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Book Review-Posttraumatic Growth: Theory, Research, and Applications

It didn’t start with the name “posttraumatic growth” (PTG).  It started at the dawn of man, when countless of our ancestors faced challenges, setbacks, and tragedies and then grew from them.  Posttraumatic Growth: Theory, Research, and Applications may be the latest codification of the concept that Tedeschi and Calhoun labeled “posttraumatic growth,” but that doesn’t mean that it didn’t exist before.  Nearly three decades after their original work, this work reports on the concept as well as the misconceptions that have attached themselves to PTG since the original publications.  This isn’t my first foray into reading Tedeschi’s work.  I’ve previously read and reviewed Transformed by Trauma, which shares stories of those who have experienced growth.

PTG Summary

To provide some context, posttraumatic growth is “positive psychological changes experienced as a result of the struggle with traumatic or highly challenging life circumstances.”  It is a framework consisting of five domains:

  • Appreciation of life
  • Personal strength
  • New opportunities
  • Relating with others
  • Spiritual change

For the most part, PTG is about the internal experience of the person rather than the externally observable, tangible results.  This is important because as is often addressed in therapies and groups, the circumstances surrounding the struggle may not change – but the response to it can.

Heroes Journey

Joseph Campbell spent a lifetime researching myths.  From his research, he discovered patterns that emerged in all epic myths across countless cultures.  That pattern he called the hero’s journey.  When Bill Moyers sat down with Joseph Campbell for a PBS series, the extended cut of their conversation ended up in the book The Power of Myth.  It highlights some of the interesting parallels between cultures and how heroes change over the course of their stories.

The key is that heroes face adversity and challenge.  They face loss and trauma.  Then, they grow.  The hero rises to the occasion and moves their personal mission forward.  They find focus and ultimately save their groups.  This indicates that, for centuries in cultures across the world, we’ve seen PTG as the best thing.  It’s the way that heroes behave, and don’t you want to behave like your favorite hero?

Posttraumatic growth doesn’t draw out this parallel in its pages, but it’s one that I couldn’t avoid as I evaluated how PTG has been a part of humanity through the ages.

Relationship to Resilience

Much has been made of the concept of resilience in modern media.  However, so much has been made of it that it has lost its meaning.  People have lost touch with the fact that resilience returns something to its original state after a challenge or stress.  While this initially seems desirable, it’s not long before you realize that the better response would be for things to become better.  Antifragile lays out the framework and conditions for how stress and challenge can make things better.  We have examples in our everyday worlds, like those who exercise literally break down their muscle tissue only for the body to rebuild it stronger than the last time.

Wouldn’t a better response to stress, trauma, and tragedy for us to find ways to be better because of it?  Of course, that is the goal, but how do you tell the mother or father who has just lost their child that they’ll be better off for it?  In deep loss and grief, it’s impossible to see that growth is even an option.

The difference is that, for PTG, the goal is greater than where things started.  Instead of returning to normal, we’re looking for a new, better normal.

PTG and PTSD

It’s a natural, but overly simplified, perspective to see posttraumatic stress disorder (PTSD) and posttraumatic growth (PTG) on opposite ends of the spectrum, but to do so prevents the reality that PTG and PTSD can coexist at the same time.  (See Traumatic Stress for more on PTSD.)  It seems counter-intuitive that you’re experiencing growth at the same time as being imprisoned by recurrent memories that refuse to be integrated into our core narrative, but one doesn’t preclude the other.  We can adjust our basic assumptions about the world and thereby achieve growth while simultaneously being unable to fully integrate the memories into our internal autobiography.

In short, they are associated with two different aspects of the trauma experience.  PTSD is associated with the recall of the event, and PTG is associated with the resulting need to adjust beliefs.  People can, and sometimes do, accomplish one without the other.

Fundamental Beliefs and Basic Assumptions

In Trauma and Recovery and Traumatic Stress, I used the language “fundamental beliefs” to refer to the basic set of assumptions that we have about the world and the way that it works.  These terms are – in effect—the same thing, and under both is the assumption that they’re hidden.  In both cases, the implication is that the thing at the heart of trauma is the way that we see the world.  It’s more than the loss and the threat.  It’s the fact that it changes the way we see the world.

This reorganization is not without its challenges, but it also creates opportunities that didn’t exist with the previous view of the world.  Does the reconstituted set of basic assumptions and beliefs create or allow for a new appreciation of life, new opportunities, better relationships, or a spiritual awakening?  In some cases, it seems that the answer is yes.

The Weakness of Thriving

As a term for PTG, “thriving” has some issues.  It means to prosper or flourish – but how do we measure that in human terms?  Happiness might be one answer, but happiness is notoriously hard to measure and predict.  Some, like Barbara Ehrenreich in Bright-sided, criticize the push towards happiness, while Barbara Fredrickson in Positivity argues that being positive has its own rewards.  Desmond Tutu and the Dalai Lama agree in The Book of Joy.  Sonja Lyubomirsky focuses on The How of Happiness.  Conversely, Daniel Gilbert in Stumbling on Happiness cautions that we’re bad at predicting what will make us happy.

Part of the challenge is separating persistent happiness – or joy – compared to moment-to-moment happiness.  Mihaly Csikszentmihalyi’s concept of flow points out that people are generally happier if they’ve had more time in flow.  (He documents flow in Flow and Finding Flow.)  Some would call it “persistent joy,” as Mattheu Ricard explains in his book, Happiness.

In short, we have a problem defining happiness in any meaningful way, and therefore we can’t use happiness as a measurement for thriving.  Sometimes people fall back on external, materialistic measures, but these fall well short of the inner experience that people who experience PTG have.

Pain as Necessary

There are stories embedded into both Buddhism and Judeo-Christian tradition about the necessity of struggle.  We’re reminded of the struggles of Job.  We’re encouraged to find mustard seeds from people who’ve not known death and pain.  We’re reminded that pain isn’t optional.  Judeo-Christian beliefs are that we live in a fallen world.  The painless world that was created in Eden isn’t available to us.  Buddhists believe in both the impermanence of life and in that life is suffering.

More practically, we know that helping chicks during the hatching process – bypassing the struggle to escape the shell – may be a death sentence.  They need the hatching process and the struggle it entails to transition.  Sea turtles that are helped to the sea after birth are hopelessly disoriented and tend to swim in circles instead of swimming in lines.  (In addition, touching a sea turtle is a federal offense, so don’t do it.)  Across nature as well as religion, struggle is necessary.

