5/13/2007

“Traumatic Stress:  The Effects of Overwhelming Experience on Mind, Body and Society”

edited by Bessel A. van der Kolk, Alexander C. McFarlane, Lars Weisaeth

The Guilford Press

1996

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“The Black Hole of Trauma”

by

Bessel A. van der Kolk and Alexander C. McFarlane

Pp 3 – 23

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“What distinguishes people who develop PTSD from people who are merely temporarily stressed is that they start organizing their lives around the trauma.  Thus, it is the persistence of intrusive and distressing recollections, and not the direct experience of the traumatic event itself, that actually drives the biological and psychological dimensions of PTSD (McFarlane, 1992; Creamer, Burgess, & Pattison, 1992).  (van der Kolk/BH/6)”

“Unlike other forms of psychological disorders, the core issue in trauma is reality.  (van der Kolk/BH/6)”

“…although the reality of extraordinary events is at the core of PTSD, the meaning that victims attach to these events is as fundamental as the trauma itself.  People’s interpretations of the meaning of the trauma continue to evolve well after the trauma itself has ceased.  (van der Kolk/BH/6)”

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“When people are traumatized, the choice of defenses is influenced by developmental stage, temperamental and contextual factors.

Hence, the diagnosis of PTSD alone never fully captures the totality of people’s suffering and the spectrum of adaptations that they engage in….

However, even though psychodynamic psychiatry is invaluable in helping us understand the characterological adaptations to the memories of the trauma,

the core issue in PTSD is that the primary symptoms are not symbolic, defensive, or driven by secondary gain.

The core issue is the inability to integrate the reality of particular experiences,

and the resulting repetitive replaying of the trauma in images, behaviors, feelings, physiological states, and interpersonal relationships.

Thus, in dealing with traumatized people, it is critical to examine where they have become “stuck”

and around which specific traumatic event(s)

they have built their secondary psychic elaborations.  (van der Kolk/BH/&)”

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When the trauma originates when we do, at the time of our birth into this world, or very close to it – certainly during the first 12 – 18 months of life, and from that time until before the age of 6 years old — then these “secondary psychic elaborations” become what we know of the world for there is nothing else.

These experiences are built into the structure and functioning of our brains.

That means, then, that we get “stuck” at birth or very close to it.

Our whole life becomes a trauma reenactment, a trauma drama for there never was an alternative.

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FIXATION ON THE TRAUMA
The posttraumatic syndrome is the result of a failure of time to heal all wounds.  (van der Kolk/BH/7)”

“The memory of the trauma is not integrated and accepted as a part of one’s personal past; instead, it comes to exist independently of previous schemata (i.e., it is dissociated).  (van der Kolk/BH/7)”

We have to try to wrap our understanding around the fact that when traumas happen to a young infant there IS NO PREVIOUS SCHEMATA!

What can this possibly mean?  The very essential schematas of human life that tell us forever after how to BE in relationship with members of our species, as a member of our species, is distorted so far from ordinary that there is no possibility of “returning” to a “premorbid” way of being in the world.  These schematas are wired right into our brain, into our body, into our nervous system.  We are SET UP for a life of enacting trauma.

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“One way or another, the passage of time modifies the ways in which the brain processes the trauma-related information.  Either it is integrated in memory and stored as an unfortunate event belonging to the past,

or the sensations and emotions belonging to the even start leading a life of their own.

When people develop PTSD, the replaying of the trauma leads to sensitization; with every replay of the trauma, there is an increasing level of distress.

So in trauma enactments people keep themselves in a continually escalating state of constant stress.  They are recreating the peritraumatic conditions of the “in the midst of” experience of the trauma.

In those individuals, the traumatic event, which started out as a social and interpersonal process, comes to have secondary biological consequences that are hard to reverse once they become entrenched….

This new organization of experience is thought to be the result of iterative learning patterns, in which trauma-related memories become kindled; that is, repetitive exposure etches them more and more powerfully into the brain (van der Kolk & Greenberg, 1987; Post, 1992; McFarlane, Yehuda, & Clark, in press).

These biological (mal)adaptations ultimately form the underpinnings of the remaining PTSD symptoms:  problems with arousal, attention, and stimulus discrimination, and a host of psychological elaborations and defenses.  (van der Kolk/BH/8)”

++

Early traumas are entrenched and etched into the brain as it is forming in the first place.  This is a form of altered ontogeny.  They are carved into the brain, and they do the carving.  They are tool, process, and resulting product.

