“Dear Survivor”: A letter about the hard truths of healing from child abuse

Dear Survivor,

Credit: Oldangelmidnight from Northampton, MA

Credit: Oldangelmidnight from Northampton, MA

“Because then I knew it was over.”

That’s what most strive to feel about the lingering effects of childhood abuse, although not about the actual events. Those are long gone, and often dissociated from awareness.

Rather, most want to end sleepless nights and startled awakenings; feeling as if they live in a parallel universe, outside the world inhabited by ‘normal’ people who lack histories of abuse; intrusive images, feelings, sounds, and smells; the desire to drink, smoke, toke, shoot up, sex to oblivion; the avoidance of intimacy because of a seemingly endless reserve of anxiety simmering below a brittle surface of civility; or fighting because the rage never seems to dissipate and you just want to push back, because the planet is not big enough to hold all your hurt, let alone the emotional needs of another person.

At the first inkling of the wish to heal, some try to barter with themselves as a way out of this paradoxical life of repetitive chaos. This often starts with a naïvely made promise with oneself to be good. This promise usually starts with the belief that by being good and trying really hard, one day life will finally, if not miraculously, turn out differently. This is not an easy promise to let go of; even when it’s obvious you are failing miserably at keeping it.

Even so, there will still be a part of you that keeps the promise. Why? Often because of the secretly held wish that if you finally get it ‘right’ the love that wasn’t there will materialize, or your savior will come and magically change everything (releasing you from both effort and responsibility), or the opportunity for revenge will become available, and there you have it: the transformative moment you have waited for has arrived.

This I can tell you is a colossal waste of time and the imagination. Even if the perfect love, the ideal savior, or the opportunity for the most humiliating payback becomes available, you will never become who you might have been had the abuse never happened, or get the time back that you have wasted waiting for your personal Godot.

You might think I am giving you that old song and dance about picking your ass up off the curb, brushing off the dust of trauma, stomping its dirt from your shoes, and manning up to life’s inevitable trials and tribulations. Not at all. Rather, I think childhood

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In mental illness, let’s go beyond nature v. nurture to look at what interferes with the brain’s function

AmindbodyBased on her ethnographic study of psychiatric residency programs, anthropologist T.M. Luhrmann concluded psychiatry is “of two minds”: one “mind” emphasizes the role of neurochemistry, while the other “mind” places more importance on the context of our suffering, including relationships past and present.

Identifying the origins of mental illness likely depends on both interpretations. There is an undeniable organic component to mental illness, just as psychological and social conditions are inexorably linked to mental well-being. But like the Democrats and Republicans, these two approaches are often pitted against one another, often leading to that old, tiresome nature versus nurture debate.

Unfortunately, in a world of limited resources, including limited time, the implicit guiding question — Where should we place our focus? — naturally divides our attention. Is it helpful to explore genes and neurobiology in our efforts to reach best outcomes? Or is it better to explore the social conditions that contribute to mental disorders? Unfortunately, much like U.S. politics, the treatment of mental illness often is derailed when such questions become fodder for polarizing arguments that serves allegiances and professional agendas more than persons in the throes of mental suffering.

Instead of worrying if nature is more influential than nurture, perhaps it would be more helpful to identify what counts as optimal functioning for the brain. Perhaps we could then focus on the value of combining information, thus leading to better outcomes rather than increased competition (and often, market share). I think the significance of function often gets overlooked because we aren’t adept at looking at any issues from multiple levels. Although the term biopsychosocial was coined to address the issue of scale and focus in the treatment of mental illness, it often feels piecemeal in approach.

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Want to reduce mental illness? Address trauma. Want to save the world? Address trauma.

Our Earth and and moon.

Our Earth and moon

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Different explanations have been given for the increased number of people suffering from mental illness. Some have claimed the increase is the result of ever-expanding diagnostic criteria and syndromes that risk medicalizing normal emotional reactions. Others argue the increase is the result of the pharmaceutical industry financially courting the medical establishment as well as using advertisements to attract potential users of their medications. While both these arguments seem correct, they nevertheless fail to address that an increasing number of people regularly experience despair and anguish and are struggling to make a meaningful life, if not keep themselves psychologically, socially, and financially afloat.

I would like to suggest an additional explanation for the increase in mental illness: The upsurge is the result of the collective failure to alleviate conditions that contribute to trauma-related stress. I also believe the mental health field has stood in the way of people overcoming mental illness and returning to growth-centered lives. In particular, models of mental illness as chronic, genetic-based disorders gives us the sense that we are reaching the origins of our suffering — that is to say, the genes we inherited — when in actuality, we risk denying the traumatizing conditions in which many of us grew up or continue to live. Although a diagnosis and medications may provide temporary relief, they may also cause Americans to evade making the challenging changes that are necessary for moving into an emotionally sustainable future.

Childhood abuse and other emotional damaging experiences are so prevalent today that trauma-focused psychiatrist Bessel van der Kolk claimed the single most important health problem facing Americans is our exposure to what are increasingly referred to as “adverse childhood experiences,” which have been rigorously

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Trauma-informed psychotherapy puts the body – and love – back in mental healthcare

AloveFor the past 50 years, psychotherapy has taken a back seat to biomedical psychiatry, largely due to reliance on medications for the treatment of mental disorders. Yet clinical evidence increasingly points to chronic, unresolved traumatic stress as the source of many — if not most — mental disorders. Furthermore, longitudinal analyses show continued use of psychotropic medications is bad for the body, even causing chronic diseases. Granted, medications can stabilize a body wracked by recurrent distress, but such an approach is hardly a long-term cure. According to psychiatrist and trauma specialist Bessel Van der Kolk, “dramatic advances in pharmacotherapy have helped enormously to control some of the neurochemical abnormalities caused by trauma, but they obviously are not capable of correcting the imbalance.” To correct the “imbalance” often requires learning to inhabit one’s body and relationships in new ways.