In many traditions, it’s struggle by which we achieve wisdom (or enlightenment).  The desire to develop wisdom has challenged philosophers since the beginning of written history.  It has equally been associated with struggle and pain.  Those who have been declared wise men almost universally achieved this title through struggle.

Vulnerability and Strength

People who have been through traumatic experiences and have developed PTG often reveal a strange dichotomy.  On the one hand, their experience taught them that they were vulnerable in ways or to degrees that they didn’t believe – or couldn’t believe.  They also will say that they discovered the strength they had.  They admit to never knowing their own capabilities and only through the struggle did they realize what they’re capable of.

We often say that where we are now is great, but we would have loved to get here without struggle.  We realize that this isn’t realistic, but still, the pain and struggle isn’t fun – even if the results are worth it.

PTG as a Process

Much like trauma, which can refer to an event or the reaction to the event, PTG can refer to the outcomes – the changes.  It can, however, also refer to the process through which people grow.  While outcomes are static and finite, the process of PTG can go on for a lifetime.

In twelve-step groups, participants are encouraged to always see themselves as recovering rather than recovered.  (See Why and How 12-Step Groups Work for more.)  This has a certain fatalistic attitude attached, but only if you don’t allow for the perspective to change.  Experienced participants realize that the struggles and vulnerabilities continue to shrink over time.  Similarly, you can continue to grow from trauma throughout life – but it won’t be the same as today.

The Role of Creativity and Flexibility

Since the outcomes of PTG are obviously better – there’s growth in the name – there’s a desire to understand what influences who will and who will not experience PTG.  How do we find factors that reliably predict who will achieve PTG?  The answer seems like people who are more creative are more likely to experience PTG.  If you don’t feel like you’re creative, I’d encourage you to develop your Creative Confidence.  Everyone is born creative.  We’ve learned to be less creative and to conform to society – but we can buck that trend and be our own person.

More than what we traditionally think of as creativity, it may be that cognitive flexibility holds the key.  The ability to accept that both the pain and torment of the tragedy and the peace from PTG come from one thing is an important dialectical perspective on the event – and in general, this may be what drives us to grow.  It could also be that those with greater cognitive flexibility are those who are more readily able to reevaluate their basic assumptions and change them.  This may explain why some research shows that growth is more likely to occur for those who are younger.  It may be that the degree of fixedness in old age becomes a barrier.

The Role of Disclosure

You’re only as sick as your secrets.  It’s a common phrase for those with substance use disorders – and anyone who finds themselves in a twelve-step program.  We recognize that many of the challenges that we have in life are about where we lie to ourselves and others.  Leadership and Self-Deception particularly challenges the things that we do when we’ve stopped being honest with ourselves.  It speaks of the ways that we interact with others and the kinds of challenges that these patterns cause.

While disclosure is risky – and you’ve got to be judicious about who you share with – ultimately, the more open, honest, and transparent you can be about the trauma, the better off you’ll be in the end.  (See Trust => Vulnerability => Intimacy, Revisited for more on trusting others and the impacts.)

Self-Efficacy and Social Supports

Another big question about PTG is whether it’s more important to have self-efficacy or social support.  The answer is self-efficacy in the long run.  It’s a journey, and like any journey, no one else can do it for you.  The best case scenario is that you have people supporting you and rooting for you, but ultimately, it’s you who has to make the move towards Posttraumatic Growth.

Podcast: Headspace for the Workplace Episode 17

A few weeks ago, Terri and I were asked to join Dr. Sally Spencer-Thomas on her “Headspace for the Workplace” podcast.  We spent some time talking about suicide and how suicide loss impacts others – even coworkers at a company.  We talk about how to acknowledge survivor guilt, meet people where they are in their grief, and actively build community after a loss.

Listen to the episode here: https://www.sallyspencerthomas.com/headspace/17

For more information on understanding suicide, take a look at some of the books we’ve read and research we’ve done: https://confidentchangemanagement.com/book-reviews/psychology-neurology-philosophy/suicide/.

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.

Understanding Trust and Betrayal

There’s a lot of talk about trust, but how much do we really know about trust?  We speak of trusting others, but do we really know what we’re saying?  Trust is both deceptively simple and infinitely nuanced.  Trust is simply our perception of our ability to predict the behavior of someone else.  Betrayal is when our prediction doesn’t match the actual behavior.  Okay, but what does that mean, practically speaking?  It means that you can be more conscious of what you mean by trust, learn to trust more, and to protect yourself more from betrayal.

Trust Can Be Negative

For the most part, when we speak of trust, we speak in terms of positive outcomes.  We believe we can trust our accountant to do our taxes, and we trust our babysitter to faithfully protect our children.  However, we’ve all had situations where we expect that what the person will do will be negative.  We expect that the thief will steal from us if not monitored.  We expect the person who has struggled their whole lives with substance use to return to use again.

In these cases, we have the expectation of a negative outcome.  It’s still trust – but it’s framed negatively.  We trust that we can predict their behavior and the outcomes for them, us, or humanity will be bad.  We say that we “know” that someone will behave badly when that’s clearly not knowable in a literal sense.  Of course, if trust is negative, then betrayal could be positive.  It would be great to see our friend who has struggled with addiction succeed even if we didn’t expect it.

It’s recognizing that we can trust in negative outcomes that allows us to simplify trust to our ability to predict someone else’s behavior.  By removing the attachments to the word “trust” and replacing it with “prediction,” we can look objectively at the situations and decide how confident we are in our predictions.  The more that we believe in our positive predictions, the less we must invest in mitigating the impacts or the more we should be willing to risk for the predicted positive outcomes.

Prediction

Prediction is what human consciousness does.  The evolutionary advantage of consciousness is that it allows us to prepare, predict, plan, and protect ourselves in ways that other organisms can’t.  While it’s an amazing feat, it’s also subject to numerous limitations and biases.  It was Lorenz who wrote about the butterfly flapping its wings setting off a tornado.  Small, and unobserved, events can ultimately change a set of progressively larger events in a chain reaction that makes a large difference.

