5/12/2007

“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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Chapter 9

“The complexity of adaptation to trauma:  Self-Regulation, stimulus, discrimination, and characterological development”

by Bessel A. van der Kolk

pp 182 – 213

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affect storms

Well, here I am entering traumaville.

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“Naïve one-to-one notions about the causal relationships between trauma and these disorders [e.g., borderline personality disorder (BPD), somatization disorder, dissociative disorders, self-mutilation, eating disorders, substance abuse] would oversimplify the very complex interrelationships among specific traumas, secondary adversities, environmental chaos and neglect, nature of preexisting and subsequent attachment patterns, temperament, special competencies, and other contributions to the genesis of these problems.  (van der Kolk/CAT/183)”

“However, if clinicians fail to pay attention to the contribution of past trauma to the current problems in patients with these diagnoses, they may fail to see that they

seem to organize much of their lives [and their selves] around repetitive patterns of reliving and warding off traumatic memories, reminders, and affects.  (van der Kolk/CAT/183)”

“Whether clinicians accept the fundamental reality of past trauma in the lives of many of their patients will determine whether they understand their communications as psychotic distortions of reality or as derivations of inner experience.  Therapists’ attitudes toward these symptoms – whether they are viewed as bizarre behaviors that need to be abolished, or as misguided attempts at self-regulation – will critically determine approaches to treatment…..if clinicians deny the essential truth of their (van der Kolk/CAT/183) patients’ experiences, they can only aggravate feelings of rage and helplessness by invalidating the realities of their patients’ lives.  (van der Kolk/CAT/184)”

“Intrapsychic, relational, and social factors are not the only issues that contribute to the long-term adjustment to trauma; the biological consequences of traumatization have a different impact at different stages of development as well.

Although both adults and children may respond to a traumatic event with generalized hyperarousal, attentional difficulties, problems in stimulus discrimination, inability to self-regulate, and dissociative processes,

these problems have very different effects on young children than they do on mature adults.  (van der Kolk/CAT/184)”

“…Pitman (1995) showed that people who developed PTSD secondary to child abuse had more profound physiological dysregulation in response to nontraumatic stimuli than did people who developed PTSD as adults.  (van der Kolk/CAT/184)”

“Our own studies (van der Kolk & Fisler, 1994) have shown that traumatized adults with childhood histories of severe neglect have a particularly poor long-term prognosis, compared with traumatized individuals who had more secure attachment bonds as children.  Consistent external support appears to be a necessary condition for most children to learn to comfort and soothe themselves, [again, this is built right into the brain as neural circuits tied to mental representations and working models of attachments] and later to derive comfort from the presence of others.  [something I do not have, something that the opiod system in the brain is designed to make sure doesn’t happen – so that we can become members of our species properly].  (van der Kolk/CAT/185)”

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excellent table 9.1 Long-Term Effects of Trauma (van der Kolk/CAT/184)

Generalized hyperarousal and difficulty in modulating arousal

Aggression against self and others

Inability to modulate sexual impulses

Problems with social attachments – excessive dependence or isolation

Alterations in neurobiological processes involved in stimulus discrimination

Problems with attention and concentration

Dissociation

Somatization

Conditioned fear response to trauma-related stimuli [and to innocuous stimuli]

Shattered meaning propositions

Loss of trust, hope, and sense of agency [infant abuse survivors never had this]

Loss of “thought as experimental action” [again, infant abuse survivor’s brains never developed the correct pathway responses to the cortex, and the cortex did not, itself, develop correctly.]

Social avoidance

Loss of meaningful attachments [infant abuse survivors never had these in the first place]

Lack of participation in preparing for future [infant abuse survivors have an altered peritraumatic sense of time and their brains developed for a crisis NOW, so they never had this ability, either]

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:The primary function of parents can be thought of as helping children modulate their arousal by attuned and well-timed provision of playing, feeding, comforting, touching, looking, cleaning, and resting – in short, by teaching them skills that will gradually help them modulate their own arousal.  (van der Kolk/CAT/185)”

This is far more than “teaching them skills.”  These patterns are physiologically built into the circuits of their developing brain structure.

“Secure attachment bonds serve as primary defenses against trauma-induced psychopathology in both children and adults (Finkelhor & Browne, 1984).  In children who have been exposed to severe stressors, the quality of the parental bond is probably the single most important determinant of long-term damage (McFarlane, 1988).  (van der Kolk/CAT/185)”

AFFECT DYSREGULATION IN TRAUMATIZED INDIVIDUALS

“…caregivers play a critical role in modulating children’s physiological arousal by providing a balance between soothing and stimulation [connected to mothers first, and then when locomoting, to fathers’ increased stimulation]; this balance, in turn, regulates normal play and exploratory activity.  (van der Kolk/CAT/186)”

affect attunement between caregivers and infants (Stern 1983)

“Whereas adequate caregivers maintain an optimal level of physiological arousal, unresponsive or abusive parents may promote chronic hyperarousal [or, importantly, hypoarousal as in that baby Nathan met in Seattle], which may have enduring effects on the ability to modulate strong emotions.  (van der Kolk/CAT/186)”

“Recent researcher has shown that as many as 80% of abused infants and children have disorganized/disoriented attachment patterns, including unpredictable alterations of approach and avoidance toward their mothers, as well as other conflict behaviors (e.g., prolonged freezing, stilling, or slowed “under-water movements) (Lyons-Ruth, 1991).  (van der Kolk/CAT/186)”

“Thus, early attunement combines with temperamental predispositions [and here it is imperative to consider that stress chemicals in the developing brain change genotypes and their resulting phenotypes thus altering genetic manifestation] to “set” the capacity to regulate future arousal; [consider how the pathways and circuits are built into the brain that is part of this “set”]

limitations in this capacity are likely to play a major role in long-term vulnerability to psychopathological problems after exposure to potentially traumatizing experiences.  (van der Kolk/CAT/186)”

We must consider this even in children who have seen their family butchered by soldiers in other countries, etc.  We MUST consider that their capacity to recover a life after these traumas is directly related to the brain circuitry they already had established during their critical brain growth periods of infant development!