What happens when these secondary processes to the trauma become primary processes to the individual whose brain was formed in these peritraumatic settings?  We get a secondary brain rather than a primary one.  The only reason these processes are considered secondary in the first place is if we consider that the brain they are affecting was formed under primary conditions.  If the brain was formed under peritraumatic conditions, then this secondary has become primary, and therefore they are now primary processes themselves because they made the brain to fit their conditions.

Ordinary, peaceful, calm and safe conditions are then “secondary” to these brains.  The set point for homeostatic equilibrium has been moved, and everything in the brain has adjusted itself to operate from that “threat of extinction” point.

We have to remember that when the trauma is caused by early caregivers, and there are no other alternatives for caregiving, protection or relief, people themselves become the trigger for the “increasing level of distress.”

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I believe there is a very big difference between a threat to life and a threat of extinction.

If a person has begun to form their feathers, so to speak, and has begun to form a self and become a person with a growing perspective of being the one that is interacting with his or her environment, then they can feel a threat to their life.

If, on the other hand, a person has been so threatened from birth that no self has ever had a chance to form in the first place, they will not react from this biological effort to survive.  They will, instead, be biologically aware on the most fundamental level possible to animals that not only are they under threat of extinction, but their species is also.  If conditions are this horrific and anti-life, there is no alternative perspective.  There is no other primary position.

This is a default position available to species.  If the brain that runs the organism, in this case a human brain, finds itself formed from the beginning under chronic, constant peritraumatic conditions, then the default of “secondary” becomes primary.  We ended up with an entirely different brain.

Everything that was put into my brain was proof that extinction was imminent.

Any evidence that contradicted this fundamental reality was the exception to the rule to such a degree that these “safe” experiences were not integrated in the same way that trauma is not integrated into an ordinary brain because the nature of trauma is conceived by the ordinary brain to be the exception and therefore contradicts what the brain knows.

These ordinary brains have a “set point” that tells it that the world is a safe place, and that not only is survival the probability, but that extinction is a far distant very remote possibility that does not demand anything more than having access to the basic biological life preservation mechanisms available to the ordinary body.  These mechanisms can remain remote and do not have to be intimately connected to an ordinary individual’s moment-to-moment perceptual awarenesses.  They are the “back up plan” for extreme contingencies that are not likely to occur in the ordinary world.

When the biologically evolved “back up plan” becomes the primary plan, everything is different.  There is no back up plan.  There is only THE PLAN:  avoid extinction at all costs.  Our species continuance depends on ME, right here, right now.  This is not about “Maybe I’ll think about avoiding extinction later” situation.  There are no alternatives.

But what is most significant about the nature of early caregiver trauma is that in the evolution of our species, we have clawed our way up to the apex of the food chain to such a degree that, with the exception of viruses, our most dangerous predators are other members of our species.  We are our own worst enemies.

So when a newborn infant with its rapidly developing brain is exposed to constant threat of extinction by a human predator which is its mother or other primary caregiver, a myriad of alterations occur in our supposed “social brain’s” development.

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“Some cognitive formulations of PTSD have proposed (van der Kolk/BH/7) that a traumatic experience confronts an individual with experiences completely different from what he or she has been able to imagine before, and that this confrontation with the trauma radically shakes the individual’s attitudes and beliefs (Janoff-Bulman, 1992).  This may be true in some cases in which people encounter totally unexpected events or are confronted with aspects of the human capacity for evil that they had never before imagined.  However, often trauma does not present a radically new experience, but rather confirms some belief that an individual has tried to evade.  For many patients, what is most destructive about a traumatic even is that it confirms some long-feared belief, rather than presenting them with a novel incongruity.  (van der Kolk/BH/8)”

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“Ordinarily, memories of particular events are remembered as stories that change over time and that do not evoke intense emotions and sensations.  In contrast, in PTSD the past is relived with an immediate sensory and emotional intensity that makes victims feel as if the event were occurring all over again.  (van der Kolk/BH/8)”

“…paradoxically, the ability to transform memory is the norm, whereas in PTSD the full brunt of an experience does not fade with time.  (van der Kolk/BH/9)”

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“Because people with PTSD have a fundamental impairment in the capacity to integrate traumatic experiences with other life events,

their traumatic memories are often not coherent stories;

they tend to consist of intense emotions or somatosensory impressions, which occur when the victims are aroused or exposed to reminders of the trauma….

Related to why we cannot tell a coherent life story – problems with declarative and autobiographical memory because we have flashbulb memories and dead spots – fried brain memory cells – but kept all the emotions;  they are embodied within us without words or connection to the factual part of the memories

These intrusions of traumatic memories can take many different shapes:  flashbacks, intense emotions, such as panic or rage; somatic sensations; nightmares; interpersonal reenactments; character styles; and pervasive life themes (Laub & Auerhahn, 1993).

