Book Review-Invisible Heroes: Survivors of Trauma and How They Heal

Trauma survivors aren’t heroes in the same sense that a first responder is.  We see the first responder at the scene of an accident, like a house fire, and see how their actions are protecting all of us.  We don’t get to see the hard work that trauma survivors do, because their work is internal.  That’s why the title Invisible Heroes: Survivors of Trauma and How They Heal makes so much sense.  The work is invisible on the outside – until the trauma victim reemerges transformed by the trauma.  (See Transformed by Trauma for examples.)

Predictable Pacification

Too frequently after a trauma, a person blames themselves.  They think that they somehow – often magically – should have avoided the situation.  Of course, in many cases, there is no way to see or avoid the situation.  It’s one of the random things that happen in life.  Even in those cases where we could have made different choices – and likely will in the future – there’s little reason to ruminate over the choices that were made.

This need for a sense of control – innate to all humans – drives us to take too much accountability for the things that have happened and how we might have made things turn out differently if only we had done something differently.  We fail to accept that we may not have done anything wrong or incorrectly.  We believe we had to have done something wrong, so that we can maintain our belief that the world isn’t random and that we’re able to predict it.

The degree to which we believe we can predict the situation influences the degree to which we feel peaceful.

Unworthy

One of the challenges with the unnecessary attribution of blame to ourselves from the randomness of life is that we can take on ourselves a sense of unworthiness.  That is, we believe that not only did we make a mistake (guilt) but that we’re unable to do the right things (shame).  We start with shame, but eventually we start self-punishing and self-isolating, perhaps progressing even to a place where we believe we’re irredeemable.  There’s nothing that can happen to make us worthy of interacting with other mortals.

Sometimes, this thinking style becomes so pervasive because of continued trauma and abuse that the idea of returning to what others would consider normal is uncomfortable.  It can feel weird and uncomfortable for people to treat you as a fellow human instead of someone beneath them.

The truth is that no one is irredeemable.  Everyone deserves to be treated as a human – even if that’s not their norm.

Demarcation

Substantial traumas often create a division in a person’s lifeline.  There’s a time before the trauma and a time after the trauma.  Often, traumas cause a major change of course.  One of the ways you can recognize that someone acknowledges their experience was one of trauma is that they’re able to acknowledge their life is different – in more than a tactical and mechanical kind of way.

With smaller traumas, or traumas that persist over a longer time, it’s harder to see this demarcation point, but it’s rare that trauma doesn’t cause us to change in some way or another.

Something that Happened to Me

With time, in the post-trauma space, it’s possible to recount the trauma without reexperiencing it.  Until we can establish an explicit memory of the trauma and come to some terms with what it does – and does not – mean, many victims reexperience the event while retelling the story.  With new traumas, it’s important to not push them to recount the events, because doing so may accidentally amplify and anchor the trauma in their mind.  Rather, we should let people share at the speed, detail, and level that they’re able to.  If we can create a safe space for them to process the trauma, they can move it to something that happened in the past.

It is even better when we can recognize that one trauma or even multiple traumas don’t define us.  Yes, there is that demarcation line where things changed, but it’s not the entirety of who we are.

Work is Hard and Necessary

I’ve never found anyone who would dare to say that overcoming and moving past trauma is easy.  Even those who are grateful for where they are today would neither recommend their trauma nor relish the work they had to get to their place of healing.  Victor Frankl in Man’s Search for Meaning explains his time at a concentration camp.  While he exposes some of the things that helped him and others survive, he doesn’t recommend it.

There’s a delicate balance of experiencing the event while replaying it at a level that’s safe enough but vulnerable and raw enough that it’s possible to make sense of the event.  Sometimes, the only sense of control you can get in a trauma is the extent to which you allow yourself to experience it and your insistence that it won’t define you.

Mastering the Waves

Trauma survivors will tell you that you’ll always experience triggers that connect you to the traumatic experience, but they change.  It can be likened to riding an emotional wave on a surfboard.  You are still moved by it, and you’ll likely end up in the water at some point.  In the meantime, you can stay above it, using the energy to propel you forward.  Surfers, even professional surfers, fall off their board, but until they do, they’re able to do some amazing things.

