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The Trauma Tool Kit
Healing PTSD from the Inside Out
By Susan Pease Banitt
Theosophical Publishing House Copyright © 2012 Susan Pease Banitt
All rights reserved.
Road Map for Healing from Trauma
Trauma arrives unwanted in all shapes and sizes. It can appear early in life or late. It can be as large as a country or as small as an individual. It can be sudden or cumulative, or both. Trauma knows no rules, no ethnic identity or age. It does not know when to say when. You can be at the breaking point, and still more trauma will come. Why? Maybe the answer is ultimately unknowable, but if we have encountered trauma we want answers. Many of the world's greatest texts, scriptures, and works of art owe their origin to struggles around this very question. Here's what is knowable about trauma and traumatic stress: (a) trauma is a universal human experience; (b) there is an endpoint to all forms of trauma; and (c) it is possible to recover fully from traumatic stress.
Post-traumatic stress disorder has been increasingly featured in the media, and it may be the disorder of our time. Legions of returning soldiers and hundreds of thousands of child-abuse survivors compose just a few of the ranks of those with PTSD. But, you don't have to be diagnosed with PTSD to be dealing with traumatic stress. You might be in the first several weeks of recovering from a traumatic event such as a natural disaster, accident, sudden life change, or medical diagnosis. You may have been running beyond your capacities in a high-pressure job or lifestyle for years, and the effects are now catching up to you. Or you may have some symptoms of traumatic stress but not enough to qualify for a full-fledged psychiatric diagnosis. If you are reading this book, chances are you have come looking for some help with traumatic stress, either for yourself or for a loved one. What I would like to say to you, then, is congratulations. Congratulations for surviving and being alive, for reaching out for help and picking up this book. Whether you have PTSD or are struggling with chronic overwhelming stress, no matter how dire your life may be or may have been, it is possible to lead a healed, vibrant, and joyful life.
Traumatic stress entails a great deal of confusion, as if we were dropped in a perilous foreign land with no familiar landmarks and no map, all the while experiencing tremendous pain. Because of my own deep journey through trauma as well as my role as healer with traumatized people, the terrain of trauma has become very familiar, with reliable guideposts, paths, and stages. These stages are your roadmap through the experience of trauma. You can use these developmental steps to assess where you are and where you are headed or need to go. Depending on your progress, some of these may seem easier or harder, obvious or puzzling. You may feel overwhelmed at the length of the journey or resist certain steps (e.g., why should I have to be the one to forgive?). Not to worry. Do not fight your natural feelings; just notice them, and keep moving forward. When you look at a map, what is the first point you look for? Where you are going? Nope. You look for that You Are Here arrow. Once you know where you are and where you want to go, only then can you make your journey safely and without a lot of unnecessary detours.
Healing from trauma has a developmental path all its own with distinct stages of healing. Like other models of healing, these stages are not necessarily linear, progressing from one to another in order. In psychology we think of time moving upwards in a spiral rather than in the usual straight line. True healing consists in forward and apparently backward directions in healing called regressions. Regressions can feel like out-of-control backsliding, but they are really loops in the spiral that end up moving forward again and are universal to human development. For example, when a baby learns to walk, often sleep patterns that have been well established for months become chaotic for a couple of weeks. This behavior does not mean the baby has gone backwards in its development, even though regression looks and feels like that to the new parents. The baby brain is busy incorporating a new ability, walking. When the skill is consolidated, the baby will continue to progress in its development.
As you look at the stages in healing from trauma, know that, like that baby, you may need to go backwards (regress) occasionally to a previous stage in order to go forward again. Some stages may take a few months, while others can take years. Some manifest according to age and development. Certain stages may loop or overlap simultaneously. Healing from trauma is very individual. There is no one-size-fits-all approach to how people traverse this terrain. Because trauma involves the wounding of multiple dimensions within the human being, the stages of healing from trauma are also multidimensional. So, use what follows as a guideline. Nothing as complex as the human mind can be completely outlined. This roadmap is not supposed to be dogma. As you go through these steps, if they fit for you, great; if not, temporarily put them aside and focus on healing where you are.
The seven stages of healing from traumatic stress are, in the usual chronological order, trauma shock, rebooting, acceptance, feeling and releasing, integration, restoration, and forgiveness. These are not merely psychological stages but whole-body processes that unfold as one moves through the journey of healing from trauma.