It’s not just weather that exhibits these characteristics.  People, too, have hidden recesses of their psyche that we’ll never see or understand, and they can – and often do – change their behaviors.  When we’re trusting, we’re expecting something from others based on the information we have – which will always be incomplete and limited.  However, in many cases, this limited information is enough to generate positive value through trust.

Trusting Is Risky

However, inherently, trusting someone is a risky proposition.  It requires a bit of mental algebra to calculate the amount of risk involved.  On one side of the equation, we have the probability of betrayal and the potential impacts that the betrayal will have on us.  On the other side, we have the probability that our prediction is correct and the benefits that it brings.  We assume, for instance, that our accountant will do our taxes well and won’t steal from us.  The benefits are that we get our taxes done without the painful learning process – and we don’t have to worry about an IRS agent showing up at our doors because we’ve not paid them.  For most people, this is simple.

Babysitters are a bit more complicated.  Here, we have a potentially high impact event.  What if one of our children would be harmed or even die while they’re watching?  The probability is very low of course, but it’s not zero.  On the trust side, we get to go out to dinner and rejuvenate our relationship with our spouse.  It’s frequent that two partners don’t evaluate these risks (or rewards) the same way.  The result is that for one of the pair, there are more verification steps built in.  Before the babysitter is selected, we look for certifications and references to increase our confidence that they’ll take good care of our precious children.  During the date, we may call to check in – and verify.  In today’s technological world, we’re also likely to check in with cameras and other forms of monitoring to ensure our expectations are being met.

No matter how mundane the opportunity to extend trust, we’ll find this basic algebra in operation.  What’s the impact and probability of betrayal against the benefits of deciding to trust?

Trust Is Contextual

Algebra doesn’t change based on the context, but trust is different.  While we speak as if trust is a constant, it’s highly contextualized.  For instance, you can trust your babysitter to watch your children and your accountant to do your taxes – but woe to the person who trusts the babysitter to do their taxes and their accountant to watch their children.  When we trust we really are saying that we can predict behaviors inside of a narrow band of established circumstances.  You may trust the babysitter to watch your children while their love interest is out of town, but do you trust them when their love interest is in town, and you predict that they’ll have them over and become too distracted by them to appropriately monitor your children?

Whenever we’re evaluating trust, we must know what context that we have the trust – under what conditions we believe we’re able to predict the end behavior.  Kurt Lewin said that behavior is a function of both person and environment.  If we’re trying to predict behavior, we need to take both into account.

Trustworthy

Much has been made about people who are trustworthy – that is, worthy of trust.  However, we often confuse the way trust works when we speak of people who are trustworthy.  Even if someone is trustworthy, that doesn’t mean I must trust them.  It means that they – and perhaps others – believe they should be given trust because they’ll do what they say they’ll do.  It’s still your choice on whether you’re going to trust someone – and to what degree.

Trust is always a choice that you make.  It can’t be demanded.  Whether a person is trustworthy or not isn’t the point.  The point is your decision to trust and that can be based on several factors, not just the trustworthiness of someone.  In fact, even if someone is outwardly not trustworthy, the choice to trust them may be the difference between a continuing relationship and not.

Experience and Fear

Some people, through genetics and childhood experiences, are more likely to trust – and be betrayed.  It can be winning the genetic lottery or developing a secure attachment with their guardians or other factors that we don’t fully understand.  Conversely, individuals have grown up in unpredictable and relatively hostile environments where their very survival was in question repeatedly.  They are thereby primed to expect a lack of safety and the need for fear.  These extremes obviously make someone more – and less – likely to trust.  For most of us, our experience growing up was somewhere in the middle – but it still influences our ability to take the risk of trusting.  It’s better to not get the rewards but not take the risks for some of us.

At the heart of the difference between those who are more and less likely to trust is the degree to which we feel we have the coping skills if we are betrayed.  These coping skills can come in the form of the things that we can personally do, or it can be in the form of the people that we believe (trust) will support us.

There are also factors about the way that we process that can make us over (or under) estimate the probability and impact of betrayal.  Obviously, the larger the impact and the less likely we are to be able to cope, the less likely it is that we’ll extend trust.

Basic, Blind, and Authentic Trust

Most of the trust that we have in the world is so low stakes and normal that it falls well beneath our conscious radar.  We expect that cars will stop at stop signs and stop lights even though we’ve heard cases where this hasn’t been true.  We expect that our bank will have our money, that our credit card transactions will go through, that our phones will work, and the electricity will stay on.  There are thousands – if not millions – of things daily that we simply trust because it’s easier.

Consider the situation of asking your colleague to look after your luggage at the airport while you go down the hall to buy a sandwich or use the restroom.  Most people wouldn’t give it a second thought.  That’s true whether we trust and respect the colleague or not.  It’s simply too much trouble to make conscious decisions to trust about everything.

Sometimes, this gets converted into blind trust, where our trust is disconnected from the signals that might warn us that our predictions of someone’s behavior might be off.  The owner who doesn’t follow up on the strange disconnect between profitability and assets.  The wife who notices lipstick on her husband’s collar or handkerchief that isn’t hers but ignores it – or buys the weak story she’s told.  This is where we’ve stopped looking at validating our predictions – and we’re putting ourselves at greater risk of betrayal.

In other times, we’ve got lots of data that reaffirms that the trust that we have in someone is well founded.  There are those few people in your life who are always there without fail.  The people that you know you can count on no matter what.  You authentically trust them to continue their behaviors, because you’ve seen them do it again and again in a variety of different circumstances.  Authentic trust is earned through having gone through bad things with people and knowing they’re there for you.

Building Trust – Make, Meet, Renegotiate

People wonder how they can make people trust them instantly.  This isn’t possible, because other people are always deciding whom to trust and whom not to trust.  However, you can build trust with other people.  Benjamin Franklin had a simple way to build trust.  He’d ask for someone to extend to him a small amount of trust.  Often, he’d ask to borrow a book from someone.  He’d read it and promptly return it.  This simple act of meeting his commitment to return the book paved the way for larger and larger opportunities for trust.

Franklin’s model was simple.  As for something small, make a commitment, and then meet the commitment.  Keep doing that to continue to build trust.  I’m sure there were times when Franklin couldn’t keep his commitment and he’d be forced to renegotiate.  Perhaps to ask for an extra week or month to read the book before returning it – or maybe even to take it with him to France.  By renegotiating, he continued to build trust because the other person knew Franklin was serious about his commitment and that he wanted to make sure that he met it enough to be willing to have uncomfortable conversations.