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Does this next statement relate to “core affects” in that other (hard to read) article?

“Cole and Putnam (1992) have proposed that

people’s core concepts of themselves

are defined to a substantial degree by their capacity to regulate their (van der Kolk/CAT/186) internal states

and by their behavioral responses to external stress.  (van der Kolk/CAT/187)”

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Core concept of self = capacity to regulate their internal states

+

behavioral response to external stress

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I would instinctively and in-formatively agree wholeheartedly with this idea from Cole & Putnam

Glasser would call this “getting their needs met”

I am constantly looking for the wholes, and places where the information in these articles does not go far enough.  This material is 11 years old.

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“The lack of development,

[we have to add, changes in development leading to an altered brain formation]

or loss, of self-regulatory processes

[here, again, I would say that we have “self-regulatory processes” all right, but they are not the ones most people get that prepare them to react to a benevolent, predictable world.  Ours our formed in an entirely different unpredictable, chaotic, peritraumatic environment that prepares us to function best as adults in that same kind of world]

in abused children leads to problems with self-definition:  (1)  disturbances of the sense of self, such as a sense of separateness [!!!], loss of autobiographical memories [I never got them in the first place, so how can they say I lost them!!], and disturbances of body image; [what, like I wasn’t even aware that I had a body, which has a lot to do with depersonalization] (2)  poorly modulated affect [from reading Barrett’s article, I did not even develop emotions normally.  I think this is a very important point!] and impulse control, including aggression against self and others; [impulse control is in the brain – relate this specifically to parts of the brain affected – cortex, ability to perceive a future, cause and effect – which one can’t “learn” in an entirely unpredictable world] and(3) insecurity in relationships [what relationships?  And what about the security of relationships with siblings?  And with place (like the homestead)?] such as distrust, suspiciousness, lack of intimacy, and isolation.  (van der Kolk/CAT/187)”

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“Abused children have trouble functioning in social settings;

they tend either to draw attention to themselves or to

withdraw from social interactions.  Thus, they

tend to display either angry, threatening, fearless, acting-out behavior or meek, submissive, fearful, incompetent behavior.

[I learned as a child to remain in neutral, having as few behaviors as absolutely possible!  I never knew what I “did wrong.”  It was best to do nothing at all.]

Problems in articulating cause and effect make it hard for them to appreciate their own contributions to their problems and set the stage for paranoid attributions.  (van der Kolk/CAT/187)”

This is another important consideration concerning mother.  If she could not “articulate cause and effect” even in her thinking, she DID have the stage set for paranoid attributions.

Which she did regarding me, and with her other fairy tale children in her fairy tale life.

This ties to Kestenbaum’s article of ambivalent children not having boundaries that would let them know who was distressed, so they can’t have empathy, and cannot respond to another’s distress because they always experience others’ distress as their own.

That’s a LOT of distress!  Not only do you have your own, but you have everybody else’s, also, though you are never aware of this.

This is an amplification of distress!

FEELING ANOTHER’S DISTRESS AS YOUR OWN

If you can’t tell what your own emotions are, if they did not develop correctly, and the capacity to recognize and modulate them did not develop correctly, then not being able to tell your emotions apart from anybody else’s is not helpful!!

It is way too much stimulation, which amounts to way too much “non-information”

Information is only information in the way our brain evolved to interpret and use it

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MANIFESTATION OF THE ABSENCE OF SELF-REGULATION

“The lack or loss of self-regulation is possibly the most far-reaching effect of psychological trauma in both children and adults.  (van der Kolk/CAT/187)”

Mine was very much physical trauma, as well

“…the younger the age at which the trauma occurred, and the longer its duration, the more likely people were to have long-term problems with the regulation of anger, anxiety, and sexual impulses (van der Kolk, Roth, Pelcovitz, & Manel, 1993).  (van der Kolk/CAT/187)”

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“Pitman, Orr, and Shalev (1993) have pointed our that in PTSD, hyperarousal goes well beyond simple conditioning.

The fact that the stimuli that precipitate emergency responses are not conditioned enough and that many triggers not directly related to the traumatic experience may precipitate extreme reactions is merely the beginning of the problem.

