For example, I once employed an office manager who admitted to embezzling funds from the practice. She was terminated on the spot. Several weeks later, I was completely over any hurt, anger, resentment, and sense of betrayal. But I did not rehire her. I forgave, but without reconciliation.
This is as opposed to the couples I’ve counseled after one of them committed infidelity and/or other egregious offenses. To aim for a happy marriage—or life—there must be forgiveness (letting go) with reconciliation. In that context, forgiveness must be repeated thousands of times in a fifty-year marriage, hopefully for lesser violations. Recall the Jesus quote when asked by Peter, “Lord, how oft shall my brother sin against me, and I forgive him? Till seven times?”
Jesus answered, “I say not unto thee, until seven times: but until seventy times seven,” or indefinitely (Matthew 18:22, King James Version).
When working with trauma clients, my chief goal is to help them live in the present, while looking forward to the future. Consider whether this is a goal you’ve achieved. You should be able to remember the past, laugh, and tell stories about painful events and the lessons learned from them. But you should not be stuck in the past with pain, avoidance, resentment, intrusive recollections, recurrent nightmares, or excessive guilt, etc. These symptoms point to unresolved pain in the past and require forgiveness, or letting go.
Modern Day Prophet?
An eighty-two-year-old woman sat on my couch one day and said, “So what I’m hearing you say, doctor, is that you want me to let go of everything that makes my head crazy.” She was no prophet, but to me, that remains the best definition of forgiveness I’ve ever heard. In the chapters ahead, I will show you how you can learn to let go of those things that make your head crazy. Remember that by definition, what you don’t let go of, you hold onto for the rest of your life. More importantly, the unresolved trauma owns you for the rest of your life.
What counterbalances the horrible stories that trauma clients tell me is their ability to finish their traumas once and for all. In the chapters to come, I will refer back to these six contributors and describe how their emphasis on closure and release comes to life in my approach to overcoming trauma. In fact, I’ve named the procedure after Fritz Perls, as a tribute to his brilliant understanding of healing from pain in the past. In chapter three, I’ll explain what “The Fritz” entails and how you can apply it to your unfinished business.
Chapter Two
Trauma Destroys the Soul Thanks to Mr. Avoidance
•
“Now, don’t hang on. Nothing lasts forever but the Earth and sky. It slips away, and all your money won’t another minute buy. Dust in the wind, all we are is dust in the wind. Everything is dust in the wind.”
—Kansas
Trauma is Bad
You know about the nightmares, the insomnia, the rage, and the deep despair and hopelessness. The hypervigilance (constantly watching and scanning) makes you feel crazy, and the exaggerated startle response (jumping when unexpectedly tapped on the shoulder) is downright embarrassing. Your anxiety remains high, and your intrusive recollections of the event are just that, intrusive. They ruin your conversations, your productivity, your peace of mind. You look at the world through a glass darkly, as if someone had blotted out the sun permanently. You may still smile, but not as frequently or as sincerely. You can’t remember when you were last at peace.
But trauma has many effects, many of which aren’t widely known.. For instance, we now know that trauma is a big contributor to substance abuse. Research studies have noted repeatedly that traumatic experiences are associated with an increased risk of substance abuse. Najavits, Weiss, and Shaw (1997) noted that of women who experienced childhood physical or sexual assault, between 30–59 percent go on to develop substance abuse problems.28 Another study found that out of thirty-eight male veterans who were placed in an inpatient substance abuse clinic, 77 percent of them had been exposed to severe childhood abuse.29 Another study shows, again, that the prevalence of PTSD among chemically dependent adolescents is five times that of their peers who are free of such dependency.30
There’s more; recent research from Newtown, Connecticut, after the school shootings suggest that when experienced by children, traumatic events are tremendous contributors to many symptoms and illnesses, especially mental illness and addiction behaviors. When children had gone through six or more traumatic events between birth and age eighteen (defined as an incident of physical or sexual abuse, parental arrest, or parental conflict, etc.), children had a 4,600 percent greater chance of using recreational intravenous drugs than those who had none.31
Katelyn was an IV drug user who preferred shooting crystal meth as her drug of choice. It took me several inpatient hospital visits to learn that she had been a victim of human trafficking in her teens and had been forced into prostitution. She was physically and sexually assaulted repeatedly, totaling “about 20” traumatic incidents. Little wonder, then, that she found solace in mood-altering chemicals.
Trauma is also linked with mental illness. You know about PTSD, depression, anxiety, and now addictions. Trauma is also a contributor to psychotic illnesses and is the cornerstone of dissociative illnesses, especially Multiple Personality Disorder (now called Dissociative Identity Disorder) and possibly also of Bipolar Disorder. A client of mine who had been diagnosed with Bipolar Disorder as a teen once said candidly to me, “I was never bipolar before I was abused.”
Dr. Steven Sharfstein, former President of the American Psychiatric Association (APA), has said, “Smoking is to cancer as trauma is to mental illness.”32 Let me summarize with one of my own quotes, “Unresolved trauma is bad.”