One way to make trauma better is to learn the skills that allow you to spend more time above the wave and less time being pummeled by it.

Internal Perception of Danger

One step is recognizing that, often, the danger and fear associated with the event are in the past.  It’s quite likely that the fear of that moment doesn’t continue into the current moment – or shouldn’t.  What we come to realize is that it’s our internal perception of danger that matters more than the objective measure of risk.

We can use a set of well-known techniques to shift our perception away from momentary and current danger to a sense of relative safety.  Some of those techniques are below.

Play Acting a Different Ending

It’s magical thinking.  It’s the domain of the two-year-old – but it works.  For Victor Frankl, it was imagining his wife.  He knew she might be dead, but hearing her speak to him transcended that actuality.  He was able to create a scene in his mind that he knew to be reassuring but also false.

One way that we can reduce the suffering associated with trauma is to replay the event in our mind with different endings.  We can know they’re not real but at the same time be comforted with alternate endings.

An Army of Heroes

One alternate ending that can be valuable is to call in for a hero you can trust – real or imaginary.  These heroes can stand with us in our mind’s eye of the moment.  For some, they have a single hero who can stand with them.  For others, it’s a cadre of heroes, each with their own special skills and protections to offer.

This stands in the fantasy land of the child and at the same time offers us healing.  The real heroes aren’t the Invisible Heroes of our imagination but are those who fight their way out of the wake of trauma.

Book Review-Reducing Secondary Traumatic Stress: Skills for Sustaining a Career in the Helping Professions

When you think about it, there are dozens of professions that are focused on improving society.  We think of first responders in terms of firefighters, law enforcement, emergency medical personnel, and 911 dispatchers.  However, we forget about our mental health professionals, teachers, child protective services, and dozens of other professions that are exposed to the traumas others are coping with.  Reducing Secondary Traumatic Stress: Skills for Sustaining a Career in the Helping Professions is designed to serve those who serve others by helping them learn to address the hardest parts of their jobs.

Burnout

Early on, Miller speaks about burnout harking back to Freudenberger’s Burn-Out.  He incorrectly associates Maslach’s work with Freudenberger’s, perhaps because that’s the narrative that has been spun.  (I should say that Freudenberger’s book isn’t the oldest book on burnout: that distinction belongs to Professional Burn-Out.)

Miller, however, correctly identifies the key to burnout as feelings of inefficacy.  He challenges the notion that you’re burned out at the end of a long career and explains that burnout happens more frequently at the beginning of a career – not the end.  Of course, this is consistent with the research we did when building Extinguish Burnout.

Compassion Fatigue

Miller similarly pushes back against compassion fatigue.  He argues that it’s not that you’ve expressed too much compassion, but rather that you’ve closed yourself off to all feelings and empathy with the result of failing to express compassion for those you’re there to serve.  In Is It Compassion Fatigue or Burnout?, we speak about it from the perspective that professionals have failed to do their self-care.  The result is the same: you shut down, and it’s this shutdown that’s perceived as compassion fatigue.

Systemic Stress

Too many mental wellness programs are little more than herbal tea, soft lighting, and a once-a-month yoga session.  While these practices have some value, they’re often crushed by the onslaught of 50-minute sessions, crisis calls, and complex cases.  The physician that can’t find time for a bathroom break between 15-minute patient appointments won’t find what they need at the bottom of a teacup.  The paramedic whose sleep was just interrupted to respond to an accident doesn’t need soft lighting.

We can’t assume that we can put a band-aid on a gaping wound, and it will all be okay.  We have to match the care that we give to the need.

Feel or No Feel – There Is No Try

My apologies to Yoda.  You can’t selectively let in some feelings and dampen others.  You can’t decide to let joy through but block depression.  When we numb – either naturally or with pharmaceutical assistance – we block both the good and the bad.  This is part of Miller’s point: when we try to block out the struggles of empathy, we necessarily prevent the development of compassion.  We can either choose to open ourselves to experiences and live, or we can wall ourselves off from the world and from others.  If we choose that option, we disconnect ourselves from the broader community and their support for when we’re feeling low.

