Book Review-Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body, and Society

Traumatic experiences have the capacity to change us at a genetic level.  We can be so burdened by our traumas that we’re unable to appreciate the gift of the present.  Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body, and Society is a journey into what trauma is, how it impacts us, and what we can do about it.  One of the editors, Bessel van Der Kolk, is the author of The Body Keeps the Score and a friend of Gabor Mate, who wrote The Myth of Normal.  In short, it’s edited by people with huge respect in the trauma space.

Legitimate PTSD

Labeling is a problematic space for psychology.  On the one hand, experiments have shown that labels can have a negative impact on our outcomes.  (See The Psychology of Hope and A Class Divided for more.)  However, on the other hand, a label gives us something to call our struggles and creates an opportunity to come together around a common challenge.  (See The Deep Water of Affinity Groups for more.)  Traumatic circumstances that have debilitating consequences have had several names over the years, but it wasn’t until DSM-III in 1980 when the post-traumatic stress disorder (PTSD) moniker got its foothold.  Now for many it serves as a way for people to identify and understand what’s happening to them.

This comes with a risk.  Despite the idea of post-traumatic growth (PTG), some people believe that PTSD is a life sentence.  (See Transformed by Trauma for more on PTG.)  People are told that the flashbacks that interrupt their world today may become less frequent, but they’ll always be subject to a relapse and therefore can never be totally healed.  This reframes them as broken and, in some ways, a perpetual victim of their trauma.  This isn’t helpful.

It’s true that there is always the chance the trauma will come back up again, but recovery isn’t about resolving the symptoms forever.  It’s about resolving them most of the time and providing better coping skills when they do intrude again.

The Meaning of Trauma

In my review of Trauma and Recovery, I explain that trauma is our inability to process what we’ve seen or done.  This is echoed here – with the twist that the magnitude of the problem is bigger over time because of the reinforcement that happens.  A memory intrudes, it’s disruptive, and you take “evasive action” alongside the fear that the situation will overwhelm you; as a result, the memories are reinforced and can become even more scary and overwhelming the next time.

Because the body becomes biologically aroused for something that is no longer a threat, we attempt to disconnect our bodily sensations with the rest of our world – treating them as hostile and unreliable witnesses to reality.  However, this disconnection process leaves us ill-equipped to sense that an episode is on the horizon or is coming.  It also provides us with insufficient warning to consider our response rather than just react.

Richard Lazarus in Emotion and Adaptation explains that there is a gap between stimulus and response.  We can use it to thoughtfully respond, or we can ignore the gap and simply react.  The goal in teaching people how to cope with greater degrees of trauma without becoming traumatized is helping people develop the space between stimulus and response.

Invulnerability

Anyone who has met a boy in their early twenties has met someone invincible and invulnerable.  At least that’s the way that many see themselves at times.  They can do amazing feats that others cannot.  Surely, they cannot be harmed.  They look at their parents with their aches and pains and wonder without knowing how they could have ended up that way.  (For more on our delusions of grandeur, see How We Know What Isn’t So.)

Trauma has a way of piercing the illusion of invulnerability, whether it’s for you personally or just someone you know.  The trauma signals to some part of you that you are vulnerable, you can get hurt, and that’s world-altering.  We build our world based on our perceptions and the rules that we define for how our world works.  Jonathan Haidt in The Righteous Mind explains that we have six fundamental pillars of morality, the first of which being care/harm.  If we believe that we’re in a world that is benevolent, then bad things shouldn’t happen to good people.  Another pillar is fairness/cheating.  We want to believe that the world is fair – like us – so trauma shouldn’t happen to good people.  In short, the foundations of morality speak against our ability to easily cope when our perceptions are altered by trauma.

It’s often these changes in beliefs – triggered by something we saw or did – that represent the harder part of recovering from trauma.  We must define limits under which our beliefs function – or redefine them from scratch.

Rewriting History

I can remember the negative reaction of a professional counselor friend when I told them I was rewriting memories.  It was a sense of shock and horror – how could you tamper with your memories?  My answer is a bit different.  My memories are going to be tampered with.  Every time they’re brought to memory, they’re corrupted by a bit of the current sense of that moment.  My goal is to direct or shape the direction of the bias instead of letting it happen randomly.

Instead of allowing reinforcement of resentment, I decided to actively consider compassion – much like Buddhist monks recommend.  (See Emotional Awareness for more.)  I decided that I was going to take positive, warm feelings of the current moment along with curiosity and allow those things to reshape my childhood memories.

In Mistakes Were Made (But Not by Me), I shared that we know normal memories are not unchanging recordings; instead, they’re altered each time we recall or process them.  (I also address this in White Bears and Other Unwanted Thoughts, Intertwingled, and The Progression of Parental Alienation.)  This is the case for most of the episodic, semantic, and procedural memories that we have.  Knowing memories can be changed, we can enhance the memory – you can savor it.  It can make the memory seem more negative.  Somehow, the Sun just didn’t shine as brightly.  However, we can also be grateful for what we had and what we learned.  We can make the Sun seem to shine just a little more brightly.  Rarely do we consider this a conscious process, but it’s at the heart of the process of helping people to heal from trauma.

Closeness Under Threat

After the 9/11 terrorist attacks, there was a surge in patriotism in the US.  People came together in ways that hadn’t been seen in a generation.  It fulfils something that social scientists already knew.  When people are faced with a threat, they tend to band together.  (See Change or Die, Bowling Alone, and Our Kids for more.)  However, this expectation of closeness can be a hinderance to healing from trauma.

One of the challenges that sometimes happens when someone is faced with a trauma, something that overwhelms their internal coping capacity, is they reach out for support to friends, family, or community – but that support is missing.  In addition to dealing with the trauma itself and the foundational beliefs directly associated with the trauma, they must question their belief that others will be there for them when they need it.  They can feel as if their trauma separates them from the rest of the world, and that’s why they were unable to get the support they needed.

Ironically, those people who have an internal locus of control did better in a study of trauma recovery than those with strong social support but no internal locus of control.  That is, those people who believed they could recover themselves did better than those who expected their network of support would help them cope.  It’s not clear why this happened – but it exposes the fact that there are limits to external support and it reinforces the need to develop an internal locus of control.

This is fundamental to effective techniques like Motivational Interviewing.  It’s about supporting people until you can enable them to operate on their own Willpower and Grit.

Victims and Survivors

It’s seen as empowering to call living victims of a disaster “survivors.”  That is, of course, literally correct, but it denies the fact that they were almost certainly powerless in their victimization.  By changing to a happier label for the circumstances, we simultaneously deny part of their experience – further alienating and separating them from the “normal.”

It’s important to recognize that victims aren’t responsible for their trauma.  They weren’t asking for it or punished for being bad.  (See Trauma and Recovery for more on this concept.)  Bad things happen to good people – whether we like it or not.  We also need to empower victims to take back control of their worlds and, importantly, their recovery.  In Hurtful, Hurt, Hurting, I explained that no matter who hurt you, it becomes your personal responsibility to heal – no one else can do it for you.

Traumatic Memory

Traumatic memories are different than the regular memories that we can rewrite.  They’re stored in terms of their emotional impact.  Because they’re disconnected from the rest of our memories, they’re also fixed and unchangeable.  If we want to move past a trauma, we must find a way to integrate those memories.  That means finding techniques and tools to minimize the chances that we’ll become overwhelmed while processing them.  Strategies like desensitization and building overall feelings of safety can make it more tolerable to consider even awful things.

If the memories can’t be integrated, then they exist outside of time.  In other words, even though the circumstances of the trauma no longer apply, that doesn’t stop the experience of those memories.  Because they can’t be positioned in the larger autobiographical narrative, they appear to be happening in the moment even if the conditions are from years ago.

Traumatic memories are also frequently triggered by only peripherally associated experiences.  We’ve all heard someone say something that reminded us of a book, movie, or music.  What happens with traumatic memories is that sometimes the connections and triggers that create the memory are “turned up,” so relatively unrelated situations that share even rough resemblance to the memory cause it to be triggered.  Of course, this might be adaptive if it’s a situation that you want to be reminded of – but in today’s world, it’s rare that this amplification of the connection process is helpful.

In fact, the continued recall and the continued inability to process a traumatic memory may be debilitating.  It has the tendency to amplify the somatic and emotional effects and make it harder to deal with the memory in the future.

Memory Without Memory

One of the odd observations about trauma is that sometimes the memories of the trauma don’t have to surface to the conscious level to dramatically impact behavior.  Daniel Kahneman was clear in Thinking, Fast and Slow that we spend most of our time in System 1 – that is, not consciously considering what we’re doing.  We rely on templates, patterns, and expectations to guide us and only engage System 2 – higher-order thinking – when System 1 doesn’t seem to be working.  Traumas sometimes operate completely in System 1 and remain undetected.  Mysterious ailments on anniversaries of the trauma are common.

It’s also tragically common that a person who was victimized will reenact their trauma either by inviting the conditions for themselves or on others in similar circumstances.  This is one of the sources of generational trauma that is so difficult to stamp out.

Can’t Force Memory

Some people believe that you can force people to recall – and thus integrate – memories about an event.  However, the powers that we have to direct our thoughts are more limited than we realize.  (See White Bears and Other Unwanted Thoughts.)  Anyone who has struggled to remember the name of a person, the name of a song playing in their head, or that thing they walked into the next room for knows sometimes we just can’t remember no matter how hard we try.