Franklin’s simple model of making a commitment and either meeting it or renegotiating before it came due helped people learn to trust him.  Eventually, his name preceded him, and his reputation made it much easier to build trust with new people.  They’d ask others for their perspectives, and the word “trust” would naturally arise.

Credibility

Knowing that, as humans, we’re wired to find shortcuts and be strategically lazy makes the reputational aspects of Franklin’s life make sense.  When faced with a difficult decision about whether to trust Franklin – with things much more valuable than a book – it’s easier to look for markers than to do a thorough evaluation.  Instead of personally gaining progressive experience with commitments, people would ask others.  If I trust someone as a judge of character, and if they trust someone, then I should, too.

We see proxying trust today.  Websites proclaim the brands they work with.  Speakers show pictures of them speaking to presumably large crowds.  Wealth experts are always seen speaking in front of mansions and expensive cars or on yachts.  They are sending subtle signals of wealth to an audience trying to determine if they can be trusted.  Instead of thoroughly evaluating people and personalities, we look for simple ways to accept their claims – or to reject them.

When we’re struggling to believe other people, a good question to ask is what subtle signals are they sending that is eroding their credibility?  What credibility markers are they using that you either don’t understand – or don’t believe?  For instance, I can claim 19 years in the Microsoft MVP program, which likely means nothing to you.  It’s only in explaining that it’s a very reserved award for at most a few thousand people that must be renewed each year that you begin to recognize it’s a big deal – even if you still don’t know exactly what it means.

Contract, Communication, and Competence

Knowing whether to trust someone or not – to predict their behavior – is evaluated along three dimensions.  First, there’s the contract.  Will they honor their word, or will they do what’s right?  Second, there’s the communication aspects.  Will they, as Franklin did, notify us when things are changing and create the opportunity to shift our predictions together?  Third, there’s their competency.  They may have committed to something, but can they actually deliver?

Contract weasels are maddening.  You think that your agreement – and therefore your prediction they’ll honor it – is air-tight.  You’ve specified all the SMART things – Specific, Measurable, Achievable, Realistic/Relevant, and Timebound.  However, somehow these people find a different way to interpret something in the agreement, and therefore you find yourself betrayed.  Sometimes there are different interpretations without anyone being a weasel.  The contract terms – explicit or implicit – weren’t clear enough to ensure a single, unified perspective.

Communication, as was already explained in Franklin’s example, is best done openly and particularly when a commitment can’t be met.

Jimmy Bakker’s Fall

Reverend Jimmy Bakker was revered by my grandparents.  They religiously watched his 700 Club and PTL Club.  That was until 1987, when allegations of sexual misconduct and improper use of ministry funds landed him in jail.  It was 1961 when Bakker and his wife, Tammy, left college to become evangelists.  It was decades of building trust, working hard, and convincing people to trust him with their money.  It was undone in a matter of months.  From riding high on the continuing waves of trust to getting crushed by a complete lack of faith in him.

This is at the heart of trust.  It takes a long time of making and meeting commitments to build trust – and only a few moments or a single scandal to lose it.  Once the bubble of trust has popped, it’s suddenly possible that people – or a person – may not be as predictable as they appeared.

Reciprocal and Reinforcing Trust

One of the quirky aspects of trust is that it seems to belong to the mutual admiration club.  That is, we trust those people who seem to trust us.  The more trust that people place in us, the more we’re likely to place in them.  That’s why if we want to get trust from others, another strategy is to trust more.  All other things being equal, the more we trust someone, the more they’ll trust us.

This reciprocal nature of trust often sets up a second factor for trust – its reinforcing nature.  When the flywheel is spinning in a positive direction, we get more and more trust between people who trust each other.  Each trust bid – each time we trust the other person – when completed reinforces that our predictions were well placed and allows us to increase our probabilities for the next cycle.

Trusting More

If you want to be trusted more, there are some simple tools you can use:

  • Grant trust to others more frequently and in as large of degrees as you feel comfortable with.
  • Evaluate the conditions that would cause your trust to be well-founded and cases where it would be ill-founded.
  • Offer small opportunities for trust before larger opportunities.

If you want to know more about how trust, safety, vulnerability, and intimacy are related, you’ll want to see Trust=>Vulnerability=>Intimacy, Revisited.

Book Review-A Grief Observed

Loss and grief spare no one.  When loss cast a long shadow across the literary giant C.S. Lewis’ door, he wrote about it.  A Grief Observed is the collection of thoughts after the loss of his wife.  It’s an unfiltered account of his feelings, and the thoughts that troubled him are cataloged while he was working his way through the grief.

Isolated

C.S. Lewis was – because of his great intellect – very isolated.  Sure, he had his Inklings literary group with J. R. R. Tolkien, but according to his stepson, he struggled to relate to much of mankind.  His comments were not a criticism but rather a recognition of the struggles of the man he called “Jack” (for no reason made clear by the introduction).

However, Lewis’ isolation is only one aspect of the isolation that permeates the book.  The other form of isolation is the expectation that “British boys don’t cry,” separating them from their emotions.  While Lewis was more in touch with his feelings than most, there’s still this eerie sense that the struggle to find, name, accept, and process emotions was difficult for Lewis and the others with whom he associated.

Thinking About Endless Grief

“I not only live each endless day in grief, but live each day thinking about living each day in grief.”  This sad statement encompasses hopelessness.  Grief may remain for a lifetime, but it will change and, in some ways, get better.  However, in the depths of despair, when hope has gone away to a far away land, it’s hard to believe that the pain of today will be any less tomorrow, or the day after.  Instead of seeing the natural ebb and flow of life, we become fixated on our momentary pain and sit mourning without sense of recovery.

Like anything gradual, it’s hard to see change.  It’s hard to see moments that happiness peeks through the pain like flowers emerging in the spring.  Slowly, not all at once, grief is transformed.  When you are able to look at grief across a period of time, you begin to see and understand that it’s not the same grief you initially felt.  Lewis’ writing allowed him and now allows us the opportunity to see the gradual turning of grief as it becomes less painful and more reverent to those we’ve lost.