No Feeling is Final

What we know about feelings is that they change.  Even moods change over the longer course of time.  (See Emotion and Adaptation.)  It is hard to remember in the moment that the feeling will pass.  (See Capture.)  However, the only thing constant about feelings is that they do change.

There is something to be said for actively shaping your thoughts while accepting them.  One can work to hardwire happiness without preventing acceptance of other emotions.  (See Hardwiring Happiness.)  Too many people believe that feelings happen to you – and it can certainly feel that way.  However, we know that you can consciously influence your feelings by focusing attention on the emotions that you want to have.  Caution is appropriate here so that we don’t over emphasize what can be done, as Bright-sided and Happier? Are concerned about.

Removing Rumination

Rumination is the opposite.  It’s focusing on the same situation and the challenges associated with it without finding ways to resolve the problem.  Instead of problem solving, rumination catches us in a net of repetition.  (See Capture.)  If we want to break free from rumination, we must either seek to solve the problem, or we must learn to let go.

Miller proposes an ACES (Action, Concrete, Experiential, and Specific) model for problem solving.  You know it’s not rumination when you’re coming up with specific, concrete actions that are doable.  Problem solving doesn’t mean that you must solve the end problem yourself.  Even identifying the specific set of actions you’re going to do to ask for help is enough to allow your mind to let go of it.

It used to be that I’d be caught in a loop of trying to not forget something that I needed to do in the morning.  Now, I grab my phone, send myself a quick one-line email, and go back to sleep.  Knowing that I’ll see it in the morning allows me to let it go and move on to the important need for sleep.

Letting go of something is the other option.  It’s easier when you’re deferring it, but for some things that we ruminate on, we need to accept that we have no control of.  We can’t prevent something from happening or cause it to happen.  No amount of rumination will change the outcome.  As uncomfortable as it can be, sometimes we just must let the cards play out the way they’re going to play.

Energy Management

The narratives around burnout, compassion fatigue, and secondary traumatic stress are collectively focused on a false dichotomy.  They generally believe that your energy is drained or consumed at work and refilled at home.  The expectation is that work grinds you down, and your home life is fulfilling and life-giving.  However, for many people, this isn’t the case.

At work, they feel effective and fulfilled in their role.  They know what to do and how to get good results.  At home, they’re in a constant struggle with their spouse.  Their teenage kids don’t listen to them and are downright hostile.  They don’t know what they did wrong or what it will take to fix it – but they know they don’t like it.

More often, it’s in the middle, where some things at work build and renew a person – but there are times of exposure to trauma and tragedy.  At home, they find both love and challenge.  It’s not about the place but rather about the moment-to-moment environment that defines whether someone is receiving more energy than they’re giving.

Driving with the Brakes On

If you’ve ever had the experience of having a car brake caliper freeze up, you quickly have discovered what it’s like to drive with the brakes on.  (Hint: it doesn’t end well.)  A less eventful situation might be what happens when you forget and leave a parking brake on.  Unfortunately, that’s what happens with too many people.  Their sympathetic and parasympathetic systems get locked into a fight, and they get stuck or oscillate.  If we want better results, we’ll find a way to either have the brakes on or put our foot on the accelerator.

Generally, when the parasympathetic system (brakes) is engaged, the sympathetic system shuts down – but not always immediately.  With patience and practice, it becomes easier to downregulate and recover more quickly when we do become triggered.

Blessin’ or Lesson

Miller quotes a Southern saying that “everyone you meet is a blessin’ or a lesson.”  In other words, they’ll either attempt to bring you good or bad.  Either way, you must learn to work with them.  Knowing ahead of time which one they are is one step towards Reducing Secondary Trauma Stress.