We know from knowledge management work that some knowledge is tacit, and this tacit knowledge may not be something that we can recall.  (See Sharing Hidden Know-How.)  In fact, information architecture and anthropology both actively find ways to get to knowledge and understanding without simply asking people to explain the way they think.  (See How to Make Sense of Any Mess for information architecture and The Ethnographic Interview for anthropology.)

The goal is trauma recovery – integration of the trauma in a way that is autobiographical.  In an ideal world, we’d integrate the memories and be done.  We’d never have to worry about it again.  However, much like a bone that’s been broken, has become weaker, and needs to be protected, we’ll need to be aware of similar situations to prevent repeat traumatization.  In most cases, we’re unable to collect and integrate every aspect of a trauma and instead must settle for having integrated as much of the experience as we can.  This leaves free-floating bits of the trauma still in our psyche, and sometimes those random bits can arise again – and cause us to be back in the heart of struggling with the trauma.

Irrelevance

One of the facts of life today is that we’re in a constant state of information overload.  (See The Organized Mind.)  The question is only the matter of degree that we’re currently experiencing it.  Our psychic defenses gradually decrease the amount of information that makes our conscious awareness to prevent from overburdening our resources but this can operate too slowly.  The result is that we can become overwhelmed when the information we’re taking in jumps dramatically.  However, a more serious problem is the one encountered by people with trauma when the system that performs this filtering process, the reticular activating system (RAS), suddenly starts flagging the irrelevant as potentially relevant.  (See Change or Die for more on the RAS.)  The result is a potentially debilitating level of information that becomes too much to process, and we start to engage other defenses like isolation.

It makes sense that, when impacted by an unexplainable trauma, our mind would begin to adjust parameters and try to find a combination of adjustments that allow the trauma to “make sense.”

Death and Belonging

Somewhere in the rubble that accompanies trauma is often the threat of death.  It may be that the trauma as the result of death itself – or a near miss where death was a possibility.  It may be that others died, and you became aware or watched helplessly.  As The Worm at the Core and The Denial of Death explain, death is one of the core fears that most people can never shake.  It’s natural that seeing someone else’s death or injury would remind us just how frail our lives are – and how little we can do to prevent harm at times.

In some kinds of trauma, the death card is quite hidden from view.  Instead, the focus is on a sense of belonging.  When there’s a sexual assault, it’s possible that there’s a direct fear for one’s life, but also that the experience alienates you from others.  There’s the sense that you are now separate from others either because they’ll never believe you or because you’re alone in your experiences.  In historic times, this kind of separation – or excommunication from the group – would be a death sentence.

Another variation is the damage that the trauma causes to our sense of control of our environment.  This is particularly true with sexual trauma, because in that, we can’t even control our own bodies.

Preparation and Control

Traumas are – by their nature – something that you’re not really prepared for.  Even in high-risk careers, we don’t believe that the losses will happen to us.  In fact, early on, we may want to try to assert control over things that we can’t assert control over.  We want to believe that, even if bad things happen, we’ll be able to control them.  However, control is the last great illusionist.  We believe we have high degrees of control and forget other confounding factors, particularly if they don’t line up in our favor.

The woman that we adopted as my grandmother survived The Great Depression.  Her struggle was real and difficult.  As we cleaned out her home after her death, we found multiple sets of sheets that she had horded, because she remembered a time when she wasn’t able to buy them – either because of shortage or because she didn’t have money.  We found all sorts of these stashes of things that you didn’t need more than one of – but that she felt she might not be able to get.  We also found old, broken coffee makers and other devices in minor disrepair, which she apparently kept in case they weren’t available and she needed to repair them in the future.

This is the impact of trauma who felt ill-prepared for The Great Depression.  She began to prepare in ways that most wouldn’t expect.  She wouldn’t tell you that she was preparing for the next one directly.  She’d simply state that there might be a time when they would be difficult to get.  We’ve all seen people who are holding onto things for no rational explanation.  It’s possible they’re still reliving a prior trauma of scarcity.

Control is, unfortunately, an illusion.  We believe we have control of much more than we really do.  (See How We Know What Isn’t So.)  We want control.  (See Compelled to Control.)  Because we want to be able to predict the future (to keep us alive), control is the easiest way of ensuring our predictions are accurate.  (See Mindreading and The Blank Slate for more on our desire for predictability.)  While control seems like the best solution, it is not real.  We only have control of ourselves – and then only in most cases.  We don’t control others, the environment, or the circumstances we find ourselves in.

Dissociation

One of the hallmarks of trauma is the protection mechanism of dissociation.  When the event becomes more than we have the capacity to address, dissociation creates artificial distance to help us defer the processing until a later time.  It’s the last resort for our psyche in defending itself.  A high degree of dissociation is correlated with PTSD.

People respect the role of compartmentalization in allowing people to continue doing their jobs even if the events are traumatic.  We need the military, firefighters, police, paramedics, nurses, and doctors to do what they’re trained to do in life-threatening situations.  We can’t have them running away when they’re needed most.  However, compartmentalization has its limits.  If you push it too far, there are consequences to be paid.

Similarly, the use of numbing can be an adaptive response if it’s being used to moderate the impact of the traumatic event and create opportunities to process it more effectively.  Too much numbing is a problem, as it prevents the processing of the events.  A glass of wine or a beer occasionally is fine.  When it becomes a constant need to prevent intrusive thoughts, then it’s crossed over the line and is maladaptive.

The experience most associated with dissociation is the sense that you’re watching from a third-party position.  It’s like you’re floating above the situation and seeing it as not you that’s suffering – but at the same time recognizing that it is you.  Moving into this state sometimes feels like you’re losing sensations in your body.  It’s like you know your body is there, but at the same time, you can’t really feel what’s happening to it.

Disassociation, like compartmentalization and numbing, can be adaptive for the situation because there are no other options – but that being said, it means that things are – or at least were – pretty bad.

Internal Family Systems

One of the key factors in the internal family systems (IFS) model, as explained in No Bad Parts, is the idea that our traumas cause us to exile aspects of our selves, and protectors begin to seek to protect us from further trauma – sometimes quite ineffectively.  Dissociation is the part of this process, where a part of us is exiled because it’s perceived to be the source of the trauma.  The healing process, defined by IFS, is the process of reintegrating the exiled parts of our personality and reintegrating them into our core.

Sequential Stressors

It’s one thing to have a traumatic experience once, but what if it happens repeatedly?  What if it happens over the years – or even worse, it’s a result of your career choice?  Multiple traumatic events, even if they’re smaller, have a cumulative effect.  Abuse of any kind once is problematic; continued abuse – particularly after having notified someone it’s happening – is even worse.  However, first responders, military, and law enforcement all encounter potentially traumatic events repeatedly in the service of others.  In these cases, too, the traumas can build up, but unlike other traumas that can be avoided, these keep coming as long as you have your job.

Dealing with sequential stressors if you’re not in service to others means making the trauma stop.  If you are in service to others, you’ll have to learn to get good at processing trauma and not allowing it to build up.  That’s much easier said than done in cultures that are built on toughness and competition.  Admitting that the last body you fished out of the water really bothered you can make you the target of ridicule.  Please don’t misunderstand: it’s wrong.  It’s just what happens.  Even if the ridicule isn’t out loud, it’s something that people will probably look down on you for.

Luckily, this is shifting somewhat with the world’s greater understanding of mental health and realizing it’s not a weakness.  However, cultures are often stubbornly resistant to change, and it may be hard to stand up in your service and say that you need better support and better skills to cope with the things you see and do.

The Benevolence of Humans

As I mentioned above, Jonathan Haidt in The Righteous Mind lays down what he believes are the foundations of morality, and the first is care – not harm.  Said differently, we have some belief that we’re supposed to all be benevolent with one another (at least in our tribe), compassionate, and maybe even altruistic.  This is a subject of much conversation and debate over the years, starting with The Selfish Gene, flowing through The Evolution of Cooperation, and continuing on to SuperCooperators and Does Altruism Exist?  Regardless of how it got started or whether we’re really being selfish when we’re being altruistic, most people believe that the world is a generally good place.  This is one of the biggest challenges after a trauma.

It’s been framed as “How could God let this happen?” but there are other similar thoughts about how bad things happen to good people.  The answer is randomness, but since that doesn’t allow us to predict, it’s unsettling.  In the end, we reach the level of acceptance (or delusion) that is discussed in Change or Die.  Sure, an asteroid could hit the Earth, but what are the odds?

It’s when traumas are inflicted intentionally by others that it causes us the most concern.  You can’t accept randomness when you know people like Timothy McVeigh (Oklahoma City Bombing) or Ted Kaczynski (Unabomber) are humans on the planet, too.  Even companies like Pittston Coal, which was responsible for the Buffalo Creek, West Virginia Disaster, make it hard to believe in the common decency of man.

Our first responders, military, and law enforcement see people doing awful things to other people too frequently.  It’s too easy to lose your faith in humanity, and so difficult to keep it in the face of biased – but overwhelming – evidence that humans can do horrific things to one another.

Trauma Doesn’t Define You

The Grant Study is a very famous study of Harvard students followed for over 75 years.  The results have provided insights into all sorts of parts of human behavior, including the impact of trauma.  One of the most interesting things about the study from a trauma perspective is that one of the most traumatized participants became very successful.  In fact, most people know that John F. Kennedy was the president who was shot, but few know that he scored very high for trauma in the Grant Study.