Loss/lack of self-regulation may be expressed in many different ways:  as a loss of ability to focus on appropriate stimuli; [YES!!!]

as attentional problems;

as an inability to inhibit action when aroused (loss of impulse control);

or as uncontrollable feelings of rage, anger, or sadness.  (van der Kolk/CAT/187)”

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“…people with PTSD have at least two different abnormal levels of psycophysiological response to their environment:

(1)   conditioned responses to specific reminders of the trauma, and

(2)   generalized hyperarousal to intense but intrinsically neutral stimuli.  (van der Kolk/CAT/187)”

It is vital to realize that the lack of emotional regulation is a part of overall problems in regulating the self – and that includes being able to regulate what we experience as INTENSE.  So not only might the stimuli be “intrinsically neutral” but it will appear way too intense to us – we interpret the perception of INTENSE through our filters.  These same stimuli would not even necessarily BE intense to someone else.  (This is hard for me to communicate correctly)

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“The first level involves heightened physiological arousal to sounds, images, and thoughts related to specific traumatic incidents.  (van der Kolk/CAT/187)”

For me, this is PEOPLE!!

Effective treatment is supposed to help us be “less physiologically aroused” when we “are reexposed to reminders” of our traumas.   This arousal is a chronic and probably permanent condition for those of us who had peritrauma built into our brains, bodies and nervous systems.  It is part of our damage.

Again, what would Glasser say about this?  Make the better choices anyway.

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“…Shalev and Rogel-Fuchs (1993) have shown that (van der Kolk/CAT/187) desensitization to specific trauma-related mental images

does not affect the overall physiological sensitivity of people with PTSD;

they continue to have difficulty evaluating sensory stimuli

and to mobilize excessive levels of physiological arousal to meet ordinary demands.

The inability of people with PTSD to properly integrate memories of the trauma, and their tendency to get mired in revisiting the past over and over again,

We have to realize that the memories are emotionally held in the body, and probably in the amygdala, but that the hippocampus reacts to stress chemicals and actually physically fries the neurons that would normally have recorded the factual part of the memories – it is not adaptive, I believe, for the brain to record factual memory of experiences that are so horrific that nobody in our species could continue to evolve in response to that threatening an environment.

In that case, why would the body keep the memories?  All that we end up with is a body including a brain that is hyperaroused and hypervigilant because it already knows the world is an extremely dangerous place – just on the edge of what is survivable.  The fried memories were “beyond the edge.”

are mirrored physiologically in the

continuing misinterpretation of innocuous stimuli as potential threats.

(van der Kolk/CAT/188)”

Well, this is certainly the evolutionarily different brain in operation!  We have to remember that when the brain forms this way from infancy, the picture you get is a million times more demanding of our stretches to comprehend its reality.

We must also realize that many of the people who are in the military are there because of limited options available to them due to poverty and difficult early childhood experiences.  This contributes to the increased likelihood that these people experienced traumas in their childhood.

It is the early infant-caregiver relationship traumas that most concern me because these are the ones that are directly built into the developing brain.  But all early traumas will complicate the experience of any combat related traumas such a survivor of childhood trauma will experience.

Part of my attraction to Glasser’s ideas is that such an infant trauma survivor still has to live in this world, and b focusing thoughts and intentions on finding the best possible ways to live in this “benevolent” world will help to engage the brain in an exercise to formulate abilities that more comfortably correspond to the realities of this “new and different” world that we now live in – which is NOT much related to the one our brain formed in adaptation to – and to function in.  We have to recognize our brains and reactions – and practice “doing differently.”

In order to do this, we need a support troop around us.  Glasser describes this – and for those of us not attracted to 12-step programs, this process of connecting to our “species” can be a certainly adequate alternative.

At the same time we have to realize that for those of us with severe chronic infant abuse histories, we will probably never be able to experience empathy the way ordinary people can and do.  We are, in effect, paralyzed from birth in this regard – as surely as Chrisopher Reeves was paralyzed.  As surely as a rattlesnake paralyzed my cat.  Wishful thinking is foolish, and none of us need participate in it when it comes to denying versus accepting the realities of what infant abuse does to the developing brain.

We may have impaired abilities to choose, but I believe this is one area we can exercise to our heart’s content, and improve accordingly.  Reeves still had the ability to make choices, based obviously on the limitations of his body.  And our brain is a member of our body.  We can strengthen this ability within ourselves.  By doing so we will strengthen and grow our brain, mind and self.

We must realize that we continue to misinterpret “innocuous stimuli as potential threats. (van der Kolk/CAT/188)”  We can learn new ways of being to the best of our ability.

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“Problems with attention and simulus [sic]discrimination may account for the high comorbidity between PTSD and attention-deficit/hyperactivity disorder (ADHD) in traumatized children, such as sexually abused girls (Putnam, 1995).  Problems with stimulus discrimination can also help explain the recurrent observation that,

when aroused, traumatized people tend to lose

the capacity to utilize their feelings as guides

for assessing the available information and taking appropriate action; instead, emotional arousal comes to precipitate fight-or-flight reactions (Krystal, 1978; van der Kolk & Duce, 1989).

Thus, they often go immediately from stimulus to response,

without making the necessary psychological assessment [I would say this is the cortical cognitive assessment!  The cortex is bypassed.] of the meaning of what is going on.  (van der Kolk/CAT/188)”

Our brain has already, by default, assessed the world as a dangerous life threatening place to be.  Taking the slower road to discriminating input from stimulus is not life enhancing to our brains.  We already KNOW that we are in danger. This reaction has been built into our brain and body.

We have to understand that “the necessary psychological assessment” is relevant only in a “safe” world.  We have to recognize the facts so that all of us – in both worlds – and with both kinds of brains – are on the same page.