Book Review-Trauma: The Invisible Epidemic: How Trauma Works and How We Can Heal from It

When Paul Conti’s brother, Jonathan, killed himself with the handgun that his father had been issued in the Korean War, his life changed.  It wasn’t simply that he experienced the loss of his brother, but it also caused his desire to focus on understanding trauma and why he couldn’t see the struggles his brother was facing.  In Trauma: The Invisible Epidemic: How Trauma Works and How We Can Heal From It, Conti tries to expose the internals of how we process trauma so that we can learn to see it and process it.

For Generations

One of the often overlooked aspects of trauma is that it has a ripple effect that expresses itself across generations.  In Why Zebras Don’t Get Ulcers, Robert Sapolsky shares not only the research from the adverse childhood experiences (ACEs) study but also the work on fetal onset of adult disease (FOAD).  To clarify, the stress of the mother can have a negative impact on the health of the fetus.  More broadly, we’ve begun to learn that it’s more than genetics that leads to health outcomes, it’s epigenetics.

That is, our genes are activated and deactivated by our environments.  While two identical twins start out with an identical set of genes and gene expression, through different experiences, they can end up with different gene expressions – and therefore different outcomes.

The implications of this are that a traumatic event or set of traumatic events can send ripples across time into future generations.

Marshmallows of the Future

In the person themselves, trauma changes things.  It makes the world a bit less stable.  It causes us to believe that our dreams and aspirations aren’t possible.  They’re not real.  Irrespective of the facts, we insist on staying in the here and now so that we aren’t disappointed when the future disappears.  This has a negative impact on our ability to hope.  (See The Psychology of Hope.)

When Walter Mischel tested preschoolers to see how they could handle delayed gratification, he didn’t realize what he was measuring.  (See The Marshmallow Test for a full explanation.)  Ultimately, the test was about whether children would sit with a sweet in front of them for a short time without eating it, with the promise of more if they did wait.  (It wasn’t always a marshmallow that Mischel used.)  Retrospectively, it seemed that those who could delay longer did better in life.  However, what’s more interesting are the strategies that the preschoolers used.  Some could clearly see the value despite the future, discounting what Daniel Kahneman explains in Thinking, Fast and Slow.  Other research, including Paul Tough’s in The Years that Matter Most, leads us to understand that those who have the most trauma have the hardest time trusting in future gains.

More tragically, trauma can leave us questioning our self-worth and our gifts.  We begin to consider life in terms of some sort of grand karma.  If we’re really good and worthy, then trauma wouldn’t happen to us.  Of course, that’s not fair, but it doesn’t stop the evaluation.  As The Halo Effect explains, life is probabilistic, not deterministic.  Bad things do, in fact, happen to good people.  While Thomas Gilovich explains in How We Know What Isn’t So that we have a bias towards believing better of ourselves than we should, trauma can reverse that wiring, so we believe we’re not as good as we are.

Presumed Control

If you speak with an abused child before they’re removed from the abusive situation, you’ll often hear that they believe the abuse they receive is their fault.  They believe that if they’re just a better child, their mommy or daddy won’t hurt them.  This illogical conclusion is the one that their minds are forced into, because the alternative is more painful and tragic than believing that they can, with their behavior, prevent the abuse.

If the abuse has nothing to do with how good or bad they are (or their behavior at all), then it’s unpredictable and unstoppable.  They must believe that the abuse and pain will continue forever – and that’s not something they’re prepared to do.

We all do this throughout our lives, not just in childhood.  We try to take control of the situation, so that we don’t have to fear it.  (See Compelled to Control for more.)

Inciting Illness

One way that we see this same dynamic in adults is when they believe that the trauma they experienced is their fault.  From the automobile accident that they blame themselves for to the cancer that couldn’t have been prevented, people believe that it’s their fault.  The result is shame – “I am bad” – driving the sense that they need to punish themselves.  Somehow in the punishment, they’ll equal out the scales of justice.  There are two key problems with this.  First, the sources of the traumas are almost universally external to the person.  Second, no amount of self-flagellation will even the scales.