Here’s the message.  Your trauma d”esn’’ have to define you or limit you.  Few would say that JFK wasn’t a good president or that he wasn’t successful.  You don’t have to believe that you can’t succeed or be a part of society because you’ve been traumatized.

Capacity to Trust

One of the tricky areas of trauma is that it seems to impact our capacity for trusting.  It’s tricky, because we need to rely on others to guide us through the healing process, and because trust is essential for our lives to be fulfilling.  For a basic understanding of trust, see Understanding Trust.  It is understandable that trust would be impacted by prior negative experience – trauma.  At the same time, it’s tragic that the people who need to trust most are those for whom it may be the most difficult.

Differentiating Grief and Trauma

There are often two co-occurring situations in the wake of trauma.  First is the grief response to loss.  Second is the post-trauma processing of the event.  Grief is about processing the loss and what it means to us.  It’s a natural response to a loss at any level.  Many books, including Finding Meaning, The Grief Recovery Handbook, The Grieving Brain, On Death and Dying, and Option B, discuss the grief process and how to navigate the process of grieving.  This intersects and overlaps with post-trauma processing of the event in the evaluation of what the loss means to the person personally.

The post-trauma processing is that meaning process – not just for the loss but for the broader meaning to life as well.  One can be processing the grief of losing a loved one and simultaneously processing the threat to their own lives and the way they view the world.  Losing a child to violent crime involves the loss of the child, the recognition of the external threat of death to ourselves, and a challenge to a core belief that the world is a fundamentally helpful place.  The process of separating these different concerns creates greater probability that we can find our path through grief and trauma.

Special Uprooting

Some trauma comes in the form of uprooting.  This can be a literal refugee from a country of origin, a conscious immigrant to a new land, or a psychological uprooting due to the termination of familial relationships.  The uprooting kind of trauma is particularly challenging because of two additional factors: an inability to orient in a new world, an increased workload.  (See Man’s Search for Meaning for more on the impact of uprooting.)

One of the first goals in a cognitive assessment is to assess a person’s ability to orient.  Knowing when it is (date), where they are (place), how they got there, and often a commonly known fact like who is president, tells a responder that a person has a basic connection to reality and the ability to understand their place in the world.  Uprooting someone often disrupts the ease at which they can orient both in the quick assessment perspective and from the perspective of how they can compare their perceptions with their beliefs.

The increased workload that people face is a natural response to being uprooted.  In the physical space, it’s necessary to find new people for healthcare needs, appropriate vet care, and a number of other services.  In the psychological space, it can be that you’ve depended upon others for a particular kind of help.  Maybe you asked your mother for recipes or your father for car advice.  A sudden disconnection from can leave you partially disoriented as you must either develop this knowledge yourself or find someone else that you can offload it to.

Suicide research confirms this difficulty, as A Handbook for the Study of Suicide indicates.  Immigrants are at higher risk than the general population for dying by suicide.  There is good discussion about how this may be impacted by lack of belongingness – and by a constrained ability to orient.

Progressive Re-exposure

In helping people to recover from trauma, there are four key ways of helping make the traumatic event sufficiently safe that it can be fully processed and integrated.  They are:

• Experience Shaping – Creating situations where the triggers to the traumatic memory are managed so as to occur slowly over time in a way that doesn’t overwhelm the person.
• Desensitization – Bringing the person progressively closer to the impact of the trauma to normalize it and reduce the build-up of residual emotion.
• Safety Building – Explicitly working on the overall safety context of the person so that they believe their world is more generally safe.
• Grounding – The development of skills of being connected to the present moment and to bodily sensations to help the individual feel the traumatic memories less intensely.

The Role of Informal Support

While much is made of the professional support and resources for supporting people suffering from trauma, there is an awareness that much of the efficacy in any therapeutic relationship – professional or not – comes from therapeutic alliance.  “Therapeutic alliance” is a fancy way to say relationship.  (See The Heart and Soul of Change.)  Consistently, social supports – in the form of family, friends, and community – have been proven to be powerful tools for recovery.  They’re more available and more trusted than professionals.

In building trauma-resilient communities, we cannot ignore the fact that improving community responses has a powerful and durable impact on outcomes.

CISD/CISM

In my review of Opening Up, I exposed some of the problems with Critical Incident Stress Debriefing (CISD) and Critical Incident Stress Management (CISM).  Both effectively encourage people to discuss a potentially traumatic incident soon after it occurs.  These debriefings are not generally scheduled by the exposed parties but are rather timed to meet the needs of the trauma or crisis team.  The research on the efficacy of CISD/CISM is mixed.  Some studies indicated small to moderate positive impacts, while others indicated negative outcomes.  The metareviews are careful to indicate that the individuals doing this work may have a big impact on the outcomes, and poorly executed CISD/CISM can lead to worse outcomes.

Some of this may have to do with the concept of psychological safety as discussed in The Fearless Organization by Amy Edmondson and The 4 Stages of Psychological Safety by Tim Clark.  CISD/CISM is frequently used in first responder situations where there is often a low degree of psychological safety.  Most professionals in this space avoid vulnerability to their peers, because of a fear of lack of confidence or teasing.

An analogy about CISD/CISM is appropriate.  CISD/CISM is like bereavement counseling for someone who has lost a spouse.  It’s a good idea to offer it.  Conversely, it’s bad to force it upon the spouse the day that they learn of the death.  It’s too soon, and they may not be ready.  This in and of itself may be enough to explain the negative outcomes.

Trauma Compensation

One of the biggest challenges with trauma is that it’s contextual to the individual.  Nuances and tiny differences in the experience can mean a big difference.  Of two sisters caught in the Buffalo Creek, West Virginia Disaster, one is relatively unaffected, while the other is nearly paralyzed by fear.  The individual experience of seeing the wall of water and the girls’ mother swept away was enough to create completely different experiences for the sisters.

In addition, exposure to something today may trigger an unresolved trauma from the past.  This leads to the question how much of today’s trauma is from the current event and how much should be assigned to the previous one.  These issues and others make people wary about claims of trauma.  There’s always the concern that someone is claiming trauma to get a payout.  As a result, we often dismiss legitimate trauma that people have, because we cannot understand how it was traumatic and/or we believe they’re just trying to get a trauma related payout.  While there is no doubt that this happens, it’s difficult to separate legitimate need for assistance from those who are looking to score.

Perhaps the best way to deal with trauma is to find a way to avoid Traumatic Stress in the first place, but that’s easier said than done.

Book Review-In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness

Trauma is – in more ways than one – that unspoken voice.  In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness is what Gabor Mate describes (in the intro) as Peter Levine’s magnum opus.  Gabor Mate is no stranger to trauma work, having written several books, including The Myth of Normal.  In an Unspoken Voice isn’t Levine’s most popular work – that’s Waking the Tiger.  Trauma, Levine writes, is a fact of life.  He continues with, “It does not, however, have to be a life sentence.”  Said differently, we are all traumatized by things that happen in our lives, but we don’t need to remain in the trauma.  We can enable our minds to integrate and find meaning from the trauma and allow our bodies to release it.

Epigenetics

The idea that our bodies would release trauma is consistent with Bessel van der Kolk’s work in The Body Keeps the Score.  There are ways that our biology reacts to, and in some ways holds on to, trauma.  Robert Sapolsky in Why Zebras Don’t Get Ulcers demonstrates that, in animals, stress does have a physiological response, and this psychological response can activate different genes.

Several decades ago, genetics were all the rage.  The thinking went that the genes were the blueprints of the body, and thereby they dictated who you would become.  It was like a great clock was set in motion.  Great work has been done to develop a map of the human genome – and to interpret the signposts in the form of genes.  However, as we’ve learned more, we’ve realized that the blueprints are subject to modification by the environment.  Epigenetics is the study of how our genes are activated – or not – based on our environment.  In identical twin studies, we still find a striking amount of differences (and spooky similarities).  In The Nurture Assumption and No Two Alike, Judith Rich Harris explains how it is possible for twins with identical genetics to end up so different.  Small differences matter.

In The Rise of Superman, Steven Kotler explains how people do seemingly superhuman feats.  The answer is that they continue to make small, incremental changes over a long period of time.  It’s the same thing that Anders Ericsson explains in Peak – purposeful practice and attempts to improve may only make small changes every day, but over time, these changes matter.  Einstein said that “compound interest is the eighth wonder of the world.”  It’s that compounding of skills that pulls people apart.  Someone randomly tries an activity and likes it.  From there, they invest more in growing in that direction.  Add a few decades, and you see radically different people.

With trauma, the arc is bent differently.  But those genetics that are enabled can be disabled.  The weight of trauma can be discharged by the body, and people can move forward – if they’re taught how.

Defining Trauma

The real challenge with trauma isn’t in the external circumstances that have been foisted upon us.  The real challenge is how we react to those circumstances.  Being traumatized is about the times when the events are happening – but trauma lingers after the event.  In the normative case, trauma results in a healing process.  When the body and mind’s response are effective, it can lead to post-traumatic growth.  (See Transformed by Trauma for more.)  It’s the same as Nassim Nicholas Taleb explains in Antifragile.  We need stressors to become stronger – but they need to be of magnitudes and timing that we can leverage to our advantage.