Trauma literally stuns the mind. When the mind can't accept what it sees, or when the amount of information about reality becomes too big to process, people go into psychological shock. Broca's area, the center of language in the brain, may shut down, rendering victims temporarily mute. You may have seen this phenomenon if you have ever come upon the scene of an accident. The victims are often staring off into space, unsure of where they are or what has just happened to them. They might be wandering aimlessly or sitting on the ground with their heads in their hands.
Trauma shock occurs in the immediate aftermath of a traumatic or horrifying event. Signs of trauma shock can include a fixed stare; a racing heart rate; a feeling of spaciness, dizziness or lightheadedness; incongruence between words and tone of voice (e.g., speaking in a monotone when describing the trauma); a feeling of being out of one's body; muteness; rigid bodily posture; and a deceptive calmness that belies the seriousness of the event. Trauma shock is not to be confused with the medical term "traumatic shock," shock that results from a physical injury. Trauma shock is a purely psychological mechanism that kicks in automatically, much as physical traumatic shock does. In a situation in which physical injury may have occurred, it is important not to confuse the two. Medical personnel can help rule out any physical traumatic shock to the body that can look like this first stage of trauma. Of course, physical shock should always be treated first.
It is easy to think that someone in trauma shock is all right. To the untrained eye, the victim can look calm, like someone in control of the situation, when nothing could be further from the truth. People in trauma shock have an almost locked-in feeling; they seem to have disconnected their internal world from their outer expression and being. They sometimes describe later how they were "screaming on the inside." People can also experience trauma shock as being numb, dissociated, or ungrounded. Trauma shock is like a system freeze or crash in a computer; one is overwhelmed with too much emotional data to process all at once.
Trauma shock is not well understood in our society yet. Recently, in Portland, Oregon, a suicidal man was shot because he did not answer a policeman quickly enough in the heat of crisis. To many psychiatric professionals it seemed obvious that the man, whose brother had just died suddenly, did not answer because he was in a state of deep trauma, but the police assumed he did not answer out of a dangerous resistance to orders, so he was fatally shot, a tragic outcome for all involved. Had the police had a better understanding of the mechanisms of trauma and how trauma shock affects the speech centers of the brain to the point of muteness or delayed speech, they would not have confused a traumatized suicidal man with a dangerous sociopathic one.
Ideally, trauma shock would last just long enough for one to get help and pass quickly. In some cases, though, I have seen people who were in mild to severe states of trauma shock for weeks, months, or even years. Trauma shock can occur at the time of the event but also in the future, whenever the trauma is retriggered. Many of the people who cannot move through the stages of healing from trauma keep getting stuck in trauma shock, a helpless and uncomfortable state of frozen numbness. The first step in releasing trauma shock is recognizing it. Just knowing you are dealing with shock will help to move you forward in healing, along with some techniques described later in this book.
If trauma shock is like a computer system freeze or crash, then the next stage involves rebooting our brain and functioning. Now there still might be some bugs in the system, but to carry on with our daily lives we need to get our brains up and running. How easily we do this depends both on the severity of the trauma endured and the number of previous traumas we have lived through.
In rebooting, we get grounded in our bodies and engaged in our lives again. We reenter relationships, but everything has changed. This time of reentry is delicate and fraught with hazards. Others wish to support us, but they have no clue what we have been through unless they are trauma survivors themselves. We often feel as if we are moving through an alien landscape even though externally nothing has changed. Our internal landscape has shifted so profoundly that we can have a sense of disorientation at this stage. It's as if someone has put an invisible 150-pound backpack on us and then encouraged us to move about freely. Easier said than done.
This changed landscape itself is traumatizing. Rebooting finds us in territory where we have the potential to feel challenged, alienated, and abandoned at every turn. We want to share our experience, but we don't want to see the look on peoples' faces when they hear our story. Some stories are so horrendous that those suffering from traumatic stress feel they can never tell them to anybody. We naturally want company (the human being is a social animal, after all), but feel it's hopeless. This feeling creates for many a secondary level of trauma, the trauma of disengagement, lack of functioning, and abandonment, sometimes perceived and sometimes real. It is not unusual for previously healthy relationships to fall apart at this stage or for people to lose their jobs or marriages.
When these secondary traumas kick in, sometimes trauma shock returns. I have seen many people who have been caught in a repeating loop of trauma shock and rebooting for years. If you find yourself in this situation, I want you to know that healing is possible. The way out is to move forward into the third stage.