Years and even decades after the original trauma, victims claim that their reliving experiences are as vivid as when the trauma first occurred (van der Kolk & Fisler, 1995).

Because of this timeless and unintegrated nature of traumatic memories, victims remain embedded in the trauma as a contemporary experience, instead of being able to accept it as something belonging to the past.  (van der Kolk/BH/9)”

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“Paradoxically, even though vivid elements of the trauma intrude insistently in the form of flashbacks and nightmares, many traumatized people have a great deal of difficulty relating precisely what has happened.  People may experience sensory elements of the trauma without being able to make sense out of what they are feeling or seeing (van der Kolk & Fisler, 1995).  One of the gravest symptoms of having been overwhelmed by a traumatic experience can be total amnesia.  For example, describing the reactions to trauma in some Holocaust survivors, Henry Krystal noted that “no trace of registration of any kind is left in the psyche; instead, a void, a hole, is found” (Krystal, 1968)  (van der Kolk/BH/10)”

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“Triggers for intrusive traumatic memories may become increasingly more subtle and generalized; what should be irrelevant stimuli may become reminders of the trauma.  For example…a combat veteran may become upset by the sound of rain because it suggests the monsoon season in Vietnam.  (van der Kolk/BH/10)”

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“…compulsive reexposure of some traumatized individuals to situations reminiscent of the trauma.  (van der Kolk/BH/10)”

“Understanding this seemingly paradoxical phenomenon is of critical importance, because it could help to clarify many forms of social deviance and interpersonal misery.  (van der Kolk/BH/11)”

“Reenactment of victimization is a major cause of violence in society.  (van der Kolk/BH/11)”

“Self-destructive acts are common in abused children.  Studies consistently find a highly significant relationship between childhood sexual abuse and various forms of self-harm later in life, particularly suicide attempts, cutting, and self-starving….  Simpson and Porter (1981) sum up the consensus conclusion in stating that “self-destructive activities were not primarily related to conflict, guilt, and superego pressure, but to more primitive behavior patterns originating in painful encounters with hostile caretakers during the first years of life.” (van der Kolk/BH/11)”

“Many traumatized individuals continue to be revictimized.  (van der Kolk/BH/11)”

“These phenomena are seldom understood by either victims or clinicians as repetitive reenactments of real events from the past.  Understanding and remedying the fact that traumatized people tend to lean traumatizing and traumatized lives remain among the great challenges of psychiatry.  (van der Kolk/BH/11)”

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I suspect this has something to do with what Siegel refers to as the anticipatory functioning of the brain.

This in turn must be related to the brain’s feedback loops.

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AVOIDING AND NUMBING

“Once traumatized individuals become haunted by intrusive reexperiences of their trauma, they generally start organizing their lives around avoiding having the emotions that these intrusions evoke (van der Kolk & Ducey, 1989).  (van der Kolk/BH/12)”

Isn’t this a contradiction from the fact that they reenact the trauma?  Reenactment seems more like a life organization that will guarantee that they have the same emotions.

“Avoidance may take many different forms, such as keeping away from reminders, [??? See above] ingesting drugs or alcohol in order to numb awareness of distressing emotional states, or utilizing dissociation to keep unpleasant experiences from conscious awareness.  (van der Kolk/BH/12)”

“This avoidance of specific triggers is aggravated by a generalized numbing of responsiveness to a whole range of emotional aspects of life…..numbing probably has a very different underlying pathophysiology from avoidance.  (van der Kolk/BH/12)”

“Studies of combat veterans (e.g., Kardiner, 1941), concentration camp survivors (Krystal, 1968), and other victim populations (Titchener, 1986) have described a gradual withdrawal and detachment from everyday activities.  Krystal (1968) called this reaction “dead to the world,”….  (van der Kolk/BH/12)”

“Thus, many people with PTSD

not only actively avoid emotional arousal, but

experience a progressive decline and withdrawal,

in which any stimulation (whether it is potentially pleasurable or aversive) provokes further detachment.

To feel nothing seems to be better than feeling irritable and upset.  (van der Kolk/BH/12)”

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We cannot modulate our level of arousal or stimulation.  This is particularly true for those of us who suffered infant abuse.  Our brain did not acquire the capacity for self-regulation.  FEELING itself can be distressing because of these disabilities.

The act or process of FEELING an emotion becomes distressing.  The feedback loops work overtime and wear us out.

