Transformation and Healing After Trauma, Loss and Grief

My Mythic Garden

A blog by author and trauma expert Gary W. Reece, Ph.D.

Trauma Legacy: Long Range Effects
By
Gary Reece, Ph.D.

One of the dubious benefits of aging, is that one begins to get historical perspective, a sense of the arc of history; not only one’s own, but of one’s profession and that of those with whom I have worked with over the years. This is all prelude to a very unique opportunity I have had in my life to follow previous clients through the course of their own histories. In particular, I have been working with a male client since he came to me as an adolescent, and periodically ever since, not continuously but as crises in his life occurred, he would seek me out and then we would work on a few issues and then he would stop. Recently he has returned at the age of fifty. The persistent theme in our work together is the trauma he experienced as a very young child and the recurring effects which continue to plague him as an adult.

John, I use this pseudonym for all my clients, and I have decided to pursue a course of treatment I am now using for individuals who have had unusually difficult life histories: most qualify for the diagnosis of PTSD. He represents a type of client whose life has been seriously, catastrophically affected by early life trauma. Its effects are so profound that they continue to dominate his psychological present life in very troubling ways. The most profound effects are an indelible sense of shame, overwhelming depression, and an outlook on life that is pervasively dark and pessimistic. He also experiences great difficulty with intimacy, trust and hyper-vigilance as he revealed in his last session. “I often get up in the middle of the night and patrol the house to make sure my family is safe, it’s like standing guard.” His trauma is so deeply embedded that he unconsciously believes that he does not deserve happiness and that sooner or later he is doomed. These are wide and encompassing areas of psycho-social development and function: areas that are particularly related to the inconsistent and troubling attachment behavior of John’s mother early in his history. As van der Kolk notes on the role of trauma, specifically attachment patterns:

Recent research has shown that as many as 80% of abused infants and children have disorganized/disoriented attachment patterns, including unpredictable alterations of approach and avoidance toward their mothers. . . Thus early attunement combines with temperamental predispositions to “set” the capacity to regulate future arousal; limitations in this capacity are likely to play a role in long term vulnerability to psychopathological problems after exposure to potentially traumatizing experiences. (Traumatic Stress, Pg. 186)

The source of these pervasive effects I have traced to his early history. That is why I decided to work systematically on seeing if we could recall his life story and try to systematically link together the trauma into one coherent narrative. The benefit of this approach is that it is 1) systematic, 2) begins the process of recall which leads to desensitizing the old pain, and 3) leads to integration of the material which has heretofore been dissociated. I call it Narrative because the effects have been so extensive and dominating that I believe that we must go back to the original event and integrate it into his own personal life story in order to reduce the effects, but also to make sense of it: a coherent narrative. This defuses the emotional component of the trauma as well as unlocks the dissociated elements and brings them to consciousness. We began this new approach last week.

But first a historical context for his life: I first saw John when he was in his late teens. He was brought to me by his family because he had been extremely withdrawn and had stopped eating. He looked weak and very depressed. I recommended hospitalization when he revealed to me that he was having very disturbing violent fantasies towards his family. This was in the era of Charles Manson and “Helter Skelter.” He was hospitalized in a psychiatric hospital for two months and then returned to see me on an outpatient basis. During the hospitalization he was placed on a series of anti-psychotic and anti-depressant medications. For months he remained very withdrawn and depressed. I had fears that he might remain in this highly regressed state. His biggest accomplishments were to make it to our regular weekly sessions and when at home struggled from his bedroom to the living room to watch cartoons.

At this level, about the only therapy that took place was going for walks in the park, play some basketball, and stop for ice cream while we talked. Gradually over a year he began to exhibit some signs of progress and his mood lifted. He surprised me one day by announcing he thought he might try taking a class or two at a local college: which he did. This was a major step forward.
I will compress this part of his history to say he completed college, got a job, dated, got married and had two children. He did this while working in his father’s trucking business. He did this for a number of years until the big economic crash which eventuated in moving in with his parents and going bankrupt. All of this, of course, was traumatizing and caused him to return to therapy. I saw both he and his wife for several months. They weathered the bankruptcy and eventually were able to move and find a new home. Putting their life back together was difficult but they managed it. Surviving this major life crisis gave John an immense sense of pride in being able to create the dream he had always had, a home for his family. Part of his dynamic is a strong drive to be a better man than his father. In the mean time John decided, a complete break with his family was necessary. Since the family business was trucking, he decided to change professions and returned to pursuing his college course of becoming a psychiatric technician and got a job with the State working in a psychiatric hospital for the criminally insane.