An Embarrassment

“An odd byproduct of my loss is that I’m aware of being an embarrassment to everyone I meet.”  The man Lewis was couldn’t escape the boy he had been nor the cultural expectations of the time.  No man could possibly hide the excruciating pain of the loss of a spouse, and he saw his failure to hide his emotions as an embarrassment.

We know today that the loss of a significant person in our life requires our brain to literally rewire itself.  Over time, we begin to separate aspects of our total experience so that one person does some functions and other people do other functions.  Everyone needs to do things like eat and take care of themselves, but they often reduce their capacity for cooking or other duties as the other person picks them up.  We naturally allow people to become experts in areas, while we mostly ignore them as a part of our optimization.

However, the death of a spouse means that we are severed from those parts of our shared thinking that, though external to us, we’ve come to depend upon.  It’s as if we’ve lost a part of ourselves – and we have.  We wouldn’t admonish someone whose physical pain involuntarily caused tears in their eyes as we do with those who grieve at an emotional loss.

Loss of Past

One of the odd things that happens is that people become severed from their past as well as their present and future.  It makes no sense that the loss of someone would create a tear in the past, but it does.  Suddenly, the places that you loved to visit together lose their luster.  There’s the twinge of pain as you feel the loss more prominently.  It makes you doubt that you were ever happy there.  How could this be a place of joy when I feel so bad now?

This doubt is even more pervasive as it challenges you about the very nature of reality.  Was what you believed was your history even real or was it a fantasy that you conjured up in your mind.  How is someone to know?

Links

Navigating through the waters of grief, it’s important to hold on to the memories and not let the waves of doubt erase them in a blind attempt to ease the pain.  We must cherish the times that we had with those we’ve lost as a testimony to their life and to our commitment to continue their light in the world.  If you’re navigating through grief, the pictures, recordings, and creations of the loved one are precious.  In the end, it allows A Grief Observed to be a grief shared – and that makes it lighter.

Book Review-The Grieving Brain: The Surprising Science of How We Learn from Love and Loss

Often, it’s described as a brain fog.  It’s the inability to think after the loss of a loved one.  It feels like you’ve got to make so many decisions, yet your ability to make them is compromised at best.  The worst part is you don’t know how impacted you are or how long it will last.  That’s why The Grieving Brain: The Surprising Science of How We Learn from Love and Loss is so important.  It’s a map of the territory that begins at our loss and continues throughout our lives as we learn to navigate in the absence of our loved one.

Life Map Navigation

Without knowing it, we all use a “map” to navigate our lives.  The map is the predictions we have of what will happen.  (See Mindreading for more on the role of prediction in our lives, and Superforecasting for more on how we do it best.)  It is knowing what we’ll take care of and what will be taken care of for us.  It’s the things we can count on and those we can’t.  (See Trust => Vulnerability => Intimacy, Revisited for more about our relationship with trust and other people.)  When we lose someone close to us, that map no longer makes sense.  (See High Orbit – Respecting Grieving for more about what “close” means.)

Gary Klein, in Sources of Power, explains that we’re always making models in our heads.  These models unconsciously guide the way we respond.  The removal of someone close in our lives radically alters the way that things work, which takes time to adapt to.  We literally must reevaluate every assumption – and get reminded about the thousand or more things that we took for granted because that person was there.

Tethered to Them

We’ve all talked with people who are constantly reminded of their loved one.  Whether it’s the home, bed, car, or restaurant that they loved together, the reminders come in big and small ways – and they’re never ending.  Two things shift over time.  First, the degree to which the reminders are recognized decreases.  As we habituate to the experiences without our loved one, we are generally triggered to be aware of their absence less often.

Second, their loss becomes more accepted.  We begin to rewire around the idea that they’re not present and won’t be present, so we stop being so intensely aware of their absence.  I say this with care, because I don’t want anyone to believe that grief is ever done or that it goes away – it’s just that it changes.

Another more subtle transformation is that we stop focusing exclusively on the loss and can begin to accept the positive memories of the times that we did have with them.

Psychological Distance

The same parts of our brain that compute distance across space and time seem to also compute the relational distance between us and others.  We collectively use this mechanism to predict whether someone will be there for us.  The further away in space, time, or relationship, the less likely we believe they will be there when we need them.  We equate separation – and therefore loneliness – using the same framework.  (See Loneliness for more about loneliness.)  It might be said that the brain encodes distance in here, now, and close.

Not Accepting Gone

Many people who have lost their loved one acknowledge a state that is both knowing they’re gone and feeling like they’re not at the same time.  It’s not surprising, as memories are encoded differently in different parts of our brain.  We can intellectually know something – and still emotionally struggle with it.  There’s an added complication: we’re wired through evolution to consider the possibility that our loved one will return.

There’s an advantage to protecting our children and our families if we expect that our loved ones will return.  We’ll be willing and able to invest more resources in ensuring that the children are okay.  In evolutionary terms, people often went off, and their return was uncertain.  We’d never know if they left us or were injured or killed.  While most losses today are certain, those losses which involve an ambiguous return are those that are the most challenging.

Cooking a Memory

It would be convenient if our memory was a perfect representation of the past.  It would be great if we could find our way to any bit of our history and faithfully play back our experience.  Unfortunately, that’s simply not the case.  We see many places where our brain automatically fills in the gaps in ways that hide our ability to recognize that it has done it.  (See Incognito for a visual representation of this and Thinking, Fast and Slow for Kahneman’s explanation of System 1 to System 2 handoff.)  Memories are stored in different parts of our brain and are reassembled on recall.  Like a chef fetching pieces from different places, our brain reassembles an approximation of the events.

The most challenging aspect of this process is that the “recalled” memory is more like recreated, and it’s done with elements of the current context rather than the original context.  When we’re depressed, we’ll recreate the memory with more negative elements.  This can lead to a reinforcing loop that can be very problematic.  (See Capture for more.)

The Griever’s Journey

Kubler-Ross’ description of grief has been criticized for being overly simplistic and linear (particularly in The Grief Recovery Handbook).  The Grieving Brain calls it an “old outdated” model.  Make no mistake, it’s not perfect; however, I believe George Box, a statistician, who said, “All models are wrong, but some are useful.”  O’Conner believes that the popularity of the model is due to is similarity to the monomyth that Joseph Campbell called the hero’s journey.  (See The Hero with a Thousand Faces.)  In a follow up email conversation with O’Conner, she was able to provide the research that supports these statements.