Those of us stressed early during brain formation do not have the “calm and serene” set point programmed into our emergency brain-body.  We cannot attain homeostatic equilibrium internally.  We have to try to control the external environment and our interaction with it in order to control or maintain our internal equilibrium.

Emotional states are dangerous for us because we cannot regulate their intensity or duration.  We cannot regulate how intense the triggers are or identify what triggers us, so pervasive was the trauma during our brain formation stages.

Our emotions are not correctly identified or classified or differentiated.

Our trauma memories are often implicit, formed before we had words.

Many of our trauma memories are stored ONLY as emotions.  The factual part of the memories got fried as they were trying to be stored.  We have massive undercurrents of emotion stored as memory without the semantic or factual components.

Any emotional tone can get caught in these undercurrents and swept into our awareness and current experience.  The process overwhelms us.

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“It would be an error to think of this detachment and withdrawal in PTSD

either merely as a psychodynamic phenomenon,

or as a deficit of certain neurotransmitters that can be “fixed” with the administration of neurotransmitter supplements (i.e., antidepressants or other psychopharmacological agents that stimulate the release of neurohormones…).  (van der Kolk/BH/12)”

This is grim stuff.  Grimmer than anything the Brothers Grimm could ever have imagined!

This is the stuff our lives are made of.

Welcome to Traumaville!

“Roughly speaking, it seems that the chronic hyperarousal of PTSD depletes both [reminds me of what Tomkin said about emotions incurring a physical debt] the biological and the psychological resources needed to experience a wide variety of emotions (van der Kolk et al., 1985; Litz, 1992).

McFarlane et al. (in press) have proposed that as intrusive memories [and remember, these can be NOTHING BUT EMOTIONAL MEMORIES] come to dominate their thinking, people with PTSD become more and more sensitized to environmental stimuli that remind them of the trauma.

Thus, over time, they become less and less responsive to various stimuli that are necessary for involvement in the present.

They have proposed that this underresponsiveness leads to a series of changes in the central nervous system that are similar to the effects of prolonged sensory deprivation (see Chapter 10).  (van der Kolk/BH/12)”

Boy, what a vicious cycle they are describing.  I have not encountered this perspective or this exact information before.

“Litz et al. (1995) have proposed that the resulting failure to process emotional events fully leads to further physiological hyperarousal and to psychosomatic problems.  Indeed, psychosomatic problems and emotional numbing in PTSD are intimately related (van der Kolk et al., in press).  (van der Kolk/BH/12)”

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INABILITY TO MODULATE AROUSAL

Oh, boy, where have I seen this phrase before, Dr. Schore?

“Although people with PTSD tend to deal with their environment through emotional constriction,

their bodies continue to react to certain physical and emotional stimuli as if

there were a continuing threat of annihilation;

they suffer from hypervigilance, exaggerated startle response, and restlessness.

Research has clearly established that people with PTSD suffer from conditioned autonomic arousal to trauma-related stimuli;

However, evidence in recent years also suggests that many traumatized individuals suffer from extreme physiological arousal in response to a wide variety of stimuli (see Chapters 4 and 10).  (van der Kolk/BH/13)”

This is a condition of TOO MUCHNESS!

Too much in the beginning.  Too much from the beginning.  Being overwhelmed overwhelmed overwhelmed!

Talk about a disorganized-disoriented attachment style!

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“People with PTSD tend to move immediately from stimulus to response without actually realizing what makes them so upset. (van der Kolk/BH/13)”

This is the autonomic automatic response pathway that bypasses the cortex.

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Boy do I know this one!  As did my mother.

How in the world, literally, are we supposed to get along and function like this?

What about all those now being traumatized in this war who were abused as infants?

The compounding nature of the double traumas of infant abuse and any “new” traumas is nearly an overwhelming reality to contemplate.

The only good thing I can say here is that without them even realizing it, when they talk about people with current PTSD there is no doubt a huge overlap between the two populations.

They are just not putting 2 and 2 together!

When they do it will make things more clear.  We can begin to differentiate what is causing which symptom and which response.  We can begin to see the patterns, and I mean that literally.

What is happening in the brain-mind-body of a person whose brain formed in infant abuse conditions is different from what happens to somebody whose brain formed under “normal and ordinary” conditions.

We are two different machines.  We live in two different universes.  Trauma creates rules that link us together – the infant abuse survivors and those others who suffer severe traumas later on.