When we can’t integrate the traumatic experience into our experiences and beliefs about the world, we encounter post-traumatic stress disorder (PTSD).  (See Trauma and Recovery for more.)  All trauma involves loss and often disrupts our beliefs.  We have to deal with both.

The Battlefield of the Mind

We tend to conceptualize our minds as a single consciousness that operates as a concerted whole.  However, our brain evolved over time in periods that have led to a conceptualization of a triune brain – three parts.  The most vivid analogy is Jonathan Haidt’s Elephant-Rider-Path model, which places a small rational (conscious) rider, on top of an emotional elephant, walking down a default (and easy) path.  (See The Happiness Hypothesis and Switch for more.)  While not completely analogous to our understanding of the brain’s evolution, it highlights the gap between emotions and reason – and helps us to understand that earlier parts of our evolution will win when there’s a battle in our mind.

I’d be remiss if I didn’t acknowledge the truth that we overlook the neurons that exist outside of our brains.  There is much to be learned and understood about how the nerves in our guts are connected to and influence our thoughts.  However, the research and consistency are much weaker here.  (See The Heartmath Solution for a bit of this.)

The challenge, as Levine puts it, is when lower-level parts of our brain are telling us to run, and the higher-order parts are pushing for us to be restrained – or any variation where different aspects of our brain disagree.  The result is a battlefield of conflict that can be as traumatic as the circumstances themselves.

Fight, Flight, or Freeze

At the most basic level, the reptilian parts of our brain seek to decide whether a stressor should cause us to fight, run away, or freeze.  We fight when we believe we’re stronger and the injuries we sustain will be minor.  We flee when we believe that we’re weaker or will sustain too many injuries.  Freezing doesn’t seem to make much sense on the surface.  Why would we give up and just “let whatever happen”?  The answer is layered.

At the first layer, our brains and animal brains are wired to detect motion.  (See Incognito and The Tell-Tale Brain for more.)  If we freeze, it’s possible that the stressor – predator – may not even discover we’re here.  Thus, there will be no conflict.

The second layer is that we may believe we’ll ultimately be harmed less if we don’t fight or flee.  Consider the mouse that is being played with by the cat who goes limp as the cat loses interest.  The mouse can run away when the cat is no longer focused.  Clearly this is a risky gambit – but one that may be advantageous at times.

Largely to support the first layer, evolution has supplied a strategy – tonic immobility.  It’s a mechanism whereby motor impulses are suppressed, and the animal becomes motionless.  What’s important, in Levine’s view, is that at the termination of this process, it’s necessary for animals – including humans – to shake off the excess energy that they’ve held back.  He believes that without the discharge of this energy, people will become stuck.  Perhaps at some level, the body never fully releases the tonic immobility and remains, in some ways, frozen.

Fundamentals of Fear

Richard Lazarus explains how we come to fear – and what we can do about it – in Emotion and Adaptation.  He separates the stressor from the stress consistent with our fight, flight, or freeze response.  He suggests that, for every stressor, we evaluate the probability of a negative outcome and its impact, and we dampen this with our perception of our coping capabilities.  This is consistent with and extends the concept, because he recognizes that, between the stressor and the response, we can choose our response.  Daniel Kahneman in Thinking, Fast and Slow says that System 1 (lower-level thinking) can choose to engage System 2 (rational thought) or not.  In the best case scenario, our thinking is integrated to the point that our emotional, reptilian, responses trust the neocortex and want to engage these resources for assistance when problems are too novel.

The point here isn’t to criticize historic responses that may not have engaged higher-order thinking.  Rather, the point is that it’s possible – and that possibility exists even in the post-processing of an event.  It is, in fact, one of the key ways that we can learn to process trauma better.  We use our neocortex to downregulate the emotional response.

Cage the Elephant

Many well-intended people suggest that trauma be directly confronted.  Effectively, they’re picking a fight with an elephant.  If you’re in a sailboat, and you need to go to a point that’s directly into the wind, you can’t point your boat in that direction and hope that things work out.  Sailboats tack into the wind, moving closer and closer – but never directly challenging the wind.  Similarly, when we’re trying to help others address trauma, it’s almost never effective to try to address the traumatic experience and tell them to just “accept it,” “suck it up,” or “it wasn’t that bad.”

Rather than enter into a direct confrontation with our feelings, a different tack is to listen to them.  To seek to understand them.  To be curious about their origins.  Once we’ve made peace with what we feel – and the reasons why we feel it – we can slowly shift our thinking from confrontation to cooperation.  The reasons driving the emotion don’t have to be right.  They just must be acknowledged for their perception.

While our emotions are subject to influence from the neocortex, the degree to which we can influence them is complicated.

Medial Prefrontal Cortex Dampening

The amygdala is the core of our immediate, reptilian, responses.  It’s the driver of emotions, including fear.  It’s subject to the influence of the medial prefrontal cortex.  In short, we can talk ourselves out of being so afraid, but only if the medial prefrontal cortex and the amygdala have a functioning relationship.

The tricky part of this relationship is that a fear response necessarily focuses resources.  As Why Zebras Don’t Get Ulcers explains, digestion, immune response, and reproduction are all substantially turned down to save energy for fighting or fleeing in the face of stress.  The same can be said of the brain.  Fear can change which portions of the brain are given the oxygen and glucose they need to do their job.  In short, a spike of fear can shut down the medial prefrontal cortex before it can respond.

Luckily, this can be trained.  There’s enough oxygen and glucose available ambiently for the medial prefrontal cortex to down-regulate the amygdala – if it reacts quick enough.  Some of the frequently documented outcomes of low-blood sugar is irritability and a reduction in willpower.  (See The Power of Habit and Willpower for more.)  In the context of the medial prefrontal cortex having enough resources to do its job quickly enough to not get shut down, this makes perfect sense.  Low blood sugar means there’s less ambient energy for the medial prefrontal cortex to draw upon to wrest control before it’s shut down.

Trauma Feedback Loop

The problem that can lead to persistent trauma comes down to a negative cycle of overwhelming emotions and avoidance.  Because the traumatic event isn’t able to be processed – it’s overwhelming – people avoid reactivating memories of the trauma to prevent being overwhelmed.  This avoidance indirectly makes the trauma worse and makes it harder to deal with.

The trauma is wrapped in another layer of overwhelming emotions when it’s pushed away.  Like a candle gaining wax when dipped, it gets larger and larger, bit by bit.  The process increases in frequency: the more we push it away, the more potential triggers appear.  It’s like White Bears and Unwanted Thoughts explains: we can’t block out a thought, because to do so requires that we consider the thought first.

The heart of helping people with trauma is to separate the overwhelming aspect of the trauma – including the emotion of being overwhelmed.  That means slowly re-exposing people to the traumatic memory at levels they can accept – and learn from.  The longer the process of reinforcement happens, the harder it is to maintain safety and unwind the trauma feedback loop.

Dissociation

A natural tool that humans use for traumatic events is dissociation. (It was previously known as disassociation.)  This cognitive process has us remembering the events as if they happened to other people.  Many people claim to be experiencing events from outside of their body.  This is an adaptive solution to an impossible traumatic event in many cases.  However, the problem is that dissociation can become maladaptive if it continues after the event has stopped.

When we’re trying to help others through trauma, we want to be on the lookout for situations where the person starts the dissociation process.  While it’s often internally experienced as seeing things from a third perspective, in the room it appears like the person is shutting down and beginning to stare off into space or at a distant, fixed object.

Containment

What Levine calls containment, others might call “holding space.”  (See Alone Together.)  Richo would call it “allowing.”  (See How to Be an Adult in Relationships.)  Containment provides a safe space to recall and process traumatic events.  It’s the heart of therapeutic relationships – and good friendships.  Trauma, as defined in this context, is a response to an overwhelming situation.  Containment creates a larger capacity so that the traumatic events no longer have the capacity to overwhelm.

The process of creating the space includes the traditional aspects of what The Heart and Soul of Change calls therapeutic alliance but also psychological safety.  (See The Fearless Organization and The 4 Stages of Psychological Safety.)  It’s creating relational trust and belief that, no matter what happens, the person will remain safe.  (For more on trust, see Trust => Vulnerability => Intimacy, Revisited.)

Moments and Moods

Emotions can be intensely painful.  What is difficult to see in those moments is that emotions, by their very nature, will fade.  Just because someone is acutely feeling a loss doesn’t mean they’ll feel it the same way forever.  In fact, you cannot feel the same way forever.  When processing trauma, it’s peaceful to know whatever the current feeling, it will change.

Moods are something a bit different in that they last longer than emotions.  They are, however, still not the degree of permanence they’re often assigned.  As a part of our burnout work, we encourage people to do an exercise that’s titled “Hindsight 20-20.”  The short of the exercise is to look back at a traumatic event that’s more than five years old and recall what you felt then vs. what you feel now.  They’re almost always radically different.  The point of the exercise is to help people realize how their emotions, moods, and perspectives will change over time.  Most people who do the exercise say that they knew things were different, but they didn’t think it applied to their circumstances today.  Others have commented on how intellectually they were aware, but they didn’t realize how wrapped up in the current emotions they had become.

Reality Is Not What You Think

Our perceptions are our subjective reality, but that doesn’t make them objective reality.  Each person has their perspective of the world, what they see of it.  The problem is that this doesn’t make everyone’s reality match our own.  One of the key points in conflict resolution is to address the differences in perspectives among the parties.  Incognito, The Tell-Tale Brain, and The Hidden Brain all argue that what we experience as reality is a fiction that our minds create.  It’s what we form our beliefs about the world from and why, when our experience of the world differs from our expectations, it’s often painful to readjust.