The reference to Joseph Campbell’s hero’s journey is a direct assertion made by the research – but that assertion is made in a very loose way with no attempt to map Kubler-Ross’ model to the monomyth.  The assertion that the model is outdated is proposed by some of the backing research.  In particular, the references are to other models – which O’Conner explains in the book.  However, where Kubler-Ross’ model is something that people can identify with, and it provides a framework for what to work on, the other models are largely descriptive.

Loss and Restoration

The one model that’s interesting – though still difficult to execute on – is focused on the oscillation that happens.  In grief, people spend some time on loss.  They spend some time on restoration.  These are natural oscillations.  Sometimes, those grieving are focused on the loss and what will not ever come to be.  Other times, they’re focused on how to make their situation better.  “Better” may mean the mechanics of life, or it may be a proactive approach to try to prevent others from feeling the loss they’ve felt.

What’s important is the recognition that this oscillation is healthy.  There’s no clear indication when – or if – this oscillation will end.

Yearning

Perhaps the one key word in The Grieving Brain is ”yearning.”  It’s the desire to be with the person whom they’ve lost.  It’s a preoccupation with the idea of what might be happening if they were here.  Yearning naturally fades over time.  While you always will miss the person who’s gone, the deep-felt longing or yearning is transformed over time.

Loneliness

Compounding the loss of a person close to you is that the person whom you’d turn to for support is the very person whom you can never talk with again.  You can certainly talk to them, but they’re not going to respond with a caring word or a gentle touch.  Loneliness explains the challenges with experiencing loneliness – and they’re not good.  It’s one of the most challenging experiences that someone can have.

Complicating this loss of someone close is the tendency for other, more distant, friends, relatives, and colleagues to take a step back.  Some will argue that this is to create space for the person.  For others, it’s clear that they’re not comfortable with the topic of death, and as a result, they retreat to protect themselves.  (See The Worm at the Core and The Denial of Death for more.)

Positive Emotional Toolkit

There’s a misconception about the need for someone who is grieving to stay in a sad, depressed state eternally.  Sometimes, there’s a focus on working through the grief.  However, this often undermines the need for positive experiences.  A good strategy is to create positive experiences – and to work through the feelings of guilt or inappropriateness that may accompany these experiences.  The loved one you lost undoubtedly wouldn’t want you to be sad and depressed forever, but sometimes we believe that finding joy isn’t appropriate.

More than appropriate, it’s practically required.  So, it’s a good idea to build yourself a positive emotional toolkit.

Good – Then and Now

Grief changes the rules of the game.  Things will never be the same again – however, that doesn’t mean that they can’t be good again.  They’ll just be good differently.  We can say that things were good then, before the loss – and they’re good now, despite the loss.  The truth is that we don’t have to stay in The Grieving Brain forever.  Sometimes the right answer is to accept that today – or at least tomorrow – can be good, too.

Book Review-Professional Burn-Out

I was giddy.  It was a book published in 1977.  Professional Burn-Out wasn’t that big, but it was a book that predated Freudenberger’s Burn-Out book, which was published in 1980.  It still cited his journal articles on the topic – but very few people would even know about this book.  I have to credit The Burnout Challenge for directing me to it.  In the irony of ironies, it further discredits the premises in The Burnout Challenge.

Outline

Rarely do I share outlines more or less directly from a book – but here, the outline shines light on the idea of burnout and its factors.  It starts with looking at personal and professional factors for burnout:

  • Personal Sources of Burnout
    • Not Setting Limits (see Boundaries)
    • Not Paying Attention to Our Own Needs and Limits
    • Not Communicating Our Feelings
    • Isolating Ourselves Physically and Psychologically (see Loneliness and Acedia & Me)
    • Political Nature of Work
    • Powerlessness (see The Hope Circuit)
    • Ignoring Positive Attention from Others
    • Lack of Professional Identity
    • Becoming Overinvolved
    • Professional Survival Skills
    • Inability to Live with “Gray Areas” of Life
  • Organizational Sources of Burnout
    • Not Including Staff in Policy Making Procedures (see Reinventing Organizations)
    • Lack of Structure that Allows People to Share Strong Positive and Negative Feelings (see The Fearless Organization)
    • Lack of Positive Feedback
    • Lack of Ability to Personalize Workspace
    • Not Sharing Wants and Needs and Not Encouraging Others to Do the Same (see Radical Candor)
    • Lack of Adequate Supervision
    • Dead-End Jobs
    • Lack of Skill-based Training
    • Few External Rewards
    • Limited Vacation Time
    • High Client/Staff Ratio

What’s key here is that many of these same concepts have shown up in other work since publication – and many of these are directly addressed by our bathtub model as explained in Extinguish Burnout.

Three Degrees

Professional Burn-Out proposes that there are three levels of burnout:

  • First: Signs and symptoms are experienced mildly and occasionally.
  • Second: Signs and symptoms are more persistent and difficult to move out of.
  • Third: Signs and symptoms are continuous. Psychological problems begin to accompany the signs of burnout.

Signs and Symptoms

The list of signs and symptoms at a personal level include:

  • Fatigue – This label to what is commonly called exhaustion today.
  • Worry – This also includes an inability to separate work from the rest of our lives.
  • Inability to make decisions – This is commonly seen when someone is overwhelmed. (See The Organized Mind.)
  • Guilt – Here, there’s a sense that the work that is being done isn’t of high enough quality. Today, this is often called inefficacy.  We’re guilty, because we don’t feel effective enough.  (See I Thought It was Just Me (But It Isn’t) for more on guilt.)
  • Physical symptoms – Often, our minds impact our bodies. We continue to find that our physical symptoms are driven by our minds.  (See Why Zebras Don’t Get Ulcers for more.)
  • Alienation – We see that we’re disconnecting from friends. This leads to feelings of Loneliness.
  • Criticism/Griping – Today, we generally call this cynicism. Cynicism is the result of our feelings of inefficacy.  (If you want more about an appropriate level of happiness, see Bright-Sided.)
  • Anger/Resentment – Also known as being “snappy”. (See A Force for Good for more about how to work on anger.)
  • Accident proneness – Another sign of cognitive exhaustion associated with high levels of stress, people may start bumping into walls. (See The Rise of Superman about chemical exhaustion in the brain.)