Perhaps what we are dealing with is two different universes.  Trauma is the black hole that connects the two.  Those of us whose brains formed under these conditions might need to just totally recognize the details of how our brains formed differently and KNOW that we will never come “out of it” with a normal brain.  We cannot be “restored” to being “normal.”  It is an impossibility.  We will always be citizens of that altered universe.

People whose brains formed normally in the beginning have their feet in the ordinary world.  Their recovery process would be similar to ours to some degree, but only so far as we look at the exact “symptoms” that we might share in common.

The best we can hope for is to learn enough ABOUT what ordinary and normal is that we can better pretend to be LIKE that, mimic them better so that we can get along, something like what Dawn says in her gorilla nation book.

If we relate only to those of us who KNOW this reality because of our past early history, we might feel like we are being empathized with, but that is not possible because we cannot empathize.  We can cognitively understand, perhaps.  But with one another we are very likely to do nothing but connect on the trauma level and spend our time doing nothing but these trauma drama reenactments….

They have ordinary brains trying to adapt to trauma.

We have trauma brains  trying to adapt to normal.

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“They tend to experience intense negative emotions (fear, anxiety, anger, and panic) in response to even minor stimuli;

as a result, they either overreact and threaten others,

or shut down and freeze.  [I would add here, fall into a state of immobilizing confusion!]

These hyperarousal phenomena represent complex psychological and biological process,

in which the continued anticipation of overwhelming threat seems to cause difficulties with attention and concentration.

In turn, these difficulties give rise to distortions in information processing, including narrowing of attention onto sources of potential challenge or threat.

Here again I would note how hard it is for me to LISTEN for threat in a voice at the same time I am trying to listen to the words.

Children and adults with such hyperarousal tend to experience sleep problems, both because they are unable to quiet themselves sufficiently to go to sleep, and because they deliberately wake themselves up in order to avoid having traumatic nightmares.  (van der Kolk/BH/13)”

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The confusion comes when I cannot select from a range of potential reactions to a situation.

I cannot prioritize using any kind of logic because I cannot tell what is appropriate in a social situation that is distressing to me and that places me under pressure of “performance.”

This can appear as a FREEZE response, but it is NOT the same thing.  It is NOT dissociating.  It is a form of paralysis where I CANNOT respond.

Time seems to alter at these points, either slowing way down or speeding up.  I feel out of synch with the world around me, and thus like I am separate from it.

It is a misattunement, a misalignment, a rupture that I have no skills to repair, no hope of repairing.

With it comes a lack of trust that I will be OK in the situation.  Part of me rushes into the future to grab the worst possible outcome, like getting sucked into the tornado of a feedback loop that is so much bigger than I am.  The worst possible outcome, the worst possible scenario is always present.  I would suspect that training of the higher brain could help with this if accurately and carefully orchestrated and methodically implemented.

Things feel surreal and unreal and disconnected.  I have called this a difficulty with transitions – including a difficulty with transitions between states of mind – mine or others.

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“Perhaps the most distressing aspect of this hyperarousal is the generalization of the threat. (van der Kolk/BH/13)”

“The world increasingly becomes an unsafe place:  Innocuous sounds provoke an alerting startle response; trivial cues are perceived as indicators of danger.  (van der Kolk/BH/13)”

Ordinarily, autonomic arousal serves the very important function of alerting people to pay attention to potentially important situations.

However, for person’s who are chronically hyperaroused,

the autonomic nervous system loses that function;

the easy triggering of somatic stress reactions makes them unable to rely on their bodily sensations as an efficient warning system against impending threat.

The persistent, irrelevant firing of warning signals causes physical sensations to lose their functions as signals of emotional states and, as a consequence, they stop serving as guides for action.

Thus, just like neutral environmental stimuli, normal physical sensations may take on a new and threatening significance.

The person’s own physiology becomes a source of fear.  (van der Kolk/BH/13)”

Not only do we have an altered set point for balance and attempted equilibrium, we lose the only tool available to get there!

I cannot state how profound and significant, how relevant and true these words are!

These words mirror who I am.

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I can also see how we become dependent on external crutches to regulate how we feel – if we are prevented from receiving this information internally.  If you drink, you feel better.  If you do drugs, you feel better.  If you gamble, or have sex, or cut yourself — Then you are down.  Then you are up.  It is like relying on a big external hand to control the yo-yo that is connected to our internal states.

If you DO this or DO that you will feel this or feel that.

Because our internal guiding mechanism is broken.

And I thought it was bad when I read Schore saying the autonomic system was decoupled.  Is this what he meant?

Our very nervous system is in a shambles!