Humans are, at their core, prediction-generating machines.  (See Mindreading.)  Many believe that consciousness is the solution to the need to be better at prediction and therefore survival.  However, because reality is self-generated, it sometimes becomes so misaligned with objective reality that a correction is needed.  Evolution provided for several mechanisms for this.  Our reaction to humor is the most positive reward we get to our brains detecting an error – and correcting for it.  The short is that when we laugh, we’re responding to the detection of the misunderstanding of what the comic said.  Intentional misdirection or not, we get a dopamine reward for detecting and correcting the error.  (See Inside Jokes for more.)

Other forms of error detection don’t leave us feeling better.  Consider the glass funhouse at carnivals.  You can proceed through the maze with a hand in front of you safely detecting the presence of a glass pane in front of you – or you can boldly go and accept the invariable nose bumps in the process.

Feelings Are Only Feelings

Feelings feel real.  They feel like they’re reality.  Here, I’m using feelings as an encompassing term for both emotions and perceptions.  Collectively, we give them too much weight.  In How Emotions Are Made, Lisa Feldman Barrett shares a story where she went on a date before getting physically ill, and how, at the time, she had misinterpreted the feelings that she was having for attraction.  In A Beautiful Mind, John Nash develops a technique – after struggling with imaginary people for much of his life – for asking someone he knows is real if the other person with them is real to ensure that the people he’s speaking with are real.

No matter how real our feelings appear to be – whether emotion or perception – that doesn’t make them real.  Nor does it stop us from treating them as real.

Self-Medicating Placebo

The placebo effect is well known in medical research.  The control group, by nature of their having some hope, often improve.  (See The Psychology of Hope, The End of Hope, and Warning: Psychiatry Can Be Hazardous to Your Mental Health for more.)  However, Levine reveals that the placebo effect may be triggering our brain to manufacture natural pain killers.  To understand how this works, you need to know that opioids bind to specific receptors in our brain – the same receptors that natural endorphins bind to.  Science discovered a drug, Naloxone, that competitively binds with the same receptors – without the feelings of pleasure.  Competitive binding really means that it’s more effective at binding to the receptors than the naturally occurring compounds – and the synthetic opioids that we’ve developed.  Today, it’s used to help prevent overdose.

Here’s the tricky part: Levine’s brother, Jon, while studying pain patients, treated half with morphine and the other half with saline (placebo).  Both reported pain reduction.  Then he gave both the naloxone, and both reported that their pain was higher.  Jon’s study was replicated by others.  The implication is that, with the idea that there was a resolution in sight, the brain naturally started producing the neurotransmitters that it associated with happiness and less pain.  The naloxone took that away, just like it took away the artificial high of the morphine.

That further lends credence to the idea that we have much more control over our responses than we generally believe.  It turns out that our minds and bodies can speak In an Unspoken Voice.

Book Review-Never Broken: Songs Are Only Half the Story

I was born with a genetic defect.  It’s never been officially diagnosed, but I know it’s a limitation.  I’ve been born without the “fan” gene.  That is, fan in its real meaning of “fanatic.”  I knew Jewel’s music and appreciated it.  Music is for me like air.  If there’s not music playing around me, it’s playing in my head.  My musical tastes are what others would call eclectic.  Jewel’s music made it on my likes list – which is much shorter.  Never Broken: Songs Are Only Half the Story is her story of growing up and being grown up.  I would have never found it except through my research on trauma and the book The Myth of Normal, which references it.

The soulful stories that exist in Jewel’s songs come from deep exploration and much trauma.  Her challenges with her parents are at least an order of magnitude more than mine.  (See Fault Lines for more about that.)  Her story is about struggle, loneliness, heartache, and ultimately triumph.  What intrigued me about the book more than any other thing is how she found a path of growth instead of one of numbing.  (See Transformed by Trauma for more on growth post trauma.)  Never Broken is an opportunity for her to share her love of people and compassionate desire to minimize their suffering.

A Few Parallels and Lots of Differences

I won’t go into the complete story, because the book does a wonderful job – and it’s her story – but I will say that there were times that I felt resonance with Jewel’s experiences and other places where we clearly walked radically different paths.  I left home at 18, not 15, and I’ve never been homeless.  And at the same time, there were echoes that were deeply stirring as I considered feelings of loneliness, making strong decisions, figuring it out, generational trauma, divorce, and more that resonated.

As I share my story woven with hers below, I do so as an example of how we all face traumas – some are the same as each other.  Some traumas we face are uniquely ours.  However, we can view traumas as similar enough to connect and support each other.

Loneliness

I related in my review of Loneliness that being alone and being lonely aren’t the same thing.  I’m no expert on Alaska but my visit and the feedback make it clear that there are times when people are alone.  However, Never Broken doesn’t talk about loneliness in that way.  The loneliness that Jewel speaks of is that sense that you’re not understood.  It’s the sense that the world you live in is foreign to others and almost as if you speak a different language.

In Straddling Multiple Worlds, I share a few aspects of how even being in multiple worlds instead of one can be alienating and difficult.  The reason for your disconnect could be that you’re struggling to get by in a world of the affluent, or that you’re thinking in ways that aren’t “normal.”  Feeling like you don’t fit in is deeply alienating and ultimately lonely.  It’s even more separating and lonely when you have the courage to stand for your convictions.

Strong Decisions

There are a few very key, defining moments in my life that I know were important.  One was when I was in Boston and visited the Church of Scientology.  (I explain this in my review of The Paradox of Choice.)  Another was the time I decided that I could be afraid but that I refused to live in fear.  Jewel rightly points out decisions in her life that made the difference.  She explains about her decision to be honest in her writing when she couldn’t be with people.  She also explains the decision not to take someone up on a proposition even when the money was sorely needed.

These sit alongside her decision to not drink or do drugs.  She aptly states that you can’t outrun your pain.  You must go through pain – not around it – and not run ahead of it.  It will always find you.

These are simple decisions that are hard to make.  (See How Good People Make Tough Choices for more.)  I deeply admire people who find the courage to make these hard choices and live true to themselves – or as true to themselves as any of us get.  (See Find Your Courage for finding this kind of courage and how to enable it in others.)

Figure It Out

One of the greatest gifts that I’ve received from my upbringing is the belief that I can do anything I set my mind to.  Obviously, there are limits.  I’m not going to be a test pilot or an astronaut at this point, but within reason, I can do almost anything.  The idea that you can figure stuff out comes from a sense of necessity.  For Jewel, it may have been that Alaska requires it of everyone.  I’ll certainly buy that, given it’s still a relative frontier.  For me, I don’t know where it comes from.  Maybe it was just seeing my dad figure things out and make things work.

In some circles, it might be called self-esteem or self-confidence.  However, that doesn’t really capture it.  It’s not that you don’t know you’re going to try and fail and try and fail again.  It’s that you know if you’re willing to work at something, eventually you’ll find a solution.  Carol Dweck would call it a growth mindset.  (See Mindset.)  Angela Duckworth would use the word Grit.  Roy Baumeister would say Willpower.  Rick Snyder would call it hope.  (See The Psychology of Hope.)  Margie Warrell might call it courage.  (See Find Your Courage.)  Whatever you call it, it’s a force to be reckoned with.

Generational Trauma

Trauma is whatever you struggle to process and integrate into your understanding.  (See The Body Keeps the Score.)  Sometimes, it’s things that should have never happened to you – but they did.  From the point of view of the person whom trauma is inflicted upon, it’s hard to recognize that the people who are the perpetrators of the trauma have had their own trauma in their lives.  It doesn’t excuse or make right their behaviors, but it does help you accept them as an unfortunate but natural consequence.  (See How to Be an Adult in Relationships for more.)

The greatest gift that we can give future generations is to break the cycle of trauma.  We can do the hard work to achieve the personal growth that allows us to prevent the ripple of trauma from moving forward.  Jewel notes the work that she and her father have done to dampen the impacts of generational trauma.

Divorce

I explained in my review of Divorce both its causes and its consequences.  Since then, I’ve written about The Progression of Parental Alienation and The Psychology of Not Holding Children Accountable.  It addresses what Jewel calls “The Disneyland Effect,” where parents try to “win” the children by giving them things and experiences to become their favorite.  Cruelty isn’t what it does to the other parent.  Cruelty is what it does to the children who are “forced” to decide between two people they love and who love them.

Emotional English and Worthy of Love

We have formed unspoken beliefs about emotions – whether they’re good or bad.  The trick is that most emotions are what the Buddhists would call non-afflictive.  (See Destructive Emotions.)  Sometimes, we need to work around what we learned as children and accept our emotions.  (See Emotion and Adaptation and How Emotions Are Made for more.)  The greatest tragedies I’ve seen are related to people who believe that emotions are bad instead of teachers that are sent to keep us safe.

Sometimes our emotions are so compartmentalized, hurt, or broken that we can’t experience love the way that we should.  (See Anatomy of Love, Daring to Trust, and The Art of Loving for more.)  Until we can accept that we’re worthy of love and learn to love ourselves, we’ll find it hard to accept love from others.  (See No Bad Parts for more on accepting all the pieces of us.)  In The Science of Trust, John Gottman, relationship guru, explains the things that get in the way of relationships – and being loved by others.

