my patients as “to the bone” exhausted) asdepression.

the other aspect that complicates the processing of trauma is the nature of trauma itself. Unlike sadness, anger,or happiness, trauma is not an emotion. Trauma, like depression, is an emotional construct. That is, it is anexperience made up of a lot of different ingredients, like a cake.

A cake is made up of things like flour, sugar, eggs, and salt. Ingredients which by a large when taken separatelyare not that complicated to understand and experience. Some of those ingredients are stand-alone things; theycan be interpreted in and of themselves, like eggs. You can eat a fried egg or a scrambled egg, or you can addan egg to a mixture and get a cake or a brownie.

Trauma on the other hand can be made of things like fear, sadness, physical pain, or disappointment. Ingredients when taken alone remain highly complicated and difficult to process. As if that was not alreadycomplicated enough, trauma can also include other constructs such as grief and depression.

All in all, trauma can be a complex jumble of multiple emotions, complexes, and often the processing of which includes a slow unraveling process to separate inappropriate or maladaptive coping responses (and thepotential issues those can develop) from a history, depending on how old the trauma experience is, the patientis fighting to remain unaware of.

Another factor that makes trauma so difficult to process is that the very nature of trauma is subjective anddependent on multiple factors which can differ wildly between patients, even within the same group or family.

What I mean by that is that two people can go through the same event at the same time and come away fromthe experience with different types and levels of trauma, some in attendance may not be traumatized at all.

When I was in high school, I started reading Tony Robbins books. It was the 80’s and motivational speakers like Robbins were all the rage at the time. In one of his books (Personal Power I believe), he discussed twopeople who were both POW’s during the Vietnam War. They were both captured and tortured in much the same ways as everyone else. They were deprived of food, water, and basic human dignity as everyone else in their prisoner camps.

For those of you who don’t know, or recall, something along the lines of 1500 veterans a day were committingsuicide at this time because of the extreme and traumatic experiences of the Vietnam War and the abysmal lack of understanding and appropriate care when they got home. These experiences severely traumatized almosteveryone who participated in the war in any aspect, especially those who ended up being captured.

Yet when these two soldiers were released one of them became a concert pianist and the other significantlyimproved his golf score. How did they come out of the same experience as so many others and instead ofsuccumbing to the darkness of war improve aspects of their lives?

One of the two soldiers imagined playing a round of golf at his favorite course every day, sometimes several times a day and the other would use mud or a pencil (if he had one) to draw a piano keyboard on whateversurface he could and he would imagine playing his favorite piano pieces. He was quoted in the book asactually warming up his fingers, playing scales for example, as he would if he was sitting in front of a piano before he would practice the musical compositions. He even practiced after the guards broke his fingers because they figured out what he was doing.

John McCain is another example. His fighter jet was shot down resulting not only in his capture but severeinjuries which the Vietnamese medical teams poorly repaired and which caused him pain and limited mobility for the rest of his life. He served his state as a senator for 31 years.

If these three, and countless others, can come out of the most horrific of circumstances unscathed how is it thatso many of my patients, and everybody else’s patients, often require years upon years of therapy and usecountless medications to improve their lives only marginally?

Well in a way that is due to another complicated aspect of not just trauma but human experience; they can be, and often are, cumulative.

I think we can all agree, and with very little debate, that events such as war and 9/11 and child abuse andsevere natural disasters such as fire and earthquake are traumatic events that can severely damage a person psychologically, but what people often give me funny looks is when I tell them that from a child’s perspectivebeing told no is a form of trauma or being forgotten, or even feeling like they had been forgotten–for examplewhen a child becomes separated from their parent in a store or shopping mall.

The way I explain trauma with my patients is like this: imagine a child asks his or her mother for a cookie orsome sort of treat, and his or her mom says yes. Instantly the child will be filled with all the feel-good emotionsavailable in their little body. Then say the phone rings or someone comes to the door while mom is on the wayto the pantry to get that cookie, which distracts her from going to the pantry, and eventually, she forgets to get the child the cookie.

From the perspective of the child, that event is trauma.  All the feel-good emotions are replaced by feeling badwhich is compounded by the fact the child will also wonder what it was they had done to cause their mother tochange her mind. They may not remember this specific event (depending on the child’s age at the time) butthey may remember forever that when a reward has been earned that reward can still be denied if behavior is not just so.

The child has been traumatized that quickly and depending on how the event is handled after the fact by theparent and what other events occur in the child’s life that are also traumatic, the child may grow into an adult the finds him or herself sitting in my office asking why they are so miserably unhappy all the time.

Or if that child grows into an adult who decides to Be all they can Be (old Army campaign slogan) the trauma of service may stack on top of the traumas of their childhood resulting in them coming out of combat with the types of wounds that never heal.

When it comes to processing trauma and other complex emotional responses, the methodology is the same assingular emotional events–one must allow oneself to feel the emotion to understand why that specific emotionwas necessary as opposed to any other emotion—which is not to say it is easy, but it is that simple. Whatmakes it so much more complicated to process is that often there are compounding factors and emotionalexperiences that must be discovered and processed before getting down to the originating trauma.

Think about it something like this: you bought some land and want to start an organic wheat farm. You can’t justrush out there and start growing wheat, throwing your seeds here and there all over the place, in between rocksand trees hoping for good results. I mean you could, but your farm would certainly not produce as much wheat as it could if you did the prep work.

So you learn your lesson and then go about clearing the trees, which must first be cut down and removed, butthat leaves you a field full of tree stumps, so you remove the stumps next and haul them away, but that leavesyou with a bunch of holes in the field where the stumps once stood, and you still have the rocks and rootsembedded in your field. You have to plow the field then deeply to remove the excess roots so the trees don’tgrow back and the big rocks which might tear your plow up or prevent the seeds from growing. Once all that isdone you finally have an empty field you can plant in but your soil needs nutrients so you take all those trees, stumps, and roots and shred them and ironically you spread them all back over the field to supplement the soil with the nitrogen and other necessary nutrients that the trees used to build themselves within the first place andwater must be brought in, and…

well, you get the idea?

There is a process that must be undertaken to prepare a piece of land to plant crops and there is a processthat must be undertaken to heal from trauma. With healing trauma, just like the field, only one step can be takenat a time, and you may not even become aware of the second step until the first has been completed. Thecompletion of each step reveals work that must still be addressed before planting a crop and even then, yourwork is not done just because your seeds are in the ground. Plants need time and patience and water and food, just like you do.

Each of those healing steps reveals the additional work to be done and allows the patient to fall back into denial and discontinue not just their treatment but their healing process.

The bottom line with trauma or any other emotional healing one must undertake. It may be the source from which the question I was asked emerged is one of mythology–specifically the mythology that people cling sodearly to which suggests because a traumatic event happened long ago it should no longer matter or because a process is simple it should also be easy. Nuclear fission is easy, the sun and stars have been doing it withouthelp for billions of years, but it took a lot of scientists a lot of years to figure it out (technically stars like the sunare undergoing fusion and fission mainly happens when stars explode but you get the idea).

If one is determined to complete the work, then one will be more likely to engage in the work and not give upwhen the work becomes well, work. There is a reason it is called work and not rest or relaxation, healing one’sself is difficult and often requires much digging and processing of each step and yes there is likely to be pain or at least some discomfort, it is also called a journey for a reason, but I assure you that you are worth the effortand the changes this work can have on and in your life are truly amazing.

Part II: examples of healing trauma……The Problem with Working Through Trauma