It is like receiving a diagnosis from a doctor, when you say, “Is it that bad?”  And she or he responds, “Yes, honey, I’m sorry to have to say that it is.”

++

And considering all of this, grimness and all, we are expecting these very same people to be able to adequately parent their children?  What the hell good does any body think fluffy parenting skills are going to do anybody in this condition?

This is the information Cindy needs to know so that she can write her parenting and relationship skills.

This means that from birth our nervous systems did not form right and have never worked correctly.  It also means, to me, that our feelings never developed or evolved in the same way, either.  So it is far more than an inability to NAME them.  They would most likely not even be the same beasts that people call by a name:  a rose by any name is NOT a rose, necessarily.  I do not believe that our emotions operate independently from our nervous system, and how they are wired up into our limbic system is not the same, either.

“The PTSD sufferers’ inability to decipher messages from the autonomic nervous system interferes with their capacity to articulate how they are feeling (van der Kolk/BH/13) (alexithymia) and makes them tend to react to their environment with either exaggerated or inhibited behaviors.  (van der Kolk/BH/14)”

Is this just another description of the processes that created mother’s behavior?

This description is not about having the ability to mentalize!

“After a traumatic experience, many people regress to earlier levels of coping with stress.  In children, this may manifest itself as an inability to take care of themselves in such areas as feeding and toilet training; in adults, it is expressed in impulsive behavior, excessive dependence, and a loss of the capacity to make thoughtful, autonomous decisions.  (van der Kolk/BH/14)”

Need I remind myself that I never had the ability to make thoughtful, autonomous cortical decisions in the first place.  Or even to consult the “emotional regulation executive” of the limbic brain.

What happens when the trauma begins at birth and there were no earlier levels of coping with stress available in the first place?

Then are we left with some form of innate active coping skills – that nobody even seems to want to name?

++

“People with PTSD…have problems fantasizing and playing with options.  Studies both of traumatized children…and of traumatized adults…indicate that when traumatized people allow themselves to fantasize, this creates the danger of breaking down their barriers against being reminded of the trauma.  (van der Kolk/BH/14)”

“In order to prevent this from happening, they become constricted and seem to organize their lives around not feeling and not considering options for the best ways of responding to emotionally arousing problems.  (van der Kolk/BH/14)”

“Their problems with keeping thoughts in their minds without becoming aroused contribute greatly to their impulsivity.  (van der Kolk/BH/14)”

Then how, pray tell, would we be able to keep someone else’s’ thoughts in our mind if we cannot even keep our own thoughts there?  So much for the ability to mentalize!

“People with PTSD have difficulty in sorting out relevant from irrelevant stimuli; [and like I said (e.g., the video store conversation in Sioux Falls) I can’t sort the relevant from the irrelevant responses, either] they have problems ignoring what is unimportant and selecting only what is most relevant.  (van der Kolk/BH/14)”

“Easily overstimulated, they compensate by shutting down…..The price of these problems is loss of involvement in ordinary everyday life.  This makes it even harder for these patients to get their minds off the trauma, and thus only increases the strength of their fixation on the trauma.  As a result, the individuals lose the capacity to respond flexibly to their environment.  (van der Kolk/BH/14)”

“This loss of flexibility may explain current findings of deficits in preservative learning and interference with the acquisition of new information…, as well as an inability to apply working memory to salient environmental stimuli….  (van der Kolk/BH/14)”

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ALTERATIONS IN DEFENSE MECHANISMS AND CHANGES INPERSONAL IDENDITY

“…people’s sense of themselves and their relationship to their environment…..  (van der Kolk/BH/14)”

++

Once a person reads this information and truly lets it sink into the reality that they include in their own thoughts, in their own minds, I do not see how it could not affect a fundamental change in how they see not only others, but also themselves in relation to the world.

We might only be talking about 10% of the population with these infant abuse altered brains and nervous systems, but how profound are these changes!

I am going to have to translate this next information — for how is it possible to change a person who from birth has never even gotten to be a person in the first place?

I do believe it is about a most fundamental violation of human rights – the right to be a person the way our best genetic potential destined us to be.  And when the very people who are responsible for damaging these children are themselves so terribly damaged, what hope is there for changing this reality as it comes down the generations?

It is important to realize that anyone who endures trauma at any age and for any reason develops PTSD will suffer the conditions of self, brain, body and mind that is being described here.  And when those very structures started out in their formation from birth under peritrauma of abuse, the problems are so compounded as to appear insurmountable as well as irreparable.

If a person’s “view of self and world” has been constructed from the start “to incorporate the abuse experience” we get an entirely different individual than who that person COULD have become.