Digging Back to Your True Self

You are not broken.  You’re just buried in the trauma, pain, armor, and busy-ness of life.  That’s a fundamental message of hope.  Too many people see the things in their life – including their behaviors – and they’re tortured by the shame of not being enough.  Somehow, they missed out on the magical elixir that would allow them to be a normal human being.  Somehow, they feel as if they’re broken beyond repair.  The view that it’s not you who are broken but rather that your true self is buried beneath other things is freeing.  You can, given time and effort, dig yourself out.  If you’re broken, there’s no telling if you can be fixed – or not.

Hard Wood Grows Slowly

There are lessons in nature.  One of them is the nature of trees.  There are, of course, many different kinds of trees that grow at different rates.  Many of the things we have that are made from wood – like the 2×4 studs in our home – come from pine.  Pine grows quickly, but it’s easily broken.  Quality furniture, things that are meant to last and be cherished, are made from hard woods – and they grow slowly.  The slow, hard path isn’t the one that people want to know – but it is the one that is lasting.

I’ve read plenty of books about how to get there quick – and why you need to do it.  Launch carries the subtitle, “The Critical 90 Days from Idea to Market”.  Traction caries the subtitle, “How Any Startup Can Achieve Explosive Customer Growth.”  I believe in hard work.  I believe in making decisions that lead to the long-term results I want – even if the short-term results aren’t great.

Jewel recounts her deal with Atlantic Records.  Little up front, just enough to get her off the street.  The largest back-end deal made at the time.  She’d get more if she sold more.  It’s a perfect example.  I did the same thing when I made my deal to sell courses through Pluralsight.  The largest back end available with almost no advance.  I wanted a way to make the long-term work, even if it meant working harder in the short term.

Angels in my Life

Jewel recounts stories of what she calls everyday angels.  (A term her fans coined.) They’re people whose words or deeds helped her at a critical moment.  They helped her to grow.  These people may have realized the impact they had – or they may not have.  Either way, the impact was made by “Indian Uncles” and concerned friends.  We all have these everyday angels in our lives.  They don’t arrive on a beam of light, nor stand with a blazing sword before us.  Instead, they come into our lives to enrich it.

I’ve had several of these people myself.  Some have stayed for the better part of my adult life.  Many have come for a time and are no longer an active part of my life in the physical sense.  However, they’ve shaped my path and lifted me up in ways that aren’t possible to explain.

We (Terri and I) try to be everyday angels.  Offering our home for people to stay with us.  Making all the Extinguish Burnout materials free.  There are dozens of small and large ways that we try our best to bring more everyday angels into existence, using Gandhi’s guidance to be the change we want to see in the world.

Audiences Don’t Care If You Sing Correctly

They want to feel something.  It doesn’t matter if you get the words, the melody, or harmony right (within reason).  What they care about is that, when they leave, they’ve experienced (or felt) something.  For over a decade, I ran live sound at church at least one weekend a month.  I learned so much about production with great people.  I realized how little what we wanted to do mattered compared to what we actually did.  The people in the audience didn’t know what was “supposed to happen.”  They just wanted to feel like it happened with them.

I learned so much about how bass can connect people to a rhythm.  Kick drums and electric bass keep the time.  If you dump more of that into the house (the sound that goes to the audience), you synchronize them to what is happening on the stage.  A weak voice can be amplified.  Short reverb can cover a vocal talent who is struggling to finish a set.  A good equalization can make the difference between hearing the vocals and having the piano (or the guitar) running all over the place.

I was lucky enough to begin to see the big waves that we were creating to unite people and help them feel connected with one another – our fundamental human need.

It’s this experience that made Jewel’s discussion about having the right band make so much sense.  Drummers have click tracks to tell them how to keep time – but it prevents them from adjusting to the natural tempo of the crowd.  Counting measures works when you’re playing a specific song a specific way, but it prevents you from doing the chorus again when the crowd starts to sing along.  I so appreciate good “crowd work” (reading the crowd and adapting).  I loved that Jewel related both the benefits and the struggles.

Tightly Packed Day

In the maid’s quarters in a house on Center Avenue in Bay City, Michigan, an alarm has been going off unheard for 20 minutes.  It’s the kind of wake-the-dead alarm they can hear in the kitchen two floors down, but I’m just starting to stir.  I’d get up and go to high school before heading out to work and finally ending my day at the local college.  My high school work was light.  Work was 20 hours a week.  I was carrying 10 credit hours a semester at college – filling all my weeknights.  I spent 15 weeks sleeping maybe four hours a night, and I was doing my homework and studying in other classes and during every scrap of time I could find.

I can identify with “I had a tightly packed day, and went about it with a starving man’s mentality, devouring everything in sight.”  I can also identify with “I was too busy surviving to cry in Anchorage.”  There were no margins.  There was nothing left.  I had every moment spoken for.  I carried the Thoreau quote, “Who can kill time without injuring eternity” on my lips everywhere I went.

What is too easily dismissed in my experience is the value it brought.  I knew that I could do it.  The memories of these times have reminded me that even in very busy parts of my life, it will end.  It is a defining moment when I can point to hard work and the payoff.

Bifurcated Sense

Some of the people who seem the most confident are those who are mostly deeply insecure.  Their image of confidence is an illusion they project – to others and themselves.  There is a split between the person they want to appear to be – even to themselves – and their deep-seated fears.  This projection itself drives people to experiencing impostor syndrome.  The resounding question is, “When will they find out that I’m not really who they believe I am?”

The more common experience of a bifurcated sense of being is an oscillation.  It’s the result of the inner battle of the mind.  One moment, there’s a self-correction to combat the overly critical inner voice.  The next moment, the inner critic is going after the voice that elevates parts of you to the grandiose.  Sometimes, these battles are epic, as the parts of your psyche fight for control.  No Bad Parts would speak of our hurt places, the protectors, and the exiles locked in a battle for control.

My language is integrated self-image.  It’s a way of viewing our self that accepts the good and the bad instead of trying to argue for all good or bad.  Instead of each part of us feeling invalidated, it can be acknowledged as a part of the whole.  (See Braving the Wilderness for more.)

Feeling Proud

When your sense of self is disrupted, it’s hard to be proud.  What are you proud of?  The constant storm of emotion and thought that pervades your existence?  Even when you’re working hard and you’re being rewarded for that hard work, it’s difficult to accept it.  It’s disconnected from your experience somehow.  Jewel’s graduation may have ended with her throwing away her diploma (she’s not sure).  Here’s a symbol of achievement – in her case, a monumental achievement – but it couldn’t be accepted, because it wasn’t consistent with her internal view.  Some of the rationalization was that she wasn’t in a position to have much stuff – but that was a rational lie (which she acknowledges).

Behind the rationalization was the quiet reality of parents who couldn’t give Jewel what she deserved.  A mother who was absent and a father battling with his own demons didn’t have the capacity to support her in ways that would remind her that she was good – that she was enough.

Enough

The opposite of scarcity isn’t abundance.  The opposite is enough.  (I gave a talk on this topic Enough Scarcity in 2017.)  Feeling like we’re “enough” is a common challenge.  Brené Brown talks about it in I Thought It Was Just Me (But It Isn’t), and Gabor Mate explains his struggle with it in The Myth of Normal.  The key question is enough for what?  The tragic answer that cannot be spoken is often “to be loved.”  It’s tragic, because it’s a sign of a fundamental lack of understanding about what love is.  Love should be your birthright.  It’s not something to be earned, bartered for, or taken.

In English, the word “love” is overloaded.  Consider that, in Greek, there are three words that are all translated to love in English – agape, philos, and eros.  I’ll dispense with eros because it’s romantic or physical love.  (See Anatomy of Love for more on this kind.)  Agape, global love, and philos, brotherly love, are the two most commonly considered, and the line between them isn’t always as distinct as we’d like.  (See My Spiritual Journey for more of the Buddhist perspective.)  C.S. Lewis also speaks of different kinds of love in The Four Loves.  When we speak of love in English, we’re often not clear.  In the context of “enough,” the meaning of love is “to be cared for.”  Parental love is what it might be called.

Parental love is supposed to be unconditional caring.  Too often, children don’t experience love from their parents in this way.  It’s often inconsistent.  Sometimes, instead of love and care, they receive cruelty and abuse.  As a result, their perception of whether they are enough or not is often hampered if not destroyed.

Underneath the need for love, we see a need for safety and our avoidance of death.  (See The Worm at the Core for more about how death drives us.)  We equate love with safety, because we only became the dominant biomass on the planet by our unique ability to work together.  (See The Righteous Mind.)  One might slip here from love to acceptance as a more basic form.  If they accept me, they won’t expel me from the community.  This would be catastrophic.  While in today’s world, we aren’t ejected from communities like we once were, the fear still lingers.  At some level, we wonder whether we’ll be left alone to die if the community doesn’t accept us.

More than any other creature on Earth, we’re unconsciously aware of our need to be connected.  That’s why loneliness can be so frightening.  (See Loneliness.)  Like much of life, it is our perception of loneliness, unlovability, and acceptance by others that matters.  The objective truth isn’t the point.  Consider, for a moment, the number of celebrities who have died by suicide and how they are loved – or at least accepted – by so many.