Inadequacy

Brene Brown calls it “enough.” (See I Thought It Was Just Me (But It Isn’t).)  It is the feeling that we’re not “good enough.”  We’re not “doing enough.”  We’re not worthy of what we have or even of being on the planet.  It’s the less extreme form of impostor syndrome that too many people routinely feel.  While inadequacy can be a powerful drive to cause people to strive to do more and be more, it comes at a cost.  The cost is both the happiness of the person and, sometimes, their life.  In Perfectionism, we learned the psychic toll that perfectionism – or inadequacy – brings.  When we believe we’re not enough, we can never get a break from ourselves.

The Costs of Survival

We celebrate the survivors of trauma of all kinds.  We admire their strength and their courage.  However, we never ask ourselves what it took to get there.  We celebrate the war hero who walked his team out of the firefight, and we don’t ask what he had to do.  We don’t want to know about the prisoner or little kid he had to kill to survive.  We don’t want to know how deep that trauma goes.  We fail to notice when we try to celebrate them, and they squirm away.  It’s more than being shy.  It’s a deep sense that if people knew what they had to do, they wouldn’t celebrate their return home in the same way.

Computers and Chainsaws

Both computers and chainsaws are tools with immense positive potential.  They’re also tools through which someone can inflict suffering.  With both, if we learn how to operate them safely, we can prevent trauma.  The unfortunate reality is that anonymous forums lead to mob-like or gang-like behavior where people become worse than they’d be on their own.  (See Going to Extremes and Delinquent Boys for more.)

Protecting people from unsafe spaces is, in part, requiring that individuals be held accountable for their comments – or, at the very least, having their name attached to them.

Not Mine

Whenever there’s a negative outcome, it’s appropriate to ask to what degree your behaviors influenced the outcome.  What could you have done differently?  What should you do next time?  These are healthy questions that can take an unhealthy turn we if decide that we need to not only own our own dysfunction in the situation but the dysfunction of others as well.  A wise friend once explained that “that’s not my shit.”  She explained that sometimes you’re not responsible for the negative outcome – or certainly not responsible for all of it.

It’s important to take responsibility for your part – but equally important that you not take responsibility that’s not yours.

Facts and Fallout

The law is concerned (ostensibly) with the facts.  They want to assign guilt and blame.  They are not equipped to help trauma victims cope with the fallout.  The penalties that are assigned to criminals are used as a deterrent to prevent their own and others perpetrating the crime in the future.  There as some crimes – like murder – for which there is no compensation.  Criminal trials aren’t concerned with that.  Civil trials are, but only a small fraction of trauma-inflicting events are the subject of a civil suit.

Criminal trials are themselves sometimes more trauma-inflicting than healing.  It can be hard to confront the person who injured you and hard to defend yourself against the questions and implications of their attorney.

Pre- and Post-Trauma

When people have a single, defining trauma, there seems to be a bright line between the before and the after.  The trauma created a change in the person (that may still be evolving).  That change can be seen in the pre- and post-worlds.  Sometimes, people speak of recovering or returning to the place before the trauma, but the place no longer exists.  We must build a new place with new awareness – and that isn’t always easy.

Given that it’s estimated that 90% of us will experience trauma in our lives, it makes Trauma: The Invisible Epidemic.

Book Review-Fighting Fires: How Emotional Trauma Sparks an Inferno

For many first responders, firefighters included, the idea of mental health is for the other guy.  It’s a tough job and you’ve got to “man up” and be tough.  However, at the same time, the things that first responders see, hear, do, and not do, are unforgettable.  They’re confronted with the worst that humanity has to offer.  It’s the most suffering, the most cruelty.  It’s also times of greatest compassion.  Fighting Fires: How Emotional Trauma Sparks an Inferno is David Lewis’ journey through trauma that he experienced outside of the job, inside the job, and through life.  No question he experienced trauma through his work as a firefighter, but that wasn’t the only trauma he experienced in his life.

Fire and Smoke

Lewis describes mental health as the pillar upon which life is built.  It’s a sound argument, since the life we experience is the one that we create.  Incognito shows us just how much of our lives and what we think is reality is made up.  Life is really what we make of it – and it can be filled with fire and smoke, or it can be fresh air.