We ARE utilizing our feelings as guides.  Our feelings tell us that the world will kill us.  The essential issue is, to me, one of trying to alter our perception of the world as being an unsafe and malevolent place.  THAT fundamental unequivocal understanding is what made us the way we are in the first place.

We are not like the securely attached children, whose coping abilities function as long as the environment is predictable.  What happens if and when it suddenly changes?  We with the supposed disorganized/disoriented attachments are built for a world of unpredictability – and what you see (from the outside) is what you get.  We appear disorganized because we are looked at by those who have never lived in this world – and certainly not from “in the first place.”

It is at the point where these two different brains, designed for two very different worlds, intersect and overlap that those of us with the “danger” brain tend to be viewed as disorganized.

Evolution of the species does not care if we have a perception of having an individual self, therefore self-regulation does not apply in the same way.  Automatic physiological response is what is going to save a potential gene-donor to the species pool.

But we are such evolutionary throw-backs that you probably couldn’t even find us looking backwards at the evolutionary map.  Humans did not evolve by being solitary creatures.  If we ever did find ourselves alone (back then) then our own abilities to survive single-handedly against insurmountable odds on the extremely off chance that we could mate and produce offspring that might eventually benefit of the continuance of our species would have been the sole reason to justify our existence.  This would NOT have been about having a self, or a happy life, or about making wise choices.  This would have been about only one thing:  enduring.  And that is what we did and what we do.  We endure because we have endurance.  Maybe not resilience, but endurance.  We are not sprinters.  We are in the long distance race for our very lives.

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“Traumatized patients experience current stressors with an intensity of emotion that belongs to the past, and that has little value in the present. (van der Kolk/CAT/188)”

But just as there is no future, there is no past for us, and everything is in the immediate now – an emergency brain that expects doom now.  So our version of the present is different, and in our world it all does “make sense.”

“Unaware of the traumatic antecedents, they tend to experience their own affect storms, as well as emotional reactions from others, as retraumatizing.

Thus, the feelings that belong to the trauma are continually reexperienced on an interpersonal level; these patients lead traumatizing and traumatized lives.

In an apparent attempt to compensate for their hyperarousal, traumatized people tend to “shut down.”

On a behavioral level, they do this by avoiding stimuli reminiscent of the trauma; on a psychobiological level, they do this through emotional numbing, which may extend to both trauma-related and everyday experience (Litz & Keane, 1989).

Thus, people which chronic PTSD tend to suffer from numbing of responsiveness to the environment, which gets in the way of taking pleasure in ordinary events.

This anhedonia is punctuated by intermittent excessive response to traumatic reminders.  (van der Kolk/CAT/188)”

Pleasure is not vital to survival.  We may be “resting” in that “dark” half of the brain, but just watch us should something threaten us!  We are RIGHT THERE then.

The rest of the time we are depersonalized and derealized – no different that a nearly dead and hopelessly caught rabbit.  Given the opportunity, we will awake and do our darndest to escape – so we can “go on being.”

But we cannot predict what will wake us up, any more than I could predict what would happen any time I tried to wake up my SELF as a child.  It was obviously best to let Linda sleep as a child, not that my life gave me much choice.

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talks about self-destructive behaviors as attempts to “regain control over their problems with affect regulation.”  (van der Kolk/CAT/188)”

I’m not sure what to say about this, as I never had the control in the first place to “regain” it

Talks about self mutilation and dissociation

“Dissociation is a frequent concomitant of self-injury.  Many of these patients report feeling numb and “dead” prior to harming themselves.  (van der Kolk/CAT/189)”

smoking is deliberate self harm in my opinion

“analgesia and numbing were mediated by endogenous opioids.  Cutting, according to these patients, gave them relief and made them feel alive.  I do not know what neurochemical agent may be released at the moment of cutting that may provide the sort of relief reported by these patients.  (van der Kolk/CAT/189)”

“…subjects with the most severe separation and neglect histories were the most self-destructive.  We concluded that childhood abuse contributes heavily to the initiation of self-destructive behavior, but that the lack of secure attachments maintains it.  Those subjects who had sustained prolonged separations from their primary caregivers, and those who could not remember feeling special or loved by anyone as children, were least able to utilize interpersonal resources to control their self-destructive behavior during the course of the study.  (van der Kolk/CAT/190)”

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“It is likely that substance abuse treatment of traumatized individuals can be more effective if the issue of recurrent posttraumatic problems during withdrawal is vigorously addressed.  Self-help groups such as Alcoholics Anonymous seem to have grasped this issue intuitively, and, with extraordinary insight, seem to have incorporated effective posttraumatic treatment in their Twelve Steps.  (van der Kolk/CAT/191)”

I’m not sure I agree with this assessment of AA.  This certainly was not my experience!

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DISSOCIATION

“Many traumatized children, and adults who were traumatized as children, have noted that when they are under stress they can makes themselves “disappear.”  That is, they can watch what is going on from a distance while having the sense that what is occurring is not really happening to them, but to someone else.  (van der Kolk/CAT/191)”

Boy, here I am over a year later after starting this book project and I have no more clarity about dissociation than I did in the beginning.  I think they are “contaminating” the concept by using this word to describe widely divergent conditions.

+ 1.  this form of making oneself disappear, or watching from a distance

“When people develop a split between the “observing self” and the “experiencing self,”

This has to do with memory – implicit and explicit, procedural, declarative, autobiographical, episodic, semantic

So many terms!  And I need to understand this, because I think there is a “version” of dissociation that is more accurately about memory.