Trauma Symptoms are Understandable
If you accidently hammered your thumb (to the delight of the nail), several predictable responses would occur within the afflicted area: your thumb would throb, swell, and likely turn the color of a California plum, all because of the body’s natural inclination to heal itself.
The mind is very much a part of the same system and also responds in a predictable manner. All trauma symptoms, as painful and dysfunctional as they may appear, are rooted in survival. While some of them may seem incomprehensible to the untrained eye, they all make sense when viewed within this survival context.
This context will become apparent as you read further, but here, let’s use an analogy that helps illustrate how PTSD symptoms function: the splinter in my middle toe.
One afternoon at the office, my client failed to show up for an appointment, so I had a free hour to myself. The top of the middle toe on my right foot had been sore to the touch for several months, so I decided to remove my shoe and sock to investigate. The top of the toe was layered with excess skin, unlike any of the other toes. Looking below the skin, I saw a black dot embedded deeply in the toe. I decided to scratch at the layers of skin to remove the excess from the toe in order to gain access to the black dot. I squeezed the toe, only to reveal a small amount of liquid pus encasing a half-inch long wood splinter. Upon removal of the splinter, the excess skin did not grow back, and the toe never hurt again.
And then it occurred to me—my middle toe story is a perfect metaphor for Post-Traumatic Stress Disorder. Let’s explore the metaphor further. My toe, unbeknownst to me, was traumatized by a very intrusive splinter. The splinter was invasive and did not belong within the toe; it needed to be expelled. But the owner/operator of the toe was oblivious to the intruder and only remotely connected to the pain. As such, the intrusive splinter remained. Since the splinter was not being removed, the body found it necessary to protect the toe from further attacks and sensitivity to the pain by providing the protective coating of excess skin. In this way, the toe (and the surrounding foot) was still quite functional despite the now buried and well-protected splinter. And yet, because something was wrong, pain and discomfort were the result.
Your system is designed for survival and will d
o what is necessary to keep you, the traumatized organism, alive at all costs. In the case of the toe, the protection was most important, even more important than removing the splinter. The layers of excess skin were evidently designed to allow the foot to continue to function despite the intruder. If cells of the toe could communicate, they might say, “This splinter has invaded our world and needs to be removed. But until that happens, our job is to protect the toe and keep the foot functional.”
But the toe was communicating pain, which we understand is the body’s way of relating that something is wrong. The message of consistent pain for several months should have been a good enough signal to me that there was something wrong. Only when I finally addressed the pain and removed the splinter did the toe return to normal.
And from my extensive work with trauma survivors, that is exactly how it works. When the traumatic episode(s) is satisfactorily digested (removed, assimilated, and released), the need for the PTSD symptoms fades away.
Survival Mechanisms Send Conflicting Messages
But sometimes the PTSD symptoms send very conflicting messages: you need to remove the splinter (trauma), but I will try to bury it so you won’t or don’t have to deal with it. The repeatedly molested child, for instance, is often incapable of addressing her traumatic experiences while she’s still young. Consequently, the mind’s protective system may allow her to block the ugly traumas out for many years to promote her survival until she is finally equipped to deal with her abuse, often many years later.
Contradictory messages from your protective mindset serve a purpose. A middle-aged Terri tells me the story of surviving a “home invasion,” where the intruder grabbed wallets, cash, and jewelry before stumbling down the stairs and escaping into the night. She presents one month later with the predictable PTSD symptoms; she continues to re-experience the event, especially running after him and yelling “who are you?,” and then watching him fall and run away. The nightmares and flashbacks do very much the same thing—remind her that her trauma (like the splinter) has not yet been dealt with.
There are symptoms of avoidance: buying an alarm system and not wanting to sleep alone (she invites her eleven-year-old to snuggle with her as they’re both “spooked” by the violation). She also checks and re-checks locks as if they weren’t successfully locked the last three times she locked them. And of course, she is experiencing the exaggerated startle response, hypervigilance, and excessive anxiety. This is all easy to understand, since Terri no longer perceives her world as safe since the home invasion.
From one perspective, Terri’s symptoms are functional. She needs to successfully process the trauma to release it, so flashbacks and intrusive recollections are useful. The avoidance symptoms of feeling a need to buy a house alarm and check locks (not to an excessive OCD level) are logical responses to the home invasion. Even the startle response and hypervigilance are ingrained reflexes designed to keep Terri alive and well.
From another perspective, though, Terri’s symptoms are irrational. Let’s say you’re a driver returning to the road after an automobile accident. Your goal should not be hypervigilance, only appropriate caution. You don’t need to check your side mirrors twenty-seven times, two should suffice. Alert is good, but employing the “grip of terror” upon the steering wheel is not.
For Terri, being hyper-aroused (extreme anxiety) and watching for potential intruders and assorted bad guys seems appropriate, but more than likely, it will do more harm (in terms of insomnia, anxiety, and depression, as well as irritability, family conflict, and poor work performance) than good. Again, appropriate vigilance, checking the doors and having a dog and/or a non-canine alarm system makes sense. Hypervigilance, not so much.