Lewis uses the analogy that fire is the traumatic events that you see, hear, do, or experience.  Smoke is the problems as a result of that fire.  He properly places the focus on the fire portion, recognizing that smoke is a result of fire.

The Charlatans

Early on in Lewis’ attempts to get better, he describes running across an “internet guru” that claimed to have the elixir that Lewis needed to be “fixed.”  All it would take is a credit card.  The free materials seemed good, so Lewis parted with hard-earned money only to realize that the content behind the pay wall wasn’t really worth it.

The real problem is it’s easy to make things look like they’re good when it’s shallow; it’s hard to make sense of it when it’s deep and it matters.  I cannot count the number of burnout books that I’ve read where the authors had no breadth or depth in what they’re saying.  They saw the opportunity to make a buck selling some books and consulting, and they dropped right in.  (Even Maslach’s latest book, The Burnout Challenge, is woefully under-researched.)

Even professional mental health providers rarely read research or use evidence-based techniques.  Too frequently, they just do what they think works, leading to Science and Pseudoscience in Clinical Psychology and The Cult of Personality Testing.  Even in an area where the public is supposed to be protected through licensure, we’re confronted with the need to carefully screen people, as Lewis points out later in the book.

Coloring in unicorns may be fine for an eight year old, but it’s not appropriate for a professional firefighter – or most other adults, for that matter.

Buffalos and Cows

For the most part, cows and buffalo seem like similar animals.  They’re both mammals.  The buffalo burger is leaner but is similar in taste to a hamburger.  (Why “hamburgers” come from cows not pigs is a mystery.)  However, they have some different behaviors.  One is how they cope with the stress of a storm.  They react like people react.  Buffalo charge into the storm, while cows walk away from it – even when they’re in the midst of the storm.

The subtle change of moving into or away from the storm has a profound effect on how long the animal is in the storm.  The buffalo will spend much less time in the storm than the cow, because the storm passes over quicker.

As humans, we often turn away from our challenges expecting that we can escape them – but rarely is that effective.  Sometimes, the right answer is to face the storm and walk into it.

Blocking

When the mental anguish becomes so strong that you’re fighting intrusive thoughts, there are many strategies that one may employ in an attempt to retain balance.  Unconsciously, there may develop a tendency towards obsessive compulsive disorder (OCD), including ritualized approaches to common activities.  We can deceive ourselves into believing that these activities protect ourselves and our families, when in reality they deprive us of the resources that we need to heal.

A more common and more socially acceptable approach is to become a workaholic.  (See The Globalization of Addiction for more.)  After all, being a workaholic means that you’re providing for your family.  However, the dark side is that work becomes all-encompassing, leaving little of the person for themselves or their families.  It’s common to believe that if you just work harder, you can block out the feelings and memories.  However, doing so deprives you of the very resources you need to live – and to recover from the pain and trauma.

Control

As Compelled to Control clearly points out, we all love the illusion of control.  The illusion protects us in a random and ultimately unpredictable world.  It calms our consciousness as we confront the challenges of the world.  If we’re in control, then we don’t need to fear the world.  We can feel safe.

Some would say that we can control ourselves but not others.  However, in some ways, we’re so influenced by our environment, and we respond so instinctively at times, that it’s hard to convincingly say we’re even in complete control of our own reactions.  (See Thinking, Fast and Slow for more about how we lie to ourselves.)

Defined by Our Responses

It’s not the tragedies and struggles we’ve faced that define us.  What defines us is how we respond to them.  Problems, struggles, and challenges are the substance of life.  We can’t escape life without problems.  In fact, sometimes when we believe we’re helping animals, we’re dooming them, because they need the struggle.  (See Beyond the Wisdom of Walt for more.)

There’s no shame in being injured – if we can heal.  If we need help to be able to heal, then we should ask for it.

Worst Case Scenario

Sometimes, we’re so afraid of playing the worst-case scenario game that we won’t play it at all.  Other times, we won’t play the game fairly.  In a bit from a comedian friend, he speaks how his mother moves from how he isn’t overly responsible through owning dogs to having a child that dies of neglect.  This wholly illogical chain of thinking is the way that too many people think about worst-case scenario.