This is a very compressed history of one person’s struggle to hold his life together and a tribute to his tremendous resiliency. There are some individuals I have worked with that when I get to know them; I wonder how on earth they managed to survive such horrendous life events in that they are functioning at a much higher level that one would expect, given their life histories. He is one of them. When I recount his beginnings you will also marvel at his ability to survive his extraordinary early trauma. Allan Schore comments on the power of this early trauma:
Most emotionally neglected or traumatized children do not turn into violent criminals or sociopaths. Usually if these children have had some positive relationships—for example with a grandparent or cherished teacher—they will manage to function, even prosper. However, those not so lucky will most likely suffer a sense of emptiness and loneliness, because they are unable to connect with others. Others connect, but only through relationships that are destructive or disturbed. (Allan Schore, Affect Regulation and Disorders of the Self. Pg. 303)

Beginnings
This is essentially the family history as we have been able to piece it together. John, told me in one of our sessions in the hospital: “When you shake my family tree, all kinds of nuts fall out.” What did he mean by that? Both sides of his family have serious major mental illnesses. His father was an abusive alcoholic, and his father was an abusive alcoholic. John’s maternal grandmother suffered from Schizophrenia, his mother was chronically depressed and anxious and suffered from Post Partum Depression after he was born. Her parents were also alcoholics and abusive, she was an only child. John’s parents married when she was 18 and he was 22 years of age. John has a sister who is four years older than he. She is quite dysfunctional and still lives with the parents and is unable to hold a job. John’s earliest memories of his family are one of “total chaos and weirdness: “Constant fighting, yelling and screaming with both parents drinking heavily.” He handled this by staying alone in his room listening to music and lying on his bed looking at the ceiling. That is the family context. This context reflects the attachment difficulties and patterns that were prevalent in his first years. In fact, the specific parental attachment behaviors that were likely to be at fault have been described by Lillas, who gives us a list of parental behaviors that lead to dysregulation in children. Below are a few of the behaviors she observed in her studies on parent-child interactions.

• Parent constricted emotionally
• Parent hostile-critical to child’s emotions
• Parent anxious, intrusive or distracted
• Parent overly hostile in punishment
• Parent withdrawn, not present
• Parent impulsively changes themes in play
• Parent vacillates between being permissive and overly harsh or rigid
• Parent physically abusive
• Parent too controlling or parent sets poor limits
• Parent at times indifferent to or resentful of child (neglectful)
• Parent does not exhibit pleasure or delight (Infant/Child Mental Health, Pg. 94)

These kinds of parental behaviors set up patterns that become a part of the emotional memories generated through every-day encounters. They eventually become linked in the child’s nervous system with other patterns of sensation and arousal which are reinforced through daily repetition and become styles of interaction. In short, they become the attachment paradigm, which is evident in his early history.

John’s early history: his mother drank and smoked while she was pregnant with him. He was born 5 weeks prematurely and spent his earliest weeks in an incubator. His sister had early medical issues causing the mother to feel very overwhelmed with two children and an alcoholic husband. The sister had heart problems necessitating several hospitalizations.
John’s earliest memory as reveled in our first narrative session. “I remember vividly being in a hospital at age 3. I am in a “Croup Tent.” I suffered from Asthma and Bronchitis due to my mother’s smoking. Anyway, I remember seeing them leaving me in this tent and I felt a sense of doom and desolation as they left me in the hospital room. The room went silent, I felt a weird buzzing kind of noise and then I shut down.” I explained to John that this is a classic response to overwhelming loss and abandonment: Dissociation. This is a condition caused by the fear being too great for a young child to process so the body disconnects from the feelings. This one incident is a metaphor for how John has handled his emotions since that event. He cannot feel. The only feelings he has are either rage or overwhelming, paralyzing depression which leads to a sense of being doomed. Chaos and neglect are the earliest forms of attachment trauma in his life. Dissociation is the most common form of defense a child can utilize to deal with what is essentially a problem without a solution. Schore describes the process:

A second later-forming reaction to infant trauma is seen in dissociation, in which the child disengages from stimuli in the external world and attends to an internal world. The child’s dissociation in the midst of terror involves numbing, avoidance, compliance, and restricted affect) the same pattern as adult PTSD) Traumatized infants are observed to be “staring off into space with a glazed look.” (Schore, Affect Regulation and Disorders of the Self, Pg. 248)

John’s earliest memories follow this theme of chaos and what he describes as family weirdness which appears to revolve around yelling screaming, fighting, and drinking. His tactic for dealing with all of this was to play alone in his room, listen to music and crawl into his shell and stare at the ceiling. His only respite from this was what he remembers as fond memories of going on trips to his grand mothers’ place up north near Reno, Nevada where she owned a bar. He would spend the summers there and feel some sense of peace and quiet, although he does remember being taken from bar to bar on family drinking episodes.

