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Book Review-It’s Not You, It’s What Happened to You: Complex Trauma and Treatment

Over 40 years ago, post-traumatic stress disorder was recognized in DSM-III.  Still, we’re finding that people who have encountered trauma are stigmatized and treated with suspicion about whether their symptoms are real.  It’s Not You, It’s What Happened to You: Complex Trauma and Treatment unravels trauma and its aftereffects in a way designed to reduce stigma and legitimize the impacts of trauma.

Prevalence

Adult Children of Alcoholics formed in the 1970s and began raising awareness of the long-term effects of growing up with one or more parents being alcoholics.  The expected instability, neglect, and abuse that would come at the hands of these parents led to lasting impacts on their children.  The vocal nature of the group helped to raise awareness of the critical impact of trauma.

It was 1998 when the first study of the adverse childhood experiences (ACEs) hit journals, demonstrating just how large the impact was.  It’s 26 years later, and we’re still sometimes fighting to create awareness for how trauma impacts people.

It impacts a lot of people, with studies indicating that 80-90% of US citizens will encounter trauma in their lives.  Basically, everyone you meet has encountered – or will encounter – a trauma in their lives and will need to learn to adapt.

Put Out the Fire

Types

Trauma – even the psychological trauma that we’re discussing here – comes in many forms.  It’s not one size fits all but rather a collection of types of trauma with different, related symptoms.  The types are:

  • Impersonal – The kind of trauma that would be defined as “an act of God.”
  • Interpersonal – The kind of trauma perpetrated by one human on another. It could be a rejection, a betrayal, a secondary trauma (more momentarily), or an institutional trauma.
  • Identity – An overwhelming loss of an aspect of identity.
  • Community – Trauma due to membership in a group and the group’s loss of identity.
  • Cumulative – Repeated occurrences of the preceding types.

One of the areas of trauma above – secondary trauma – is still one with a great deal of resistance to accept.  Those who experience it often minimize it.  They say, “But they’re the ones with the real trauma, I just saw it.”  What we know is that continued exposure to other people’s traumatic events leaves us with experiences that create our own trauma.  Secondary trauma is often cumulative in nature.  Listening to one bad story isn’t generally problematic – it’s the accumulation of days, weeks, months, and years of this emotional service that can take its toll.

Trauma and Attachment

Trauma is defined as a temporarily overwhelming condition.  It’s when your coping capacities are exceeded, and the body and psyche take defensive action, including compartmentalization and dissociation, to protect you.

Attachment refers to the work of John Bowlby and Mary Ainsworth to document how children are attached to their parents.  Others have extended this work to explain how adults behave in close relationships.  Attachment styles – the way we relate to intimate others – are largely stable over time but can be changed.  They are commonly recognized as secure attachment, avoidant attachment, anxious attachment, and disorganized attachment.  Disorganized attachment is a style that leverages both anxious attachment and avoidant attachment.

Those who have a secure attachment style – either through their family of origin or through the work that they’ve done – are more likely to have healthy attachments in adulthood.  They’re willing to separate and come back together with their partner or friends without either avoidance or anxiety.  Conversely, those with a disordered style make it difficult for others to relate to them; one moment, they’re pulling the person in, and the next, they’re pushing them away.

Trauma is known to disorganize attachment styles.  In fact, some cults seek to intentionally create trauma to trigger a less-secure attachment style.  (See Terror, Love, and Brainwashing for more on cults.)  However, the opposite can be true as well: through work, support, and safety, people can convert from less healthy styles to more healthy styles.

Loss

A common source of trauma is loss.  This can be the death of a loved one, the rupture of a relationship bond, or the loss of a desirable object or situation.  The response to loss is grief.  (See The Grief Recovery Handbook for more.)  The loss need not be a physical loss.  Symbolic losses like the loss of innocence, the loss of youth, or the loss of ritual can be losses as well.  (See The Rites of Passage for the importance of rituals.)

The importance of loss is that it’s really the experience that you have with the loss that is more important than the physicality of it.  You could lose a ragged old bear or stuffed tiger, and it would be tragic because of the lost memories – even though the value of a worn Winnie-the-Pooh bear or Hobbes stuffed toy would be minimal at best.

Fear, Anxiety, and Panic

Fear is a relatively straightforward emotion.  We believe in the possibility of a negative outcome with some degree of probability and some degree of impact.  (See Emotion and Adaption for more about decomposing fear.)  Fear, however, necessarily has a specific target.  There’s something we believe can happen that we won’t enjoy.  Anxiety, however, is different in that we cannot put our finger on a particular stressor or negative outcome.  Instead, we feel overwhelmed and ill-prepared to defend ourselves against some unseen, external force.  In the extreme, this can create physiological impacts.

These impacts can be seen as a panic attack.  Panic attacks are generally not related to a single fear but rather are the escalation of anxiety to the point where our bodies can’t handle the onslaught of neurochemicals being triggered by the anxiety.

Guilt, Shame, Impostors, and Alienation

Brene Brown has made a career of studying shame, and she explains there’s an important difference between guilt and shame.  (See I Thought It Was Just Me (But It Isn’t) for more.)  Guilt is the feeling that we’ve done wrong.  Shame is the feeling that we are wrong or bad.  Instead of being something that happened, it’s our identity.  The problem with shame is that it immobilizes us and makes us believe that we’ll never be worthy of love and connection to others.