This has to do with “flashbulb” memories and “dead spots” – wherever those notes are – some in Ratey

I did not have any self at all, certainly not an observing self or an experiencing self.  No self-reflection, awareness or consciousness.

I think of the toilet bowl memory and then I immediately think about the vision.  This ability to swim in the “ether” was present all the way through my childhood.  It is not a condition where choice operates – consciously or unconsciously.

Strange thought, to think that we have both conscious and unconscious choice-abilities!  To take response-ability one must have choice-abilities!

they report having the feeling of leaving their bodies and observing what happens to them from a distance….During a traumatic experience, dissociation allows a person to observe the event as a spectator, to experience no, or only limited, pain or distress; and to be protected from awareness of the full impact of what has happened.  (van der Kolk/CAT/192)”

Well, this is an interesting “swell on the ocean surface!”  I did not develop an “observing self” and an “experiencing self.”  There is a lack of disturbance in the water’s deep because there has never been any calm.  A tiny little fish cannot cause a perturbation in the massive waters, surface or not.  There never was any cause or effect, no predictability, and no safety.  Just presence of the perpetrator and absence of the perpetrator.  Nothing that happened in between mattered (again, matter, matron and matrix are connected, and are feminine, as is mitochondria and cognition).

These two “selves” occur during normal development, and obviously if the abuse from birth is extensive enough, chronic, and unmitigated, something else can happen.  And it did for me.

The capacity to experience declarative memory, or an autobiographical self, would be crucial to this.  As would be the storage of memory as fact along with its emotional components.  If the stress was so overwhelming (and my adrenal system was 2 ½ times larger in proportion to my infant body than it would be in an adult) there was enough stress hormone pumped into my body, the hippocampus fried the neurons under fire so that the memories were not retained anywhere – as facts that I could “get in the middle of.”  All I had was the emotional memory, then.  And emotional memory without fact is like being a fish might be, no separation between one’s scaly surface and the water that surrounds one.  Like a bird on the current of the air with its wings outstretched, gliding effortlessly aloft.

I glided and swam in my emotions because I did not have a choice.  But neither did I develop the ability to dissociate because I never had these two parts of a self – or for that matter, any self at all, to dissociate with or from.

So the question becomes, “How and when do we get an “observing self” and/or and “experiencing self?”  It happens through ordinary development, but even then is culturally determined, even if the culture is one of isolation, threat and violence.

I did not get either one as a child.

I have them both now.  I can clap my two hands together and both experience that act and observe it.  This is because they are happening at the same time – now.  I also have the memory NOW of just having performed that action a moment ago.  I am aware and conscious of the process, and can mentalize or “subjectivize” about it all I want to.  I can think about myself thinking about all of this – like mirror reflected in mirrors.

But I could not do that as a child – not even when I was 18 years old.

+ 2.  Schore’s actual vagal response – like the rabbit when caught who feigns death waiting for an opportunity to escape – conserving resources – perhaps a form of shock of “feeling no pain.”  How is this different than the numbing this author writes about with self-mutilation?

An animal does not have a separation ever between an observing and an experiencing self – therefore, I guess they do not and cannot dissociate.  Not on a psychological level?

Is it like going to sleep and not being able to wake oneself back up?

“Many of these patients report feeling numb and “dead” prior to harming themselves….They often claim not to experience pain during self-injury, and report a sense of relief afterwards…Episodes of self-mutilation often follow feelings of disappointment or abandonment [sounds like Schore’s description of the shame reaction]….The experience of dissociation itself may account for the urge to cut:  The subjective sense of deadness and disconnection from others, [again, this is what the shame response is – a sort of accidental, surprising, unanticipated encounter with a caregiver when one is expecting affirmation and shared joy and excitement – but there is rupture and no connection and precipitates the shame response] which originally may have helped these individuals to cope with extreme distress, is also quite a dysphoric experience.  Many people who habitually engage in deliberate self-harm report that self-mutilation makes them feel better and restores a feeling of being alive. [this is not a feeling I ever had as a child.] (van der Kolk/CAT/189)”

+3.  A state of not paying attention and going into a void place – compared even to what happens when you are driving and “space out”

What is the difference between disconnecting and detachment and disassociation?  When Cindy drives from ABQ and is not aware of what she is doing, her observing self is separated from her experiencing self – consciously.

+ 4.  A state of disconnection, even like in Schore’s description of the rupture and lack of repair in the shame response – and the shock of it

+5.  Some kind of disturbance in memory where time is different and “attachments” between a “self” and the environment are not the same as most usually assume – they develop differently

+ 6.  How about what it is like to automatically respond to stimuli without conscious thought as the cortex is bypassed?  Isn’t that what the following is saying?  Isn’t this a split between the observing and experiencing selves?