++

“Reiker and Carmen (1986) have pointed out that “confrontations with violence challenge one’s most basic assumptions about the self as invulnerable and intrinsically worthy, and about the world as orderly and just.  After abuse, the victim’s view of self and world can never be the same again:  it must be reconstructed to incorporate the abuse experience” (p. 362).  Of course, how old a person is when the trauma happens, and what the person’s previous life experiences have been like, will profoundly affect his or her interpretation of the meaning of the trauma (van der Kolk & Fisler, 1994).  (van der Kolk/BH/15)”

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“Many traumatized individuals, particularly children, tend to blame themselves for having been traumatized.  Assuming responsibility for the trauma allows feelings of helplessness and vulnerability to be replaced with an illusion of potential control.  Ironically, rape victims who blame themselves have a better prognosis than those who do not assume this false responsibility; it allows their locus of control to remain internal and prevents helplessness (Burgess & Holstrom, 1979)  (van der Kolk/BH/15)”

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SHAME

“The question of shame is critical to understanding the lack of self-regulation in trauma victims and the capacity of abused persons to become abusers.  Trauma is usually accompanied by intense feelings of humiliation; [I am not sure I felt this – humiliation was the name of the game, business as usual.  I had nothing to compare anything to.  This is a point of reference for how my feelings did not evolve normally.] to feel threatened, helpless, and out of control [I never had any feeling of being in control – again, nothing to compare to] is a vital attack on the capacity to be able to count on oneself. [What self??] (van der Kolk/BH/15)”

“Shame is the emotion related to having let oneself down.  (van der Kolk/BH/15)”

“The shame that accompanies such personal violations as rape, torture, and abuse is so painful that it is frequently dissociated:  Victims may be unaware of its presence, and yet it comes to dominate their interactions with the environment.  [Here again is mother] (van der Kolk/BH/15)”

“Denial of one’s own feelings of shame, as well as those of other people, opens the door for further abuse.

Being sensitive to the shame in others is an essential protection against abusing one’s fellow human beings, and it requires being in touch with one’s own sense of shame.

I guess I could do this, though I don’t know how come.

Similarly, not being in touch with one’s own shame leaves one vulnerable to further abuse from others.  (van der Kolk/BH/15)”

“The resulting

disorganized patterns of engagement

are commonly seen in traumatized people who suffer from borderline personality disorder,

who need to be helped to understand how this perpetuates their getting hurt and hurting others.  (van der Kolk/BH/15)”

Interesting in regard to mother.  So in essence her treatment of me was a projection of the intolerable aspects of herself that she could never incorporate or adequately or appropriately release from herself – that created so much shame in her that she could not feel it – it was too much, overwhelming intolerable pain of shame.

Because she could not feel her own shame, she could not feel mine, either.  Maybe that blocked all other possible feelings of empathy that she might have had toward me.

This reminds me of the Grimm’s story about the boy who could not “goose bump.”  Having a conscience and being able to feel remorse must be related here.

++++

TREATMENT IMPLICATIONS

“Truly effective treatment would need to resolve the whole spectrum of posttraumatic problems discussed in this chapter:

intrusions;

compulsive reexposure;

avoidance and numbing;

hyperarousal;

problems with attention, distractibility, and stimulus discrimination;

altered perceptions of self and others;

dissociation;

and somatization.  (van der Kolk/BH/17)”

“…it is likely that effective treatment of one problem, such as physiological reactivity, will have widespread beneficial effects on the overall system, and can secondarily decrease intrusions, concentration problems, numbing, and the ways victims experience themselves and their surroundings.  (van der Kolk/BH/17)”

:Traumatized people often are incapable of finding flexible and adaptive solutions; the trauma keeps them rigidly fixated on the past, making them fight the last battle over and over again.  However, since it is generally assumed that as long as memories of the trauma remain dissociated they will be expressed as psychiatric symptoms that will interfere with proper functioning, helping people avoid the past is not likely to resolve the effects of the trauma on their lives.  (van der Kolk/BH/17)”

“Treatment needs to address the twin issues of helping patients (1) regain a sense of safety in their bodies [I never had this in the first place] and (2) complete the unfinished past.  It is likely, though not proven, that attention to these two elements of treatment will alleviate most traumatic stress sequelae.  (van der Kolk/BH/17)”

“As noted above, the first task of treatment is for patients to regain a sense of safety in their bodies.  [never had it in the first place] (van der Kolk/BH/17)”

“For most individuals, this requires active engagement in challenges that can help them deal with issues of passivity and helplessness:  play and exploration, artistic and creative pursuits, and some form of involvement with others.  (van der Kolk/BH/17)”

Glasser would concur.