Acceptance is the most crucial and also the most challenging stage in the journey of healing from trauma. To understand acceptance we need to look at its opposite. What is the opposite of acceptance? Denial. What is denial? Simply put, denial is the automatic and unconscious response of our defensive systems to protect us from information that would destroy our sense of the world and ourselves. To fully accept what has happened to us, to embrace the trauma, means that structures of our self and our world need to go utterly away, possibly never to return. Denial protects us from unbearable loss, confusion, and intolerable anxiety, but it also puts us in prison and tosses away the key.
The process of acceptance can include recovering previously repressed memories, but it doesn't have to. For example, a victim of date rape might define her event as "having done something stupid," or an earthquake survivor might rationalize, "So many people had it so much worse than I did." This altering of reality, which can range from minimization to outright fantasy, is quite common in survivors of traumatic events. To come fully into reality and acceptance in order to heal trauma, a person might have to admit that a "funny uncle" was a pedophile, that a bomb dropped actually did kill innocent people, or that acceptable child-rearing practices never involve floggings. Acceptance always entails a shift in the current reality to one that is more horrible, if more real, than the reality of denial. No wonder it is so very difficult. Yet, without this acknowledgment and acceptance no healing is possible. Those unacknowledged traumas then remain locked within the body-mind, creating dysfunction and disease.
The horrors to which people are subjected and to which they subject others are literally endless. Humans are capable of every kind of barbarity and cruelty, and there is no era of history in which these acts have not been performed. When I used to work on an afterhours child-abuse hotline, every report of abuse in the entire state was funneled into our little room each night and weekend. Every time I thought I had heard it all, I assure you I hadn't. A person couldn't make those things up. Hearing twenty to forty stories of child abuse per night for four years, I did get to a place in which I wasn't outright shocked any more, but I could still be surprised at horrible variations on a theme. I do understand why you might not want to accept your story or tell someone else, but it is so important that you do so for your own healing.
Acceptance is particularly challenging when part or all of a memory has been repressed. What is a repressed memory? A repressed memory is simply a memory that has yet to be acknowledged in full consciousness. Cognitive psychologist Jennifer Freyd has been researching the phenomenon of repressed memories for decades at the University of Oregon. Her research shows that a memory is more likely to be fully repressed or dissociated when the victims were traumatized by someone who was supposed to be caring for them. She calls this type of trauma betrayal trauma. If you have been traumatized through abuse by a caregiver, especially if you were a child at the time, the acceptance stage can be a lengthy one. Be patient, and give yourself all the time you need without forcing the issue. Eventually you will know everything you need to know about your past; the developmental process of aging naturally aids in the recovery of memories. If your trauma stems from abuse by a caregiver, a therapist with extensive experience in betrayal trauma is highly recommended to help traverse this difficult terrain.
Feeling and Releasing
Traumatic events, by definition, overwhelm our ability to cope. When the mind becomes flooded with emotion, a circuit breaker is thrown that allows us to survive the experience fairly intact, that is, without becoming psychotic or frying out one of the brain centers. The cost of this blown circuit is emotion frozen within the body. In other words, we often unconsciously stop feeling our trauma partway into it, like a movie that is still going after the sound has been turned off. We cannot heal until we move fully through that trauma, including all the feelings of the event.
If you are very young when trauma strikes, under seven years or so, the brain is still very plastic and malleable enough to divide and conquer. The visual image gets stored in one compartment, smell in another, the narrative of what happened in yet another, and so on. This separation is why it is so hard to piece together a memory from a young age or why it feels unreal. Patients will sometimes say that they see a snapshot of themselves in a traumatic situation they can't feel or that they are having flashes of intense negative feelings without any story or picture. In some cases children can completely dissociate from events in their history until years (perhaps decades) later, when memories tend to return. If you are older than seven years or so at the time of the event(s), the brain does not seem able to dissociate as easily. In that case it is very common for traumatized people to turn to substances (prescribed or not) for dissociation from unbearable memories and sensations. The result for both processes is the same: stuck memories that have never processed fully and safely through the body for release and integration.
The key to unfreezing, making sense of your history, and moving on in your healing is feeling everything related to your traumatic event and letting the energy of that emotion leave your body forever. Scary, isn't it? Many of us spend decades trying to avoid just that. The pain seems too intense to deal with. Some people feel they should be able to do this on their own, but I say, "Don't try this at home!" You wouldn't attempt a dangerous ascent on a glacier without assistance and instruction, would you? So why try to manage unmanageable feelings on your own?
Excerpted from The Trauma Tool Kit by Susan Pease Banitt. Copyright © 2012 Susan Pease Banitt. Excerpted by permission of Theosophical Publishing House.
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