"I became what I am today at the age of twelve, on a frigid overcast day in the winter of 1975... That was a long time ago, but it's wrong what they say about the past... Looking back now, I realize I have been peeking into that deserted alley for the last twenty-six years." - Khaled Hosseini, The Kite Runner
If this quote resonates with you, you may be on a path of recognizing that certain past experiences are still impacting you in the present.
Recognizing what may have been traumatizing is a first step towards healing. Fortunately, the growing understanding of what constitutes trauma greatly helps individuals to identify it and to start healing from it.
In this post I describe how the psychological perspective on trauma has evolved since the 80's, and reflect on the primary goals of trauma healing.
What is trauma
The word trauma comes from the Greek trauma (τραύμα) meaning "wound." In psychology, an event is thought of as traumatic when it is so distressing that it overwhelms the individual’s psychological ability to cope. Often, it has long-term negative mental and physical consequence.
The lasting impact of trauma first received recognition by the American Psychiatric Association in the 80's, through the formulation of the diagnostic category of Post-Traumatic Stress Disorder (PTSD). It was in the aftermath of the Vietnam War and the growing literature by survivors of the Second World War who documented the profound impact that mass violence has had on individuals, families and communities during the war.
The category of PTSD finally provided a framework that traced survivors' mental and physical symptoms to a clear origin. As a result, natural disasters, deadly car accidents, individual and mass violence, and other life-threatening events have been recognized as experiences that can shatter one's sense of safety in the world, and leave them with a heightened sense of fear and helplessness, far after the original events were resolved.
The more recent recognition that trauma-response can be a result of events other than war, such as sexual assault, exposure to child abuse, and domestic violence, has been promoted by psychiatrists Judith Herman (1997) and Bessel van der Kolk (2014), and continues to be supported by the vast modern research on attachment.
One particular study (Felitti et al., 1998) revealed a strong and cumulative correlation between "adverse childhood experiences" (aka ACEs) and adult health status. The study showed that psychological, physical, or sexual abuse as well as exposure to domestic violence, living with household members who abused substances, were mentally ill, suicidal, or imprisoned, had powerful ramifications for one's health outcome in their adulthood. And the more adverse experiences one experienced in childhood, the greater the impact it had on them as adults.
The ACE study brought to light adverse childhood experiences that have been previously obscured. Still, the traumatizing effect that lack of consistent caregiving can have on one's development remains largely outside of public awareness. After all, it is rather difficult to reflect on what didn't happen or didn't happen consistently. And as a result, survivors of childhood neglect and emotional abuse often feel confused by their own symptoms, and might unfortunately perceive their symptoms as a sign that something is wrong with them.
The truth is that all post-traumatic responses make complete sense if we understand the context in which they had developed: in response to emotionally or physically harmful or life-threatening situation\s. And it's important to keep in mind that what may be threatening or harmful for an adult is different than what is threatening or harmful for a baby or for a child.
Trauma in everyday life
Trauma makes you feel like you don't deserve love. It makes you feel like you don't have the right to have a need, or that you are not worth anything.
Imagine going into the world with this message and trying to have loving relationships.
The vicious voices of trauma are ones that make it incredibly difficult to tolerate messing up in a relationship. Any perceived mess-up then reinforces the trauma narrative: "I am a shitty person, I am selfish, I am not worthy of love," and can swiftly lead to a shame spirale and other negative feelings. The solution may be simple: to protect one's self from the hurt they anticipate in a relationship.
There are different forms of self protection: Some avoid intimate relationships altogether, or sabotage opportunities for intimacy. Others may get vigilant of any signs of potential rejection and try to compensate through pleasing others and minimizing their own needs. Many vacillate between being attentive to others' needs at the expense of their own needs, and between growing resentful when they feel hurt or de-prioritized despite their enormous efforts.
Healing from trauma begins with identifying and then unlearning these patterns, to make room for profoundly different and new experiences.
I am worthy of love. I am worthy of having and expressing a need. I am worthy. period
If you are someone who can find it difficult to take in and stay-with the "positive," know that you are not alone. And know that there are ways to heal from trauma wounds and to welcome love and connection into your life if you'd like that.
The healing journey
In his groundbreaking book The Body Keeps The Score, Bessel ven der Kulk offers a coherent blueprint for understanding and treating trauma. He suggests four goals for trauma recovery (not necessarily in this order):
Find words to describe the deep and painful effects of trauma. It has long been observed that language holds significant power in transforming one's experience and decreasing social isolation. After all, it is primarily through words that we make sense of our experience and share it with others.
Learn tools to regulate emotions, even when one is unexpectedly triggered. Some of the tools Dr. ven der Kulk mentions in his book are breathing, moving, touching, and medication. By increasing one's ability to regulate their emotions, they can have a new experience of safety and of not-being-alone right in those moments when their body perceives threat.
Begin to trust other human beings after the shameful and horrific experience of trauma. This can begin with cultivating safety and acceptance in the therapeutic relationship, while supporting one's capacity to form and strengthen other safe social connections. When appropriate, couples therapy and family therapy can directly assist with increasing the sense of security in one's significant relationships.
Cultivate opportunities to be fully alive in the present, rather than stuck in the past. Shifting "from surviving to thriving" can be incredibly challenging. One way to think about thriving that I learnt from my teacher, Dr. Jacob Ham, is as cultivating Presence, Poignancy and Purpose. For many, reclaiming a lost childhood feels like victory, when they are able to access their own playfulness, joy, and spontaneity.
In trauma healing, each of these goals may take precedence at different times, based on one's priorities and their most pressing needs. Effective trauma therapy is never a one size fits all. It has to be adjusted and re-adjusted to one's unique preferences and circumstance. Many find that the process of reflecting on one's needs and adapting the therapy process accordingly can be healing in and of itself.
Helpful resources
Trauma and Recovery by Judith Herman
The Body Keeps The Score by Bessel van der Kolk
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