How does this differ for those of us who, since birth, were “at risk” because we had a body in the first place – a body that constantly put us in harm’s way just because it existed.  I don’t think we ever established a normal, ordinary connection to our bodies.  Especially when not even our brain or our nervous system formed correctly.

“…most people with histories of psychological trauma suffer from a range of problems with information processing.  (van der Kolk/BH/18)”

“Problems with somatization and affect dysregulation might be most usefully addressed by helping patients acquire skills that will help them to label and evaluate the meaning of sensations and affective states, to discriminate present from past, and to interpret social cues in the context of current realities rather than past events.  (van der Kolk/BH/18)”

More than a little tough when these events from the past are hardwired into our brain and nervous system.

“…critical importance of learning to identify and utilize emotions as signals, rather than as precipitants for fight-or-flight reactions.  (van der Kolk/BH/18)”

To operate as signals they must run through the cortex and they must be attached to words!

To get ourselves out of the chronic implode – explode state.

++

“Merely uncovering memories is not enough; they need to be modified and transformed (i.e., placed in their proper context and reconstructed in a personally meaningful way).  Thus, in therapy, memory paradoxically needs to become an act of creation rather than the static recording of events.  Because the essence of the trauma is that it once confronted the victim with unacceptable reality, the patient needs to find a way of confronting the hidden secrets that no one, including the patient, wants to face (Langer, 1990).  (van der Kolk/BH/18)”

“Like memories of ordinary events, the memory of the trauma needs to become merely a (often distorted) part of a patient’s personal past.  (van der Kolk/BH/18)”

“Exploring the trauma for its own sake has no therapeutic benefits unless it becomes attached to other experiences, such as feeling understood, being safe, feeling physically strong and capable, or being able to empathize with and [“or,” for those of us who cannot have empathy] help fellow sufferers.  (van der Kolk/BH/18)”

Confronting with unacceptable reality:  When the trauma originates as birth, and because we have absolutely no alternative frames of reference to consider the nature of the trauma with, how can it be “unacceptable?”  It therefore can be viewed IN THE PRESENT as unacceptable, but it cannot accurately be said that it “once confronted the victim with unacceptable reality.”

“The exploration of personal meaning of the trauma is critical; since patients cannot undo their past, giving it meaning is a central goal of therapy.  It is important to deal with the existential issues evoked by the trauma, such as the role that victims feel they played in causing (or at least not preventing) the trauma, and the particular stance they took while they were in the middle of it.  [the peritrauma of it].  These personal attributions can have profound affects on whether victims see themselves as capable and worthy of having restorative experiences, and whether they consider themselves capable of being entrusted with responsibility, intimacy, and care.  (van der Kolk/BH/18)”

++++++++++++++++++++++++

5/14/2007

What is it about these memories?  They cannot be communicated in normal ways.  They cannot be integrated into the “person” in normal ways.  So, like pantomime, we act them out.  This enactment is a form of communication.  It is an expression of the language of the right brain.

When the traumas happened so early that they were “imprinted” into the structure of the right brain in the first place as implicit memories that will never be consciously remembered – OR the factual part of the memory was fried and therefore is also never recallable, as La Doux says, the feeling part of the memory is forever, and the feeling part of the memory continues to act itself out – to communicate and express itself through the LIFE choices and behaviors and actions of the individual – like a living fairy tale or a living myth or a living legend.

What was that I found last summer about the roots of words I was searching that related to the word LEGEND??

++

Ernie wants to prove that he is unlovable by being as awful to me as he can be so that I will leave, and that will PROVE that he is unlovable.  Like he’s told me many times, “I am a bad person.”

I am proving that I can love the unlovable no matter what the cost to me personally.  I am proving that I can live with severe deprivation, and still retain the ability to love the OTHER who is NOT caregiving me.  That I can love somebody no matter how awful they are, how bad they are.

This is our unfinished business because we are enacting the MEMORY which is an EMOTIONAL memory.  These memories have no words, but if we learn to listen, we give them words by describing what we are doing RIGHT NOW – as Glasser would say – by the behaviors in our lives.

The catch is that our ability to make choices is inhibited and damaged by the brain changes that we have, by the CNS changes we have which INCLUDES the brain.  The brain and the CNS are inseparable, as is the body.  These memories are IN OUR BODIES and show themselves through our bodies.

The sooner we “get the point” and “get to the point” of what these ghostly and ghastly memories are trying to tell us, the better.