Instead of looking to the things that can happen and reasonably evaluating their probability and impact, we focus on the case where the Earth is impacted by an asteroid – something that’s both always a possibility and something that we have no ability to prevent or mitigate.

By avoiding the game, we trap ourselves into a set of beliefs about a threat or stressor that aren’t realistic.  Like a large shadow from a small person or animal, we magnify the size of the problem, because we refuse to look at it directly.

The Balance of Life

In a state of suicidal crisis, it’s possible to lose all sense of scale.  Lewis explains how buying a toy for his son and dying by suicide seemed to be of the same magnitude.  Somehow, he thought that the scales of justice would be even.  Reflecting on it, Lewis can see how “jacked up” his thinking was – but in the moment, the evaluation of the balance of life was such that it had no special meaning.

The research and reflections seem to validate Lewis’ experience that life and the possibility of hope aren’t given their due significance.

Focus Forward

Trauma, whether acute or chronic, is a tragedy.  It’s something that each of us must learn to process, to come to terms with.  We can’t run from our challenges, and we can’t pretend they don’t exist.  Eventually, they’ll add up to a point where they compel us to address them – and by that time, they’ve grown fearsome.  If we get the choice, we should want to pick smaller fires when we’re Fighting Fires.

Book Review-Trauma Therapy and Clinical Practice: Neuroscience, Gestalt, and the Body

A common experience in trauma is dissociation.  One of the clinical therapies most focused on grounding and being present – the opposite of dissociation – is Gestalt.  The intersection of these two opposites is an interesting space for healing.  Trauma Therapy and Clinical Practice: Neuroscience, Gestalt, and the Body walks in the middle of the experiences and shows how one might connect the two.

If you need a definition of psychological trauma, please see Trauma and Recovery.

Living in an Uncertain World

The heart of the problem with trauma is some event that shatters our beliefs about the world.  Psychological trauma is an event – something you’ve experienced or done – which cannot be integrated into your beliefs.  Too often, the belief that’s called into question is the one about the world being predictable.

Many people see the universe as a big clock with gears spinning and whirring.  Everything has the mechanical precision of cause and effect.  There’s no room for chaos theory or Lorenz’ tornado-causing butterfly.  (See Facilitating Organization Change.)  It is this predictable world that we live in, because it’s a place of safety.  If we believe the world is probabilistic, then we’ve got to accept that bad things can happen to good people, and that’s not okay.

Still, we know that probabilities exist.  We watch batters swing and miss at the baseball plate.  We play the lottery and expect to win – knowing that the probability is very small.  We spin the wheel and roll the dice but keep for ourselves a separate thought about the safety of our world.

The first thing to accept about our world is that it’s random and impermanent.

The Disconnect

Central to Gestalt is being in contact with oneself.  This is a conscious, and non-judgmental, assessment of the body and mind.  This includes feeling our breathing, our heartbeat, the state of our muscles, and so on.  It also includes an assessment of our emotions and whether they appear to be influencing bodily processes.

In some cases, trauma victims believe that exploring these sensations is dangerous, because it will bring back the traumatic event or that, once experienced fully, they’ll not be able to contain them.

Expanded Choices

A sign of trauma is constricted thinking.  Some things are, quite literally, unthinkable.  So, one sign that someone is recovering from – or healing from – traumas is the capacity to consider other options.  Capture explains how thoughts can sometimes enter downward spirals.  In Trauma Therapy and Clinical Practice, the statement is about the barriers to escaping those cycles.

The reality is that we always have choices.  Instead of the tightly coupled idea that someone or something “made you” do something, the more accurate statement is that you reacted to their action.  Emotion and Adaptation explains there’s a gap between stimulus and response, and that gap allows us to respond rather than react.  We can, in fact, choose our responses, if we decide we want to and we practice it.

Regulated Arousal

Much of the work on psychological trauma resolution is on increasing our capacity to process the event.  This can mean increasing our resources or decreasing the impact of the event.  Much of that is finding ways to regulate our arousal as we consider the event.  If we can reduce the emotional responses, including fear, to a more manageable level, we can better process the event.