“Thus, they often go immediately from stimulus to response,

without making the necessary psychological assessment of the meaning of what is going on.  (van der Kolk/CAT/188)”

+ 7.  What about when they say they can see infants dissociate by 12 months of age?  What is that, Schore’s vagal response?  See below p. 201

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“When children are repeatedly exposed to extreme stress, they develop what van der Hart…has called “tertiary dissociation“:  Elements of the traumatic experience may be organized by a separate state of mind, which may only come into play when that particular element of the traumatic experience is activated.  Very complex forms of such secondary dissociations can be found in dissociative identity disorder…which has also been described as a complex form of PTSD with origins in severe childhood traumatization (Kluft, 1991)”  (van der Kolk/CAT/192)”

“Dissociation can be an effective way to continue functioning while the trauma is going on, but if it continues to be utilized after the acute trauma has passed, [which is very likely to happen] it comes to interfere with everyday functioning.  (van der Kolk/CAT/192)”

“While providing protective detachment from overwhelming affects, it also results in a subjective sense of “deadness” and a sense of disconnection from others….(van der Kolk/CAT/192)”

Well, tangled up in here is part of what happened to me.  I never had the ability for “protective detachment from overwhelming affects” NOT to happen, so I just lived perpetually in that “subjective sense of “deadness” with a sense of disconnection not only from others, but from any sense of myself, as well.

How could it possibly have been otherwise?

So maybe I did not have to suffer from “a dissociative disorder” because this condition is how my brain formed in the first place.  It was what ordered my brain-mind and organized my complete being (as verb and noun) in the world from birth onward

I felt what happened to me.  I had no choice.  I could not dissociate my experiencing self from my objective self.  But this would be true for anyone abused as a very young infant before the brain develops enough to even have an autobiographical self before the age of 18 months.  (Schore’s info on brain development specific on this)

I guess it would be extremely rare for a person to be so abused before the age of 18 months that no self developed at all – or mentalizing or time travel ability.

But somehow I DID connect to the homestead, and “an other” without it being the “person of an other.”

I could not disappear and reappear because I never appeared in the first place.

It would be like trying to assemble something you bought at the store and finding that you are missing some essential components in the box.  You absolutely cannot proceed, and certainly without those necessary parts, you cannot end up with what you intended to have as a result of the assembly process.

I guess when nature determines an emergency exists, she dispenses with many of the product’s parts, stripping down to the essential basics  of what is absolutely necessary.  Having a self isn’t necessary, therefore the experience of dissociation isn’t necessary, although there must be a way that the physiological “rabbit response” is preserved in life and death situations.  I guess mine never got THAT BAD!  I didn’t have a self to protect.

+++

Linda making choices had devastating consequences.  When I chose to play the fox game, or show Cindy the hairball in the toilet, or bury my marbles, or dare to play on the playground and got my coat dirty, or walked in the puddle, or when I knew my perception was different from mother’s when I didn’t pull my pants down and I wasn’t asleep (fox) and didn’t want to drown Cindy and didn’t steal the bubble gum, that I did not write the letter “J” in the book – and forgot to keep my new shoes dry and was not drinking out of a baby bottle

Or when I just WAS present and forgot and left the wooden spoon in the dishwater when I went to the bathroom and forgot the clothespins on the line or accidentally twisted the iron cord or forgot to clean Steve’s diaper – and things I didn’t know I was supposed to do like watch for the sun on Steve at the zoo or watch that he didn’t pick up pebbles and put them on his tray or watch that Sharon’s finger was not too cold or watch that Sharon didn’t sit on the ant hill or watch to make sure that Cindy didn’t walk too close to the road bank in spring time so she wouldn’t get caught in a mud slide

Versus the deliberate like pulling the legs off of the lady bug or deliberately lying about the shampoo and tearing up the note to Michael (and leaving it where she would find it) in the wastebasket

And that as hard as I tried I could not get all 100 steps to doing the dishes right and couldn’t do it fast enough and when I did them faster I couldn’t do the job silently

That I was a terribly stressed and unsocialized child who could not play well with others, that I sat at 2 in the middle of the living room floor and played with pop beads meant I was stupid

++++

“Recent research increasingly supports the notion that making the appropriate diagnoses in these chronically (van der Kolk/CAT/192) patients has dramatic beneficial effect on their long-term prognosis (Ross, 1995).  (van der Kolk/CAT/193)”

++++

PLAY AND PRETEND

“Containing aspects of the traumatic experience in a separate ego state can be understood as an exaggeration and fixation o normal developmental processes.  School-age children are at a developmental level where they have learned object constancy.  This is a stage of development in which they know that things are not necessarily what they appear.  Children at that age take pleasure in trying on different roles; they spend endless hours trying out what it feels like to take on different identities (e.g., taking the roles of different television characters, or playing cowboys and Indians).  When children live under conditions of extraordinary stress, some can utilize this capacity to disappear into the identities of different characters to escape their fate.  However, young children only habitually come to utilize alternative identities to escape unbearable situations when their caregivers are unable or unwilling to do what caregivers usually do to help children change their internal states from agitated and dysphoric to calm and contented (e.g., stroking, rocking, verbalizing, and singing).  This occurs not only in the context of intrafamilial violence and neglect, but also when children have to undergo repeated medical or surgical procedures.  (van der Kolk/CAT/193)”

I think mother went way off track at about this age – she was not rigid in terms of the “identities” that she assigned herself.  Somehow she seemed to have preserved the ability to pretend – project – how much time did she spend alone with her books?  She was the impromptu stage director and scriptwriter, and she recruited different people to be the object of her projections.

Remember with play, that drama is a form of pretend – and psychodrama enactments and reenactments are no exception.

This amounts to a devastating and deadly “game,” not unlike what Bateman has to say about never leaving pretend mode imaginary thinking.

I wonder about Tomkins Image – how the image and pretend and imagination and archetypes and fairy tales fit together.