At an organizational level, we’ve seen an increased awareness of the problems of engagement, which closely track what we see at an individual level as burnout.  Gallup has routinely demonstrated that about one-third of people are engaged, one-third are neutral, and one-third are actively disengaged.  The reported symptoms are:

  • Increased absenteeism
  • Low level enthusiasm
  • Quality of service declines
  • Lack of focus
  • High level of complaints
  • Lack of communication
  • Lack of acknowledgement of “strokes”
  • Lack of openness to new ideas

Strategies for Dealing with Burnout

The book continues with a list of strategies for dealing with burnout, both personally and organizationally.

The personal strategies are:

  • Awareness
  • Contact
  • Peer professional
  • Work under good supervision
  • Personal skill building
  • Carving out professional time
  • Help without rescuing
  • Personal work contract
  • Dealing with one’s own unfinished business
  • Work with someone you like
  • Learning to relax without having to work hard at it
  • Regular exercise
  • Nutrition
  • Learning and using assertive skills
  • Making a want list
  • Be creative with anger
  • Take time and space for yourself

Organizational strategies are:

  • Encourage staff to express feelings
  • Support/Encourage and reward risk taking
  • Provide ongoing supervision
  • Encourage sharing of needs and wants
  • Invite staff to participate in policy and decision making
  • Train staff in burnout
  • Train supervisory staff in burnout

These approaches are not fundamentally different today than back then – even if few people are able to do all of them.  Perhaps that’s why Professional Burn-Out remains a problem today.

Book Review-The Art of Gathering: How We Meet and Why It Matters

Humans have gathered since our first dawn as a species.  We did so to share our resources and to protect one another.  We’re better together than we are alone, and it’s this togetherness that has allowed us to become successful.  However, because we’re so used to being together, we hardly give gathering a thought.  Occasionally, when we think about gathering a few more people than normal or people who don’t know each other, we’ll ponder it a bit, but it’s more accidental than intentional.  In The Art of Gathering: How We Meet and Why It Matters, Priya Parker explains that if we want to have successful gatherings, we need to put a bit of thought into it.

Go Further

There’s an old African proverb (the specific source of which can’t be traced) that says, “If you want to go faster, go alone.  If you want to go further, go together.”  It’s at the heart of why we gather.  It’s not faster.  It allows us to reach further heights.  Of course, there are a number of enabling conditions that must be just right for this to take place – but without the initial “together,” we can’t get there.

Conditions might include those that Kantor proposes in Reading the Room, those from William Isaacs’ work Dialogue, or the psychological safety proposed by Amy Edmondson in The Fearless Organization.  Efficacy may be found best using Scott Page’s approach in The Difference or Richard Hackman’s guidance in Collaborative Intelligence.

One of the most striking ways that people were brought together was in Florence, Italy, when the Medici family gathered people with different skills and interests and allowed them to work and interact with one another.  (See The Medici Effect for more.)  Their efforts to bring people together kicked off the Renaissance period.  We discovered that there were ways of teaming up and sharing that were effective at driving creativity and productivity.  (See Team Genius for more.)

Finding Purpose

Organizations which were once plagued by ineffective meetings and who have now encountered an enlightened leader require that meetings have agendas.  The agenda spells out why people are gathering, what the desired outcome is, and which items will lead to the desired outcome – at least, good agendas do this.  “Wasteful meetings” is a common disdain that comes from both internal and external large corporate surveys.  Too much time is wasted in meetings where there is no objective or agenda.  People meet because they believe they’re supposed to meet rather than to get something specific done – or to coordinate on a specific project.

Simon Sinek in Start with Why encourages us to find the purpose before everything else.  Steven Covey describes it as “first things first” in The Seven Habits of Highly Effective People.

The Law of Numbers

The size of the group matters.  Small groups of around six offer intimacy.  Groups of 12 can build trust – and some intimacy.  Groups of 30 start to create buzz and electricity.  Groups of 150 are about the limit to the number of people that can feel like a single group.  These numbers are consistent with Robin Dunbar’s research.  (See High Orbit – Respecting Grieving.)

When planning a gathering, planning for the number of people is key to designing for the purpose of the gathering.  While you may want to invite more people, sometimes those additional people can disturb the goal.

Venue Vectors

Venues come with scripts, patterns that tend to play out over and over.  They’re expected, and that expectation drives more of the same.  Sometimes, the patterns are so ingrained that we don’t even see they’re happening.  Meet at a college, and people will expect to be lectured to – rather than engaging in a discussion.  Meet in a library, and people will expect to stay quiet.  (See The Public Library for more on library culture.)  The coffee shop implies a casual meeting rather than one with a drive through an aggressive agenda.

When you pick the venue, you’re necessarily shaping how the interactions will happen.  More than just the traffic flows and the catering options, venues veer us towards or away from our purpose.

Don’t Leave Me Alone

As the host of the gathering, there’s a tension between over-controlling the event and failing to let things spontaneously emerge and under controlling the event and leaving the participants to fend for themselves.  (See On Dialogue for emergence.)  There’s the idea that, if you don’t structure the time, people will be left to themselves.  The truer response is that they’ll be left to the mercy of the other participants – and that can have some embarrassing results.

Parker recounts an event where too much freedom was given to participants, and despite the small talk, they had managed to not get introduced to one another – and, as a result, the conversation was strained.

Social Contracts

All gatherings are social contracts.  People give up something – most notably, their precious time – and they want to know what they’ll get for it.  Sometimes, it’s the opportunity to meet someone new, hold interesting discussions, or have a new experience.  However, there’s always some implicit contract about what they’re giving and what they’ll be getting – or, at least, what they might get.  After all, in most situations when we attend a gathering, we don’t know for sure what we will get.  We get a raffle ticket and hope that our number is picked for a prize.

Failure to articulate the value proposition – or potential value proposition – for the group is a surefire way to have people fail to accept the invitation and fail to show.  With group dynamics being what they are, there’s no telling what not having the right – or enough – people may do to your gathering.

Strange Confessions

Sometimes, the groups that come together can share honestly because they don’t know each other – not despite their lack of relationship.  Sometimes, the things that people must share are too heavy to be borne inside of a long-term, caring relationship.  They must first be tested in the waters with relative strangers to provide comfort that they may be shared with closer relationships without fear of recrimination.  The strange thing about the group in which these things are shared is that they invariably end up feeling like sacred spaces.  People bond and connect quickly – even if those bonds turn out to be fleeting.