Terri grasps how her symptoms have crossed the line. But letting go of these symptoms—putting them away—is a challenge because her mind’s protective system may fight to retain them due to their perceived usefulness. In other words, letting go of the checking, the worrying, the relentless scanning, and her overreaction to the shadow created by her standup Hoover vacuum may make Terri feel vulnerable. She may resist giving up her newfound internal security system.
So, what can be done to help Terri to let go of her disruptive PTSD symptoms while retaining a healthy—not careless, not excessively guarded—system of self-protection? Let’s talk treatment.
Trauma (PTSD) is Treatable
Needless to say, if trauma were not treatable (and yes, very often curable), there would be no reason to write this book. But there is successful treatment, and it’s about time someone taught it to you. Now that you understand how trauma symptoms are at least in part functional and are built to sustain or preserve life, you possess a perspective that will facilitate treatment—a perspective on how to use the Fritz.
Fritz Perls, as you remember from Chapter 1, was the German-born psychotherapist who founded the Gestalt school of therapy. Perls and Gestalt therapy were tremendously popular in the ’50s and ’60s, but Perls’ work at the Esalen Institute in Big Sur alienated traditional therapists who didn’t like how some people were embracing it as a lifestyle (i.e. mindfulness, meditation, etc.). Over time, some of Gestalt’s general concepts were absorbed into the Cognitive-Behavioral school, but many of Perls’ brilliant innovations were lost after his death in 1970.
Perls emphasized closure.33 He believed, as do I, that the issues with which humans struggle have power over us—think the stress response—until we find a way to close the wound. Again, that means putting these issues in a place where you can accept the trauma, both that it happened and that it cannot be changed, fixed, or undone. All you can do is accept it and then, perhaps, find meaning in your suffering and possibly create a plan to make your life better because of your resilience.
Recognize, though, that you have to go beyond a cognitive admission that the trauma occurred—that you were betrayed, abused, and so on—and that nothing can be done about it. For the splinter to be removed, you will need to face the pain from the trauma head-on, every aspect of it, and feel, express, and release the memories and the accompanying feelings before you can achieve acceptance, or make peace, shut off the stress response, remove the splinter, however you want to describe it. You must complete the horror of the trauma and the feelings you have been running from by expressing and releasing them. Dave’s story illustrates this process nicely.
Years ago, the fire chief called me one day to discuss an emergency—twenty-six-year-old police trainee Dave had accidently been shot in the face with blanks during a training session. Sometime later, Dave’s wife found him in the bathroom behind closed doors with a loaded gun in his mouth. He was now considering suicide because he couldn’t deal with the recurrent nightmares of the shooting, night in and night out.
But why was the shooting returning to Dave on a nightly basis? Because he had not allowed himself to process and complete the trauma. The repetition of the event was the mind’s way of alerting him that he was frightened and overwhelmed by the shooting and needed to express and release those feelings, once and for all.
Dave needed only one session of guided imagery (much more about this later in the book) to complete his trauma. Interestingly, he dreamed of his trauma one more time the night of our session and then never again. He had put the horror of the incident away for good.
Interestingly, in Dave’s case, the severity of his symptoms, especially his suicidal thoughts, worked in his favor, because he was forced to get treatment and deal with the horror shortly after the trauma. Typically, police officers and other first responders are discouraged from thinking or talking about their traumatic experiences on the job, and they experience a disproportionately high rate of PTSD as a result.34
Putting on the Fritz
So here is the Fritz, a new paradigm for successful treatment of trauma/PTSD. It’s a simple five-step process for treating PTSD. Fritz Perls, the German psychologist who inspired this process, would describe t
rauma and the associated symptoms as “unfinished business.” He would remind the suffering client that the symptoms persist because they have not yet been completed and put in a healthier place. This simple idea—that trauma will continue to dominate your mind, your body, and your life until you face it head on and release its hold over you—is the very foundation of this treatment.
The steps are not necessarily as separate and distinct as they appear when written, but all are necessary to finish with your pain in the past and put away the symptoms. In real life, the steps will occur concurrently or blend into each other, and successful resolution of a trauma may occur in one session (as in Dave’s case) or even by doing homework between sessions.
With that introduction, here are the five steps:
Remember: Tell the tale in detail.
Feel: No feel, no heal.
Express: Let the water flow.
Release: Release for peace.
Reframe: Reclaim your present life.
In my experiences, the steps of The Fritz work consistently, not occasionally, for trauma survivors who are brave enough to face their unfinished past pain. Later, I’ll devote five chapters to explaining each of the five steps in depth. For now, though, keep these steps in mind as you read the stories of people who overcame their trauma to live great lives—and stories of those who did not.
The following story reveals the archenemy of the Fritz. While Batman has the Joker, and Luke Skywalker has Darth Vader, the Fritz has Mr. Avoidance.
Face the Past and Mr. Avoidance
The best way I can explain Mr. Avoidance is by telling the story of Orlando, a seventy-five-year-old man referred to me by his wife because of his fitful sleep pattern and terrible nightmares related to his time in military service. She had always been puzzled by Orlando’s nocturnal suffering. He had been in the Navy but never saw combat. What could have happened to her husband?
Keep Pain in the Past Page 4