And I wonder about my mother playing alone, which I believe she did.  Alone with herself in a world of dolls.

And about my play with the disappearing, reappearing fox, with the marbles.  I don’t remember much about play – the boots in the water, the pop bottle, the shampoo – and NOT playing to avoid my coat dirty.  I played basketball but that took no imaginating.  I did not get to play with other children, and for me that kept me from developing an imagination so even now I cannot play pretend.  I think social play develops language and right and left brain interactions in the realm of fantasy – a sort of interactive imagination that both me and my mother then lacked.

John called said that the homestead assumed a sort of “mythic proportion” in our lives.  That is elevating my mother’s pretend mode of thinking past fairy tales to myth.  Including the myth of Utopia or Shangri-la.

“One of the principal tasks of childhood is to learn to negotiate collaborative relationships with other human beings.  Many studies of traumatized children have established that they often have serious problems in their capacity to play (Terr, 1988; Pynoos & Nader, 1988).  (van der Kolk/CAT/198)”

“Their inability to regulate their arousal, to articulate their feelings in words, or to attend to appropriate stimuli, and the ease with which they are triggered to reexperience feelings and sensations related to the trauma, make it difficult for them to be attuned to their environments.  (van der Kolk/CAT/198)”

“The functions of childhood play are to enable children to try out different roles and different outcomes; to learn to appreciate how others experience the world; and to gain mastery over dreaded feelings, people, and situations.  (van der Kolk/CAT/198)”

“When play is curtailed, the capacity to integrate the positive and negative is aborted:  Good and bad, power and helplessness, affection and anger continue to be experiences as separate ego states.  This promotes the likelihood of continuing the characteristic way of coping with fear – by dissociating, thereby consciously disavowing and not personally “owning” the reality of the situation.  (van der Kolk/CAT/198)”

Interesting way of putting it.  But I do think mother played, just not with others – he did not write “when interactive social play is curtailed.”  In my case, all play was curtailed!

“The overall result is that many traumatized children miss a critical developmental stage in which issues of competition, intimacy, and play are being negotiated.  Without these skills, adult life tends to be bleak and devoid of meaning.  (van der Kolk/CAT/198)”

IMPORTANT

“One of our studies (van der Kolk, 1991) indicated that the capacity to derive comfort from the presence of another human being was eventually a more powerful predictor than the trauma history itself of whether patients improved and were able to give up chronically self-destructive activities.  (van der Kolk/CAT/198)”

Glasser would agree with this!  This is about attachment.  He doesn’t say if this was THEN or NOW, but sounds like in the present.  This is part of why AA works.

Interesting that he puts this with his impact of play and relationships with others.

++

“One critical issue related to fixation at the developmental level of the trauma is the lack of capacity to attribute responsibility properly.  Young children, by virtue of their cognitive level of development, attribute everything that happens to their own actions or their own magical thinking…..many traumatized people (particularly those who had been first traumatized as children) suffered from a profound sense of responsibility not only for their own abuse, but for subsequent problems over which they had no control.

Is this where mother got this twist

They are like preoperational children in that their lack of conservation and object constancy seemed to make it impossible for them to see that they were not the center of the universe; they often continued to have great difficulty in seeing various people’s contributions to interpersonal problems.  (van der Kolk/CAT/197)”

This has to relate to the preschooler empathy problems, not being able to tell whose problem it was – boundary issues – it does seem “narcissistic” in that they are all that they can see – interesting difference in looking where this comes from – I wish they gave an age for this preoperational stage.

++++

“The use of projective identification – attributing to others one’s own most despised attributes, without consciously acknowledging the existence of those characteristics in oneself – has been thoroughly described by Kernberg (1975).  (van der Kolk/CAT/196)”

And it is possible to despise one’s own lovableness – as I did.  Which allowed me to love my children because I projected it out onto them.

++++

Writing this book is like taking a spider’s web apart without breaking a thread of web, and in doing so I have to look at what is connected and intertwined with what – where.

++++

I put his section on emotions over in brain parts folder on EMOTION

++++

TRAUMA AND CHARACTER DEVELOPMENT

“The combination of chronic dissociation, physical problems for which no medical cause can be found, and a lack of adequate self-regulatory processes is likely to have profound effects on personality development.  These may include disturbances of the sense of oneself, such as a sense of separateness and disturbances of body image; a view of oneself as helpless, damaged, and ineffective; [I wasn’t even conscious enough to feel this] and difficulties with trust, intimacy, and self-assertion….Social support is an important factor in determining how the personality is shaped by problems of affect regulation.  For example, we (Herman et al., 1989) found that most subjects who were diagnosed as suffering from BPD were first traumatized before the age of 7 within their own families, and suffered from substantial degrees of neglect as well.  (van der Kolk/CAT/195)”

“What is striking about the impact of trauma on character is that, regardless of preexisting vulnerabilities, a previously well-functioning traumatized (van der Kolk/CAT/195) adult can experience an overall sharp deteriorization in his or her functioning….  (van der Kolk/CAT/196)”

++++

NEGATIVE EFFECTS ON IDENTITY

“Traumatized people often fail to maintain a personal sense of significance, competence, and inner worth.  (van der Kolk/CAT/197)”

Here, again, we never had this.  Also important to recognize that inner worth can certainly be on the negative side – it is one way or the other on a continuum, not just positive, e.g., worth-less or worth-more.