Hot or Cold

For most people, the conflict in a new group is anxiety producing.  Most people are conflict avoidant, and the sometimes candid and direct feedback that evolves between two or more participants in a meeting can make others duck and cover.  Clearly, this doesn’t allow everyone to bring their best selves.  On the other extreme, there’s the problem of groups who are too conflict avoidant, and the conflicts that the group needs to have never happen.  As a result, the group gets stuck being nice and getting nothing done.  Even in gatherings, we need to consider how the group dynamics are playing out, which conflicts need to happen to get out in the open, and which conflicts can be safely avoided because they can’t serve any purpose.  (See Radical Candor for more.)

Turning an End into a Closing

Kahneman explains how the Peak-End rule guides what we think of events.  (See Thinking, Fast and Slow.)  His research showed that the ending of any experience mattered more than it should.  While endings are often left to chance, they need to be an integral part of your planning.  Parker suggests that you not end with thank yous – those can be second to last.  Instead, end with the thing that you want people to most remember or experience.  If you do it just right, you may find that everyone has a powerful and moving experience in The Art of Gathering.

Book Review-The Element: How Finding Your Passion Changes Everything

Like most people I know, I’ve not found that “one” thing that my world revolves around.  I’ve found passing interests and desires, but no central theme has emerged.  The Element: How Finding Your Passion Changes Everything is a series of stories designed to lead people to the discovery of that one thing.  Of course, this is not the only or even first book to guide readers towards finding their passion.  The ONE Thing is another example.  Unlike it though, The Element’s approach isn’t a systematic decomposition of life and its facets; instead, Ken Robinson and Lou Aronica lead us down the winding path of others who’ve found their calling.  It should be cautioned that all paths are winding – as was made clear in Extreme Productivity – and that not all winding paths lead to the desired destination.

Losing Touch

One of the key observations is that we start life with passions and little skill.  We finger paint and read the responses of the adults in the room.  From this we decide, unconsciously, whether this is something we’re good at or not.  Judith Rich Harris explains the subtle bending process in No Two Alike, where small differences in responses can send us down one road or another.  In Creative Confidence, Tom and David Kelley explain how they believe sometimes our creativity is stamped out of us by education and the process of growing up.

The consensus is that we’re often born with an innate sense for the things that we can do, and these are whittled down over time.  This is consistent with the neural pruning that happens within the first few years of life.  We start with more than we need, and then we whittle that down into what we think we’ll use.

Standardization

Measuring performance is something that can – and often does – lead to improved performance.  The advent of statistical process control and continuous improvement have been a boon to manufacturing over the last half-century.  We’ve learned how to be more efficient – and, occasionally, more effective.  The two are not the same regardless of how similar they appear in the English language.  Efficient is doing things with less waste and more output.  Effective is doing the right things.

Manufacturing principles have been applied to other industries, including healthcare and education, and the results are mixed.  In education, we’ve standardized such that the things we measure – standardized tests – have become all we work for.  When teachers are measured on math and literature, art isn’t as important.  Nor do sports bubble to the top.  (See It’s How We Play the Game for another perspective on the importance of sports.)  The result is what Deming predicted: you get what you measure.

There’s an old Dilbert cartoon where Dilbert and Wally receive news that there will henceforth be a bounty for each defect found.  Five dollars for each one.  In the next frame, Wally comments that he’s off to “Code myself a minivan.”  This, of course, implies he’s going to intentionally create defects he can later find and resolve.  The system would be perverted by a malicious actor.  No such malintent exists when a teacher tries to save their job and their school by finding ways to improve results on standardized tests – irrespective of whether students will learn to live life better or discover their talents.

It’s not that standardized testing is bad or that we shouldn’t do it – it’s that there are negative impacts to be considered.  One of those is that we may be squashing out people’s natural talents to fit the test.  Howard Gardner in Changing Minds explains that not all intelligence works the same way or fits into the narrowly-defined limits of most standardized testing.

In The Years That Matter Most, Paul Tough explains how the SAT and ACT standardized tests for college entrance are hopelessly flawed at predicting success or identifying intelligence beyond the narrow frame of academia.

Prepare to Be Wrong

There are two dimensions of wrongness.  The first is the heart of the learning process itself.  We make mistakes, learn from them, and do something different the next time.  The other level is how the world will respond to originality, how the systems will attempt to reject something that isn’t the familiar status quo.  (See Originals.)  Systems need to protect themselves from entropy, and as a result, they have a tendency to stamp down anything that doesn’t fit the mold.  The problem with this is that, sometimes, the systems aren’t designed in ways that people can learn and grow into their Element.

This all means that the systems are set up to prevent you from finding your Element.  You’ll need to be diligent if you’re going to find what should be truly yours.  In Work Redesign, we learned about Ralph, who, after years of being beaten down by the system, couldn’t be reengaged to take on more work, responsibility, risk, and opportunity.  That happens to us all – unless we can persevere in our being wrong in the world’s eyes.  (See Willpower and Grit for how to do that.)

Seek Encouragement

Some people, as Liz Wiseman points out in Multipliers, can encourage people to do more and better than they can do on their own.  One of the most challenging things about finding your Element may be finding the people who will continue to support and encourage you along the way.  Like Sherpas who know the path, mentors and other encouraging people can help you recognize that you can find yourself.  Much of The Element is about getting parasocial encouragement knowing that many others struggled to find themselves but succeeded.  The book ends with several people who didn’t find their Element until the second half of their life.  The path to find their Element was long and winding yet ultimately rewarding.

“Think Different”

It’s an old Apple slogan, but it’s also a recipe for better results.  Scott Page in The Difference explains how different perspectives make for better teams.  The difference in perspectives, experiences, and upbringings allow the room to see multiple sides of the situation and thereby consider options and approaches that simply wouldn’t be possible with a single person.  It’s the way that we can get to better outcomes – not necessarily quicker outcomes.

If you follow the path of conformity, you’ll never find your Element.  It requires unwavering consistency to search.  It will be in the last place you look for it.  If you’re persistent and perhaps a little bit lucky, you’ll just find The Element.

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 NormalIn 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.

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