Support and Solidarity

The opposite of loneliness is finding the person who wants nothing from you but believes in you.  You feel heard and seen not for what you can do for someone but because they understand your struggles at a level that most aren’t capable of.  There’s a song by JJ Heller, “What Love Really Means”.  The chorus contains the words, “Who will love me for me // Not for what I have done or what I will become.”  It’s in this sentiment that I believe we move from just acceptance to love.

Acceptance is fundamentally rooted in a belief that you subscribe to the same social norms that I do – or that I believe your deviances from what is socially acceptable are offset by what you may be able to do for me.  This may be a clue to the tragedy of artist suicide.  For them to express their creativity, they must necessarily deviate from the norm.  (See Creative Confidence for assurance we can all be creative.)  Innovators face similar asymmetry.  They are lauded for their innovations and criticized for their disruption and deviation.  (See The Disruption Mindset, The Innovator’s DNA, The Art of Innovation, and Unleashing Innovation for more.)

When the balance for innovators is in favor of the benefits, they find acceptance.  When their ideas are more disruptive than valuable, they’re summarily dismissed.  The support that they feel is conditional.  We’ve seen a gradual deterioration of loyalty over the years.  (See Exit, Voice, and Loyalty for more about loyalty’s importance.)  Robert Putnam spoke about the societal decline in Bowling Alone, and Francis Fukuyama spoke about corporate loyalty decline in Trust: Human Nature and the Reconstitution of Social Order.  In short, we’re seeing an erosion of real support and solidarity over the long term – and that’s why when you find it, it’s so special.

Innocence Traded for Wisdom

For a commercial project, I reviewed a book in progress recently.  It was focused on the loss of innocence and the tragedy that it was to lose your innocence.  I pushed back, because I believe that we’ve lost our innocence long ago.  I believe that we have our first event, and when we experience it, we’ve lost our innocence.  It’s our first heartbreak that takes that innocence.  However, a key point that was missing that Jewel relates eloquently is that innocence is traded for wisdom.  It’s a beautiful reminder that when we lose something, there is often something else there to take its place.  One of the pieces of wisdom I hope you’re able to take away is that, no matter what has happened to you, you’re Never Broken.

Book Review-The Myth of Normal: Trauma, Illness, and Healing in a Toxic Culture

I was speaking with a friend when Gabor Maté’s work came up.  The friend had seen a session and suggested that Maté had some good insight into trauma.  That’s what led me to the oddly-titled The Myth of Normal: Trauma, Illness, and Healing in a Toxic Culture.  It’s odd, because the fundamental premise is captured by a quote of Eric Fromm from The Sane Society: “The fact that millions of people share the same forms of mental pathology does not make these people sane.”  Normal is what we expect, but maybe we should expect better of ourselves, others, and society.

Not Knowing

When someone is doing something that we know doesn’t work, the question should be whether they know it doesn’t work and they’re ignoring the research – or they don’t actually know.  In medicine, the average time for an innovation to be widely adopted is 17 years.  I’ve never seen a timeline for mental health – and perhaps that’s because they’re never adopted.  So, there’s plenty of room to not know.  There’s the time between the first published report and subsequent reports that either refute or confirm the initial observations.  During the cone of confusion with conflicting reports, a failure to follow a particular path is similarly reasonable.

However, at some point, we know that something we’re doing isn’t working – or something that could work isn’t being done – and we’ve got to wonder why.  The unfortunate answer is human nature.  We’re lousy at statistical thinking.  (See The Signal and the Noise, Noise, and Superforecasting.)  We’re convinced that we know better because of our own biases.  (See How We Know What Isn’t So and Thinking, Fast and Slow.)  We can be swayed by the people we interact with to change our perceptions.  (See Going to Extremes.)  However, in the end, we must accept that we know that we’re lying to ourselves and others when we’re failing to follow what has been well-established.  (See Telling Lies, Change or Die, and Immunity to Change for more.)

This is the sad state of mental wellness today.  We don’t know our practices, we don’t do what we know to be true, and we often lie to ourselves that our experience is more relevant than well done statistical research by multiple parties.

Defining Trauma

Maté’s definition of trauma is, “Trauma is not what happens to you but what happens inside you.”  In other words, anything can be traumatic or not depending on how you process it.  Care must be exercised here not to say that someone who believes something is traumatic is more or less mentally healthy than another.  Our preference for a favorite color is no more of an indicator about who is or isn’t mentally healthy.  Seeing the impact of an automobile accident fatality may be a trauma – or not – to a first responder based on their experiences and unknowable similarities to other fatalities.

What matters is not finding blame nor judging the other person for not being “strong” enough to “handle it.”  The truth is that when you’ve traveled the world enough, you realize that everyone has their own trauma, and new events can activate old traumas in very odd ways.

Bessel van der Kolk, of The Body Keeps the Score, defines trauma as such: “Trauma is when we are not seen and known.”  I disagree.  While not being seen and known can be a trauma, I don’t think all traumas are this.  I believe that all traumas are about loss – material or not.  Peter Levine points out, “Certainly, all traumatic events are stressful, but not all stressful events are traumatic.”  That’s how I feel about requiring trauma be about not being seen.

Big and Little “T” Trauma

There seems to be some hidden competition in some people.  My trauma is bigger (or smaller) than yours.  It’s not atypical for Terri and I to hear from others that they have no right to share their trauma with us, because ours is greater.  We’re quick to point out that all trauma is trauma.  There is no such thing as a small trauma.  It’s something that the person needs to work through.  It may be deceptively hard or easy to resolve, and you won’t know by looking at it from the outside.

There is one aspect of trauma that is important and that is whether it’s sustained.  A one-time event tends to cause less damage than systemic traumas that are recurring and that the victim feels they’re powerless to escape from.  Consider the first responder who must choose to face traumatization every day on the job in exchange for their pay and their mission to help others.

The Pause Between Stimulus and Response

One of the best things about being human is the choice on how to respond.  In Emotion and Adaptation, Richard Lazarus explains the difference between a stressor in the environment and stress in terms of how we respond.  When we cultivate this pause, we create the opportunity to choose our response instead of just reacting to the stimulus.  It was Paul Eckman’s study of microexpressions that led me to understand that the startle response is different – it’s wired in.  However, our other emotions are processed differently.  (See How Emotions Are Made.)  The result is that we have a wide degree of influence over our emotions by changing the way we evaluate the stimulus in the environment.

Shame as Fundamentally Deficient

“Contained in the experience of shame,” writes the psychologist, Gershen Kaufman, “is a piercing awareness of ourselves as fundamentally deficient in some vital way as a human being.”  I contrast this with Brené Brown’s work, which I summarize as saying that shame is “I am bad.”  The difference here is in magnitude.  Brown’s work is clear that someone isn’t “fundamentally deficient” – rather they are currently or situationally deficient, something that can be rectified.

Shame separates us from humanity.  Our belief that the trauma we experienced was our fault – or we are to blame – separates us.  It takes effort and often support to reconnect with others.  The first step is often the need to reestablish compassion for ourselves.  By separating ourselves from humanity, we’ve separated ourselves from the normal compassion that we offer to any other member of the human race.

Mind and Body

In Why Zebras Don’t Get Ulcers, Robert Sapolsky explains how stress impacts the bodies of humans and animals alike.  In his work, the relationship of chronic stress and the negative effects on inflammation, immune response, and digestive problems are clear.  There is no doubt that there’s very little separation (if any) between the mind (our consciousness) and the body.  That being said, I resist those who would push the pendulum too far, as I explained in my review of The HeartMath Solution.

With cautions firmly in place, it’s clear that the way that our minds work – particularly as it relates to stress – has a very real and powerful impact on our bodily health.  When we fight our natural responses – like suppressing our emotions instead of working through them – we necessarily impact our bodies in negative ways.  People who say that all illness is a failure to meditate enough, have enough faith, or lighten their hearts are wrong.  All of life is probabilities.  A healthy body and healthy mind are a protective factor for disease, but it’s not a perfect defense.  Because someone needs medical attention doesn’t mean they’re bad.  Someone who needs mental health attention isn’t bad either.

It’s in the Genes

One of the insights into genetics over the past few decades has been epigenetics.  That is how the environment activates or inactivates genes in ways that change outcomes.  You may harbor a particular allele for a gene that could be harmful – but only if the environment activates it.  This new awareness allows us to more clearly see the complicated interactions between genes and environments and recognize that even a person’s genes aren’t necessarily bad – it can be that they’re ill suited for their environments.  (See The Blank Slate for a primer on epigenetics.)

The Line Between Healthy and Ill

We tend to think in absolutes, blacks and whites.  However, as The Halo Effect explains, life is probabilities.  At any given time, we’ve got dozens of microorganisms replicating inside of us.  Should one of them become overly successful and reproduce in sufficient quantities before being squashed by our immune system, with or without the assistance of modern medicine, we’d call ourselves ill.  However, the number of microorganisms that qualifies as ill isn’t a magical – or even knowable – number.  We’re constantly in a state of repair and protection.

Part of the argument is that the better our mental health is, the more resistant that we’ll be to these organisms – which, owing to the immune system responses to stress, this is accurate.  However, the path to this space isn’t as clear.  We know that meditation can help – but we don’t have that all figured out, either.  (See Altered Traits for more.)

Enough of Something that Almost Works

Vincent Felitti’s astute remark about addiction that “it’s hard to get enough of something that almost works.”  It’s important to recognize that we’re likely to continue something when we believe that we’re “almost there.”  In some contexts, it’s the sunk-cost fallacy.  (See Thinking, Fast and Slow.)  Maté isn’t a stranger to addiction.  His colleague, Bruce Alexander, wrote the excellent The Globalization of Addiction.  For the casual reader, it’s important to recognize that addictions are coping skills that have progressively come to control the person – rather than the other way around.