Impostor syndrome is the way what we describe a situation where you feel as if the praise or accolades that you’re receiving aren’t deserved.  The thought is “if they really knew…” then they’d realize that you’re a fraud – an impostor.  Where shame is that you’re a bad person, impostor syndrome believes you can’t be a good person in the way that other people believe you are.  If you were a truly good person, then the trauma (bad things) wouldn’t have happened to you.  There’s a core – mistaken – belief that bad things don’t happen to good people.  Clearly, they do no, matter how stubbornly we hold on to the falsehood.

Alienation is properly being separate – or alien – from the group.  When we experience trauma, we can believe that we’re separate from others.  We believe that no one else has gone through the same things that we have.  Of course, it’s literally true that no one has gone through exactly the same traumas.  However, there are many people who have gone through similar traumas, but we can’t always see that.

When asked the direct question, “Do you think no one else has experienced this trauma?” the logical answer is almost always, “No, someone else has experienced this.”  But that requires the effort to acknowledge our feelings and then contrast them to reality.

The Avoidance Trap

It doesn’t seem like a big deal.  You just don’t feel like going out tonight.  Leftover frozen pizza and a glass of wine or a can of beer seems easier.  The problem isn’t in the individual decision to forgo a social encounter – we all have days where we’re “all peopled out.”  The problem comes when this decision slowly becomes THE answer and erodes the social contact we need for our mental survival.

When our trauma interferes with our decision-making, and we fear that we won’t be accepted, that we’ll be subjected to guilt or shame or the fear that we’ll be retraumatized – that is when we have a problem.  The avoidance behavior itself amplifies the intensity of the trauma (or traumas) we’ve faced.  The subtle decision to stay in gives the trauma more power over our lives than it deserves and reinforces its ability to change us in ways that are neither desirable nor healthy.

Instant Memories

Our brain has two relatively distinct memory systems, each with its own quirks.  Our explicit memory system, the one we use when we recall facts and think about our past, is subject to adjustment over time.  We reconstruct memories, filling in details from the current moment rather than really remembering.  We color and shape our memories with our emotions, moods, and subsequent experiences.

The other side is the implicit memory system, which maintains awareness of emotional and physical state.  Generally speaking, the memories that are recalled are of near perfect quality because our emotions, moods, and subsequent experiences have little effect.  Implicit memories are ultimately converted into (or attached to) explicit memories.  This process is supposed to happen automatically as we sleep.

However, disruption of this process for any reason – including being awoken in fear or confusion of the memories themselves – prevents the processing.  Our brain makes no distinction between simulation – or replay of the memories – and current-time reality.  Until the implicit memories are anchored in time with their connection to our autobiographical, explicit memories, they come on us like we’re in the current moment.

That’s why we experience flashbacks, which can cause our pulse to race and our blood pressure to rise whether we’re conscious of it or not.  Flashbacks are incredibly scary and disorienting.  The first thought is how this can be.  Walking down Main Street, USA, and simultaneously being in a combat zone or at the scene of a disaster is incompatible, but in that moment, our brain is experiencing both.  The disorientation leads to fear.  It’s not just a fear of the recalled implicit memories but that you’re “going crazy.”  It’s terrifying to believe that you’re developing some mental illness, because we interpret ourselves as our consciousness, and we fear its loss.

In some cases, the trigger between the current moment and the implicit memories isn’t known – so there’s no way to predict when we might experience this again.  Frankly, it’s easier if you know you interpreted a car backfiring as a gunshot.  Not that you can necessarily avoid it – but at least you can understand it.

The real work is making it easier to process the memories, so they have less likelihood to intrude on the current moment.

Love, Affection, and Happiness

These are birthrights.  They are a part of the human experience, but they’re also concepts that traumatized people often believe no longer belong to them.  Because of what happened to them, they can’t expect to ever be loved.  They can’t expect others to show them affection.  They don’t believe that happiness is something they can even aspire to.

The problem is that even when these birthrights are affirmed, some people with trauma see themselves disconnected from the rest of humanity.  They believe that, somehow, the world has decided they shouldn’t have the same rights as other humans.  They believe in the isolation – and have never been told that 80-90% of people will experience a trauma in their lifetime.  What they see as something that separates and isolates them from humanity and its gifts – love, affection, and happiness – is actually a thing binds them to humanity.

The Silence of Trauma

One of the reasons that people don’t know how many people have faced trauma in their lives is because we don’t talk about it.  The belief that if it happened to me, I must have done something wrong, may be helpful in our initial coping by allowing us to feel like we can prevent it again.  However, in the long term, it’s harmful, because to expose our trauma exposes our guilt and shame.  To expose the trauma that happened because of our behavior means we’re sharing our fault.

Though it’s untrue, it’s still a substantial barrier.  Instead of meeting people every day who we know have trauma, we meet people whom we assume haven’t.  Instead of speaking of our trauma – and healing – we remain silent and sentence others to the alienation that we ourselves have felt.

To overcome the silence, we need to know – and share – It’s Not You, It’s What Happened to You.

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