His first memory of ever feeling like someone was when he was 10, “little league coach noticed him and appeared to care for him.” This is profound in that his life up to this age is so shockingly devoid of affection and attachment.

Clearly we can see the persistent and pervasive effects of family disorganization manifested in John’s emotional life as a child. Schore write
Low Stress tolerance/disorganization and disorientation reflect the fact that the infant instead of finding a haven of safety in the maternal relationship is alarmed by the parent. Because it is natural to seek proximity when alarmed, any parental behavior that directly alarms an infant should place it in an irresolvable paradox in which it can neither approach, shift its attention, nor flee. At the most basic level, these infants are unable to generate a coherent behavioral coping strategy to deal with the emotional challenge. (Pg. 250)

Just these few samples from infancy, adolescence, and adulthood serve to provide us more than enough evidence of the long lasting effects of early trauma and neglect and the deeply ingrained attachment paradigm. Hyper-vigilance, difficulty in experiencing intimacy, shame/rage, a disordered world view of negative expectations, an immune system which has been compromised, a stress threshold that is very sensitized to threat, difficulty in self-regulation, inability to soothe himself: self-loathing, self-destructive behavior and chronic depression: these are the legacy of early trauma. They continue to permeate John’s emotional, professional, and domestic life. They are the determinants of much of his adult behavior that remain a constant repetition of his early traumatic life.
Van der Kolk summarizes nicely the residual effects of information processing in PTSD:
There are six critical issues that affect how people with PTSD process nformation: (1) They experience persistent intrusions of memories related to the trauma, which interferes with attending to other incoming information; (2) they sometimes compulsively expose themselves to situations reminiscent of the trauma; (3) they actively attempt to avoid specific triggers of trauma-related emotions, and experience a generalized numbing of responsiveness; (4) they lose the ability to modulate their physiological responses to stress in general, which leads to a decreased capacity to utilize bodily signals as guides for action; (5) they suffer from generalized problems with attention, distractibility and stimulus discrimination and (6) they have alterations in their psychological defense mechanisms and in personal identity. This changes what new information is selected as relevant. (Pg. 9) A person with this kind of history presents many challenges for a therapist. Working with John has been intermittent and crisis related: we would work for a period of time on the crisis of a particular period in his life, then he would stop coming until the next crisis. During this phase of treatment I tried to help him understand the roots of his difficulties and how they contributed to the patterns of behavior in his life. During several of his family sessions I tried to help him and his wife understand the core of their conflict. As is often the case the wife came from a similar background. Classically, he reminded her of her father and she reacted accordingly. And she reminded him of his mother, (anxious, controlling, critical, and depressed). (Her father was critical, angry, irresponsible, and she felt as if she could never please him, and was the blame for everything wrong in the family. You can imagine how this impacted their somewhat volatile relationship and hindered communication and understanding. Clearly both were responding according to an attachment paradigm learned at a very early age.

At the present time, she is seeing a therapist and working on her issues, and John has now made a commitment to work on his core problems. Treatment is slow, but the primary advantage is that I am one of the few individuals with whom he has had a positive and constant relationship over the many years of our history. It is this tentative attachment which will make it possible for him to gain even further trust and allow him to explore the deeply painful and traumatizing memories in order for him to recover from his early trauma. The goal is first to recall and then to explore the painful memories in order to defuse their intensity and break the dissociation barrier, thus freeing up his ability to feel and understand his emotions. This progression will lead to integration of his feelings and help him to overcome his sense of being shattered and depressed. Through my eyes I hope to help him develop a sense of compassion and understanding for himself instead of the shame and rage he now feels. These core issues are framed by his working model of the world as a dark, chaotic, threatening place that cannot be trusted: a world where he feels under constant threat.
Much of my work with trauma patients is informed by the work of Allan Schore. His book, “The Science and Art of Psychotherapy” forms the very foundation of my therapeutic approach. He describes the work in this manner: A general principle of this work is that the sensitive-empathic therapist allows the patient to re-experience dysregulating affects in affectively tolerable doses in the context of a safe environment, so that the overwhelming traumatic feelings can be regulated and integrated into the patient’s emotional life (Pg. 91)