On the surface, it sounds simple, but it requires a set of techniques like desensitization, building safety, and the core work of Gestalt, grounding.  These tools and others allow traumas to be processed and thereby stop their intrusive nature.  (See Trauma and Memory for more.)

Between Too Ordered and Too Disordered

Live is about making decisions.  It’s selecting the right choice or option for us at the current moment.  Much has been written about how we make decisions – and the consensus seems to be that there’s an optimal range for people to operate.  (See Decision Making and Sources of Power for more on how we make decisions.)

Gestalt views this from the lens of being too ordered – or too disordered.  You wouldn’t expect that even creativity is helped by some bounds, but that’s what Creative Confidence says about how to be creative.  So, despite getting a bad reputation, constraints can be helpful.  Simultaneously, they can be too restrictive and can choke off both creativity and joy.

Sometimes the traumatized person has added constraints to their world (by themselves).  It’s important for them to determine whether those constraints are too much – or if they need to add some healthy boundaries and limits.

Hovering at the Thresholds of Tolerance

Flow is a highly productive state that lives in the narrow band between challenge and capability.  (See Flow, Finding Flow, and The Rise of Superman for more.)  In this gap, research finds 5x performance gains and real growth.  It’s not hard to imagine how hovering around the edge of our tolerance might be a powerful way to learn to process trauma.  In fact, this is the core of desensitization: keeping people safe while moving them progressively closer to something that triggers them.

By hovering at the edge of tolerance, at the edge of safety and our capacity, we expand that capacity and make it more likely that we can process trauma at some point.  It’s critical here to celebrate the progress, because it can seem painfully slow when you want a solution now.

They Can’t Hurt Me, I’m Not There

Dissociation is a natural response to an overwhelming event.  When the event is very close to the threshold for processing, it may be that it’s only compartmentalized.  That is, we’re aware of it, and we can’t process it, but we’re still present and connected.  At the other end of the continuum, there’s severe, clinical dissociation.  Dissociation is a process of distancing ourselves from an event to protect ourselves from it and its impacts.

Obviously, if there’s physical trauma, dissociation doesn’t prevent that physical trauma from happening.  It does, however, separate the processing of physical trauma.  For instance, someone in an accident may see the scene from outside (and often above) their body.  They don’t feel the pain associated with physical trauma, because their consciousness is separate from their body.  It’s this dissociation that led more than one trauma victim to say, “They can’t hurt me, I’m not there.”

A technique recommended in the book when speaking with people who may be dissociating is to ask them what percent “in the room” they are.  It’s a continuum between wholly present and not present at all.  Often, the person you are speaking with – when prompted – can judge the degree to which they are currently dissociated, providing clues about whether it’s time to add more safety to the conversation or whether it’s safe to press on.

Relationships for Healing

Healing happens in relationships.  When you look at the factors that most impact outcomes in psychological care, the number one answer is called the “therapeutic alliance.”  (See The Heart and Soul of Change for more.)  It is the relationship between the therapist and the patient.  It’s much more important than the actual techniques in use.

In difficult work with substance use disorder (SUD) patients, Motivational Interviewing starts with engaging the patient, because without a relationship – even a professional relationship – nothing else matters.

While this book is focused on clinical applications, we know that we are most likely to influence the people with whom we have a relationship.  In fact, Everett Rogers in Diffusion of Innovations believes that it’s the only thing that can change someone’s attitude – and ultimately their behaviors.

Disorganized Attachments, Trauma, and Cults

Perhaps the most disturbing thought from Trauma Therapy and Clinical Practice is the way that trauma creates a disordered attachment style where none existed before.  Terror, Love, and Brainwashing explains that it’s disordered attachment that makes cults possible.  Often, the cult leader induces the trauma – but it’s also possible that a recent trauma could make people more susceptible to cult leaders, because they’re already partially or completely in a disordered attachment style.

I don’t believe you need to be a clinician to find ways to help people who have experienced trauma reconnect, and Trauma Therapy and Clinical Practice may have the tips to make that easier and faster.