Fortunately, the psychotherapeutic treatment of psychological trauma has advanced significantly the past several decades. In part, this is due to scientific discoveries of how the body and relationships naturally defend against traumatic stress. In particular, trauma-informed psychotherapies that draw from neuroscience and attachment studies are more holistic and scientifically based than ever before, although they often support the intuitions held by originators of psychotherapy such as Pierre Janet, Sigmund Freud, and C. G. Jung.

The neurobiology of trauma

Pierre Janet was the first to recognize how the body responds to present events as if past traumas were recurring — what today we call flashbacks. He observed patients

“continuing the action, or rather the attempt at action, which began when the [traumatic event] happened, and they exhaust themselves in these everlasting recommencements.”

Today we know the neurobiological reasons for flashbacks. Unlike narrative memories that seamlessly integrate

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What I learned about the importance of ‘tend and befriend’ while surrounded by a SWAT team

aswat2The pretty South African woman sitting next to me said our flight from Johannesburg to Port Elizabeth was taking longer than expected, although I hadn’t noticed. I arrived in South Africa only a few hours before. Jet lagged, I was wrestling with the cellophane wrapper guarding the plastic cutlery that came with my in-flight meal.

She told me she was flying to “PE” (what the locals call Port Elizabeth) to attend a luncheon with former U.S. President Bill Clinton, who had flown there earlier that day. As she smoothed her cocktail dress and pushed a loose hair behind her ear, she asked if she could squeeze pass me for a quick exit once the plane touched down.

Having learned Clinton was in town, I wasn’t surprised when we landed and could see emergency vehicles, their lights flashing, parked near the terminal. Cynically, I thought of the money and resources spent in the spirit of good deeds, something I too was guilty of as I flew from the U.S. to South Africa for a conference on violence in the Congo. As if there wasn’t plenty of violence in America I could be addressing.

Of late, I had come to expect violence as commonplace. The last two years as a trauma-focused psychotherapist largely involved supporting people as they worked to create lives without violence or its lingering effects. That’s what being “trauma-informed” often means: being violence informed. It wasn’t easy work. I was suffering a bad case of vicarious traumatization from supporting too many people who had been senselessly hurt and were still hurting, often decades after being victimized. Some

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“Unfinished Conversation: Healing From Suicide and Loss”

Unifinished_ConversationRobert E. Lesoine’s best friend Larry took his life by suicide on October 15, 2005. Although Lesoine knew Larry was struggling with feelings of disappointment, dejection, and loss, along with the return of debilitating pain associated with a past injury, Lesoine did not see the intensity of Larry’s despair.

In his grief, Lesoine, who practices Buddhism, initially planned to write to Larry for 49 days following his suicide. Buddhism claims that during the 49 days following death, consciousness is suspended before incarnation into the next life. What started as a deeply personal effort to grieve and continue his connection with Larry, Lesoine later expanded into a guide for grieving death by suicide, titled Unfinished Conversation: Healing From Suicide and LossIn this book, Lesoine, along with marriage and family therapist Marilynne Chöphel, uses memoir, journaling exercises, and mindfulness practices to guide those who have lost a loved one to suicide towards greater self-understanding and compassion, which often are the hidden gems of the grieving process.

Grieving may be one of the most painful and courageous tasks we endure as human beings. Grieving is an initiation into what depth psychologists sometimes call the dark night of the soul; myths like Persephone’s Journey into the Underworld, and similar spiritual tales, were created to model the inevitability of loss and its cyclic nature, teaching us that although despair and grief are inevitable, they too shall pass. Perhaps the pain of losing someone to suicide is that the deceased was unable to foresee the cyclic nature of suffering. And as suicide’s survivors, perhaps by choosing to accept the natural order of grieving, and being willing to both be with suffering and transform it, the survivor can also transform the departed’s choice of suicide into something meaningful. This, I believe, is one of the central lessons of Lesoine and Chöphel’s guided journey through grief.

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Attachment theory through a cultural lens

Father and child (photo by Fredrik Lidarp), Australia

Father and child (photo by Fredrik Lidarp), Australia

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In an article titled “Attachment and Culture (citation below),” Heidi Keller exposes attachment theory’s Western, middle-class assumptions. She argues:

… the definition of attachment in mainstream attachment research are in line with the conception of psychological autonomy, adaptive for Western middle-class, but deviate from the cultural values of many non-Western and mainly rural ecosocial environments.

Keller shows how attachment theory, particularly research that follows on the heels of John Bowlby’s original theory and Mary Ainsworth’s Strange Situation Procedure, assumes the most formative attachment relationship occurs between a mother and her infant. (For a further discussion of Bowlby’s and Ainsworth’s work, see my post, Let There Be Love!) But Keller points out that the primacy of the mother-infant bond for attachment may only be the norm “in Western middle-class families which compose less than 5% of the world’s population.”

In most cultures and socioeconomic groups, limited

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