What brought John to me this time was a major crisis symptomatically located in his body where he was experiencing a kind of seizure, a blockage of his entire back and pelvic area. This I came to diagnose as a collapse of the implicit self. It is signaled by the amplification of the affects of shame and disgust and by the cognitions of hopelessness and helplessness. The trigger for these emotions was his decision to leave his wife. Subsequently he moved into an apartment and then in a two month period felt this collapse of his core self and bodily experience of numbness and dysfunction. That’s what brought him back to see me. His entire demeanor was preoccupied by his feelings of shame and hopelessness. He was full of self-hatred because he felt he had violated his commitment to his family by abandoning them.

It is difficult to encompass the entire theory and philosophy of psychotherapy and describe the course of treatment in one short article. But I think Schore describes the encounter well when he describes it as “work occurring at the edges of the regulatory boundaries of the windows of affect tolerance and the fault lines of the self. In this encounter the therapist and patient are precariously balanced between order and chaos. The process is guided by the sensitively attuned therapist who provides a safe zone for the patient to explore the terror, deadness, and hidden fears and psychic catastrophes which have been blocked from awareness. I told him we will not break down the wall, but systematically allow for material to surface one painful experience at a time. The wall is there for a reason, to protect the vulnerable psyche from overwhelming terror. Terror and chaos balanced by structure and support provided by the therapist. Shame appeared to be the “monster behind the wall.”

This sense of shame was so immobilizing that I felt it must be dealt with before we could do any further trauma work. Schore eloquently describes the experience of shame: The experience of shame is like a microscope which amplifies and expands visible defects-undesirable aspects of the self are exposed. . .shame throws a “flooding light” upon the individual who then experiences a ‘sense of displeasure plus a compelling desire to disappear from view, an impulse to bury one’s face or to sink right then and there, into the ground. This impels him or her to crawl through a hole and culminates in a feeling as if he or she ‘could die.’ (Pg. 97)

Jean Paul Sartre in “No Exit” describes the experience more poetically as “A sudden shock induced deflation from grandiose omnipotence to a spiral-as a ‘flowing off’ or leakage through a drain in the middle of one’s being. A shame triggered crack in my universe.”

I think both of these descriptions describe very adequately the devastating and paralyzing effects of shame. It was this profound sense of worthlessness that we began with. It apparently surfaced like a tsunami when he separated from his wife and family. He was relentless in his self-disgust because he felt like he had “become like his father” something he worked his whole life to be the opposite of him.

As we discussed this sense of shock and shame: that he had “become like his father.” The feelings hung in the air; it was like a sense of desolation filled the space between us and despair “hung over the blighted landscape” where we both felt helpless that anything good could grow here” (Schore, pg. 98) This revelation was so heavy that he just sat there, unable to talk or feel anything. We sat in silence for several minutes. We both had a sense that we had opened up the wound that was at the core of his being. When someone reveals this deep sense of shame, the tendency is to want to hide and move quickly away because they feel so exposed, vulnerable and embarrassed. The therapist’s task is to support and permit the expression without judgment and to explore the depth of the feelings to expose their origins so that the client feels accepted, understood, and that these feeling can be tolerated and survived. This is essentially a continuing process of healing these very old and deeply embedded wounds. If he is to survive, he must face and feel these difficult emotions which have been so disconnected and kept him from feeling anything else. We will continue to work on learning to feel, care, and believe he is worthy of his life. Working with a shattered self is very delicate work, much like trying to Humpty Dumpty back together again.

I conclude this piece by another quote from Schore:

Though terror speaks of life and death and distress makes the world a vale of tears, yet shame strikes deepest at the heart of man. While terror and distress hurt, they are wounds inflicted from outside which penetrates the smooth surface of the ego, but shame is an inner torment, a sickness of the soul. It does not matter whether the humiliated one has been shamed by derisive laughter or whether he mocks himself, in either event he feels himself naked and defeated, alienated, lacking in dignity or worth. (pg. 97)

Rebuilding a life while trying to function in a stressful job, carry on family activities and maintain a relationship with your partner and being in constant inner turmoil requires great courage, tolerance for inner chaos, and commitment and trust in the process. It is a great privilege to be the guide on this amazing journey. The very essence of the Hero’s Journey.

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