In this context, it’s easy to see how anything that almost works could become an addiction.  Anything that quells the fear, anxiety, and disruption of a calm mind is a welcome friend when nothing else works.  Certainly, the traditional substance-based addictions get priority, but we’ve long given up the pharmacological theory of addiction.  (At least, if we’re reading and accepting the research, we should have.)

Women are Unexploded Bombs that Need Defusing

Michael Klein, former head of the family practice department at BC Women’s Hospital in Vancouver, told Maté, “You learn in a very biased environment that sees childbirth as scary and dangerous.”  It’s not hard to understand that, with this perspective and training, doctors would tend to do caesarean section deliveries instead of natural childbirth.  Natural childbirth is akin to letting the timer on the bomb click down to zero.  Of course, a different view recognizes that the birth of a child particularly is a rite of passage.  (See The Rites of Passage.)  It’s a period of changing relationships to each other and to life for both the mother and the child, and in addition to the medical needs of both, there’s a need for connection.

Too many women believe that their medicalized birthing process was a trauma.  It’s not surprising in the context of knives, being ordered what to do, and restraints, that it might be considered as such.  How did we take such a precious moment and privilege and turn it into something that is traumatic?

Doesn’t Play Well with Others

I can’t recall whether I was told that I didn’t play well with others on a report card or whether it was just a fear of mine.  I do know that, in the context of Maté’s beliefs that “plays well with others” means “conforms to society’s expectations,” I’ve failed miserably.  I was building circuits and soldering by the time I was 11 years old.  When I’d fumble and burn my fingers, my teachers would be concerned and call my mother.  In today’s culture, I’m absolutely certain that we’d have a visit from child protective services.

That’s just one of a hundred ways that I was different from the norm – and why I had and sometimes still have trouble relating to others.  It’s common to have people ask me about sports teams or what sports I’m interested in.  I shrug a bit and say that it’s not me.  Friends who have known Terri and I for years still forget that we really don’t watch television.  Occasionally, we’ll watch a movie or, even less frequently, a series.  If you ask us what we have watched, you’re likely to be disappointed – because we haven’t.  (Conversely, if you ask if I’ve read a non-fiction book your odds are substantially better.)

It’s My Fault

There’s a trap when your parents aren’t good.  You can decide that they’re not good people, but they’re the people that are responsible for taking care of you.  Conversely, you can decide the poor treatment that you’re receiving is because you’re a bad kid.  While the second seems worse, it’s much better, because there’s something you can do about it – you can be better.  It’s an awful weight on a child, but it’s better than accepting that your parents aren’t good parents.  You need them.

The controversy has been raging for decades about whether to spoil the child or to let them cry themselves to sleep (to simplify the argument).  I cover this in good detail in my review of Parent Effectiveness Training.  Here, I believe we need to find some balance.  We need to help children, particularly young children, know that they are loved, heard, and supported.  We need to let them know that they will be safe and okay.  Conversely, we do need to allow them to learn skills like self-soothing.

However, the more interesting aspect of the discussion is the need to avoid performance-based love when interacting with our children.  (See The Road Less Traveled for more.)  When we withhold affection until the child does something that makes us feel or look good, we send the unconscious message that we don’t love them – we love what they can do for us.  This makes it hard for them to develop self-esteem and recognize that they are inherently worthy of love.  (See Words Can Change Your Brain for more.)

Consumer Culture

“Viewed from a corporation’s bottom line, one could not imagine a more desirable consumer profile than those who can’t get enough of what they don’t need but feel they must have.”  We’re all, as the book Happier? explains, looking for a way to become happier and marketers, are selling it.  They’re not selling products or features but rather the idea that some thing will make us happier than we are today.

Here, too, I’m not normal.  I don’t care about brand names, and I never have.  The cool kids could do what they do.  I was going to do what I did.  I live in the same house I’ve lived in for nearly 25 years.  It’s not uncommon for my vehicles to be over 10 years old.

However, Maté’s point is that much of the world is caught on a hedonistic treadmill, believing that the next thing will be the thing that unlocks perpetual happiness and joy – despite decades of evidence in their own lives that it doesn’t work.  Consumerism almost works – and is its own form of addiction.

Not Mental Illness, Injured

Maté shares some of Darryl Hammond’s story, including a visit with Dr. Nabil Kotbi, who reportedly said, “I don’t want you to call what you have a mental illness. You have been injured.”  This is the heart of much mental illness.  It’s an injury that we weren’t able to address.  When the underlying trauma has been addressed, the mental illness not only abates but may disappear entirely.  If we change from asking “What’s wrong with you?” to “What happened to you?”, we may find that the answers are much more productive.  (See Restoring Sanctuary for more.)

The Lack of Biomarkers

Mental health has postulated for some time that there should be clear medical markers for problems, and once those markers are found, it will make diagnosis easier.  A simple lab test or procedure like an X-ray, it was promised, would identify the specific problems opening up their resolution.  However, we have not found these markers – and I seriously doubt we will.  In my review of Descartes’ Error, I explained that some problems may be biological (hardware) but others may be conditioning (software).  In either case, software can work around hardware issues.

I’m reminded of John Nash and how he found strategies to validate that the people he was interacting with were real people and not delusions.  (I cover this more in my review of Incognito.)  Rather than looking for the medical source of all problems, we should be looking at the ways that we can help people build better lives.

Normal or Disease?

“A University of British Columbia study looked at the prescription records of almost one million B.C . schoolchildren over an eleven-year period and found that kids born in December were 39 percent more likely to be diagnosed with ADHD than classmates born the previous January.”  This leads to the question: is ADHD really just age-appropriate behavior?  There’s definitely a growing consensus that we’re overmedicating children for ADHD when they may be doing age-appropriate behaviors.

How many other things have we turned into a medical (or mental) diagnosis that is completely appropriate for someone’s age?  It’s a scary thought.  It’s particularly scary when you consider the number of people on SSRIs and how few of them are in the suggested therapy.  (See Warning: Psychiatry May Be Hazardous to Your Health.)  We need to use medications to allow us to proceed through therapy productively – and then to stop them.  The research supports this, but few people read the research.

Sensitive People

It’s a gift.  It’s also a curse.  When we look at the people who struggle, suffer, and die by suicide, they are disproportionately represented by the artists and the people who are sensitive.  Opening yourself up to all the emotions available to you can be an amazing experience, and it can also expose you to raw suffering.  The trick is to find ways of opening yourself up and being as sensitive as possible while remaining inside the space that your coping skills can handle.  Too little emotional reception and expression, and you risk a psychotic break, as your emotions finally break through.  Too much sensitivity, and you may not be able to moderate the feelings into a consistently safe range.

Sense of Control

In our bid to protect the parts of ourselves that are hurting, we aggrandize ourselves and seek to assert that we have control over things – all things.  However, as Compelled to Control explains, control is an illusion.  We never really have control over anyone else and often barely control ourselves.  Kurt Lewin backs this up with his observation that behavior is a function of both person and environment – we can’t even control our own behavior all the time.  (See A Dynamic Theory of Personality for more.)

This sense of control provides us with feelings of safety, and we’ll go to great lengths to protect it.  It’s the only way that we can feel as if we won’t be hurt any longer.

It’s Not Worth It

In our work with burnout, we zeroed in on feelings of inefficacy at the core of burnout.  (See Extinguish Burnout.)  It’s the mismatch between what we’re putting into something and what we’re getting out.  The problem is that our expectations and the results are rarely in harmony.  Instead, we put in massive amounts of work and have little to show for it.  It can feel disheartening, demotivating, and just bad.  It’s a pathway to depression, and the research supports that burnout inventories are often early predictors for future depression.

Tragically, some people begin to believe that life is not worth it, it’s too hard, and they’re not good enough to keep on living.

Am I Enough

Ask people who are in helping professions if they’ve done enough at the end of their careers, and their answer may be yes.  But if you ask them “Are you enough?”, the answer may be more difficult.  There’s a subtle but important difference between I’ve helped so many people and I’m good enough as a human.  It separates the results, which may be positive, from how we feel about ourselves and our lives.  The results can be terrifying.

If we’re honest, we all struggle with “Am I enough?”  It’s a constant source of question in myself and is shared by those who trust me enough to share their struggles.  We forget – or discount – that we’re enough simply because we exist.  We forget that the question itself is bad.  Maybe someday I’ll get consistent at reframing the question to “Am I loved?”  The answer – even if it’s just by the dog – is always yes.  That should be enough, but if my friends and loved ones are any indication, getting there is harder than it seems.

Not As I Would Have It

Many people have heard the serenity prayer – at least the first part.  The part that’s often dropped includes “taking the world as it is, not as I would have it.”  It’s important, because it’s a grounding reminder that we must take reality for what it is – even if we don’t like that reality.  We can’t will our dead loved ones to life.  We cannot change what is merely by our thoughts.  It’s hard to accept realities you don’t like.  However, it’s harder to live with a perception of the world that isn’t real.

The thing is, while normal may be a myth, there is some objective reality out there – one that we are best to align ourselves with.  If we want to reduce the friction and see the world as it is, we may just see that there is an illusion called The Myth of Normal.