16. Trauma recovery sensitive, controversial

By Tom O'Connell

Who among us has not suffered from trauma? And who has come through the early years of life without being wounded physically or psychologically?

It's obvious that veterans of combat have experienced trauma. And so have those who have been flown to treatment centers in helicopters. But what about the wounding from childhood abuse and neglect? Or living with addictions? Or ongoing harassment? 

The first meaning of "trauma" in Webster's New World Dictionary is "a bodily injury, wound, or shock." The second one is "Psychiatry--a painful emotional experience, or shock, often producing a lasting psychic effect and, sometimes, a neurosis." Important words here are "painful emotional experience" and "lasting psychic effect."

To improve their understanding of traumatic stress, therapists came to a Cape Cod Institute workshop to hear Bessel Van der Kolk, widely recognized for his work as clinical director of the HRI Trauma Center. He is a professor of psychiatry at Boston University, and has been president of the International Society of Traumatic Stress Studies.

He told therapists at the session offered by Albert Einstein College of Medicine, "The psychiatric profession continues to be periodically fascinated by trauma, alternating with a stubborn disbelief in the relevance of patients' stories. Despite clear evidence that the effects of trauma can be profoundly debilitating, and that the care of traumatized children and adults is enormously expensive, the idea that reality can profoundly and permanently alter people's psychology and biology continues to be controversial."

Van der Kolk asked these thought-provoking questions? "Are these patients malingering and suffering from moral weakness, or from an involuntary disintegration of the capacity to take charge of their lives? Do they suffer from false memories, or are they, in fact, victims of indelible memories of the past?"

In truth, trauma is real, has lasting effects, and the effects can be physical, mental, emotional, social and spiritual. Those effects can do serious harm to a person's ability to manage the challenges of life. And Van der Kolk's insights aimed at therapists can help us when we deal with our own trauma, or the trauma of others.

He urged therapists to "give your patients permission to stay with their feelings." And in helping patients identify their painful emotions, he said touch was important. "In our culture we suffer from increased alienation and a lack of touching. We've noticed in our research that patients who were getting better were doing psychotherapy and also finding somebody to work on their bodies through massage, tai chi, etc. As long as they used just psychotherapy, with words only, their bodies were totally armored."

He explained that the body seems to have no language to express itself, so parts of the self in pain will split off and reside in the body. He stressed the value of paying attention to the body and its sensations, and connecting the traumatic story with the bodily effects.  "Take all the time you want to feel that sensation in your body." The challenge is to connect the sensations and the person's experiences, images, emotions, and beliefs.

After traumatic stress, "people see the world through a trauma lens and aren't likely to see alternatives," noted Van der Kolk. So the therapy is to "instill new memories in their minds, not in the here and now but in the there and then...Get them  back into the state when they remember viscerally what happened to them. Read the effects. Describe. Translate. Then the person feels understood and willing to go deeper into the emotional state." Eventually the patient may be able to say, "That's how I'm trapped!"

As for abused children, he said they are caught between rage and immobility. "Women inhibit, try to hide their rage. To know rage, we need to know it can be contained. Rage is a very big thing, along with the realization that once you're abused as a child you become an orphan. Abandoned and left to self, you know that when the chips are down there's nobody there."

Van der Kolk explained, "Trauma is always associated with a negative image of the self, which may include shame, a feeling of being damaged, and not being good enough. The negative self-image needs to become conscious. When the traumatic memories get resolved, the images of the self get resolved as well."

According to this traumatic stress expert, a major portion of therapy is telling the story, feeling the impressions that arise, and getting in touch with the story's meaning. "Let people talk," he urges. Closure is important too. An example would be a patient making this kind of statement: "I was an innocent seventeen-year-old when that happened."

Is traumatic stress real? Yes. Are its effects sometimes crippling? Yes. Can therapy improve the situation for sick and suffering traumatic stress victims? Yes.

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