“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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