FAKING LIFE

“Traumatized patients are frequently triggered by current sensory and affective stimuli into a reliving of feelings and memories [the feelings are a component of the memories, and may be all we have if stress has fried the facts] of their past trauma.  Being so easily propelled into feeling aroused, anxious, freightened [sic], and dissociated, they cannot count on themselves to have a stable presence in the world, and to react consistently to their environment.  This inner sense of hatefulness and unpredictability will generally be expressed in social isolation and avoidance of intimate relationships.  These patients often experience their competence as part of a “cover story” with which they “fake” their way through life.  (van der Kolk/CAT/198)”

Nicely put!  And here, again, I would look toward Glasser for some assistance on how to make some positive changes given these conditions as they exist….

++++

“After exposure to interpersonal abuse, people learn to watch their fellow human beings like hawks.  (van der Kolk/CAT/198)”

This doesn’t do us much good when we don’t understand their cues and cannot empathize with them – nor them with us due to the extremity of our emotional conditions.

“Many people who were traumatized by their own caregivers develop an uncanny ability to read the needs and feelings of people who may have power over them.  This may well alternate with episodes of extraordinary failure to understand other people’s motives.  (van der Kolk/CAT/198)”

“Early exposure to abusive and (van der Kolk/CAT/198) unpredictable parents makes many children exquisitely aware of other people’s needs – a capacity that they can subsequently utilize for self-protection.  Unfortunately, such exquisite sensitivity often lacks a feeling of personal satisfaction, as it is a mere replication of a survival skill acquired in childhood, and not accompanied by a sense of trust, belonging, and intimacy.  (van der Kolk/CAT/199)”

This is also, for me, about always listening to the intent/emotion in voices separately from the words – hard!

And about being very sensitive to energy levels and noise in my environment – I hate it – compounded social problems by being raised in such a remote place where “signs of people” were hated

++++

behavioral reenactments of the trauma – “a person may play the role of victim, victimizer, or both.  (van der Kolk/CAT/199)”

“Reenactment of one’s own victimization seems to be a major cause of the cycle of violence (Wisdom, 1987)”

vulnerable to being victimized on future occasions

INCREASED ATTACHMENT IN THE FACE OF DANGER

Trauma bonds

“It is well understood that people in general, and children in particular, seek increased protection when they are frightened (van der Kolk, 1989).  Most cultures have rituals designed to provide such increased care when members of those cultures have been traumatized.  When nobody else is available, people may turn towards the sources of their fear for comfort:  Both adults and children tend to develop strong emotional ties with people who intermittently harass, beat, and threaten them (Dutton & Painter, 1981; Herman, 1992a).  This phenomenon was initially described as the “Stockholm syndrome.”  (van der Kolk/CAT/200)”

He doesn’t talk about the attachment system being activated and how in times of distress we naturally seek proximity and comfort from that person – who in childhood also was our perpetrator – and may be so today.

++

“When the inevitable disagreements and power struggles that are part of any relationship cannot be managed with either total control or perfect submission, people with abuse histories tend to be unable (van der Kolk/CAT/200) to articulate their wishes, to fail to understand the other person’s point of view, and to be unable to compromise.  Having had little experience with nonviolent resolution of differences, partners in such relationships often alternate between an expectation of perfect behavior leading to perfect harmony, and a state of helplessness in which all verbal communication seems futile.  (van der Kolk/CAT/201)”

++++

TRAUMA AND DEVELOPMENT OF BPD

“…trauma, especially prolonged trauma at the hands of people on whom one depends for nurturance and security, will significantly shape one’s ways of organizing one’s internal schemes and ways of coping with external reality.  (van der Kolk/CAT/201)”

This includes our internal working models of attachment – as an organizing or disorganizing force.

“We theorized that the characteristic splitting of the self and others into “all-good” and “all-bad” portions represents a developmental arrest – a continued fragmentation of the self and a fixation on earlier modes of organizing experience.  (van der Kolk/CAT/201)”

Which may be why I did not become borderline.  I did not have a self by 18 months of age, therefore I did not have a self that was capable of fragmentation!  In the same way that I did not have a self to dissociate with.  (Except what about infants they can “see” dissociate at 12 months of age?)

“We proposed that the self-mutilation, which is often experienced by therapists as a display of masochism or as a manipulative gesture (van der Kolk et al., 1991) [masochism toward others?], may in fact be a way of regulating the psychological and biological equilibrium when ordinary ways of self-regulation have been disturbed by early trauma (Herman & van der Kolk, 1987).  (van der Kolk/CAT/201)”

“In this framework, psychotic episodes in borderline patients can be understood much like the flashbacks seen in Vietnam veterans:  as intrusive recollections of traumatic memories that were not integrated into the individual’s personal narrative, and instead were stored on a somatosensory level…. This idea first introduced the issue of dissociation into our work; subsequent research in BPD has found

dissociation to be highly correlated both with the degree of BPD psychopathology and with severity of childhood trauma (Kluft, 1990; Putnam, 1989).  (van der Kolk/CAT/201)”

“Our study (Herman & van der Kolk, 1987) showed that many psychiatric patients had histories of trauma, but that the BPD patients stood out by having the most severe abuse histories:  More than half of all BPD patients had histories of severe physical or sexual abuse starting before the age of 6.  Trauma in patients with other diagnoses usually started much later, near puberty. …a small proportion of our BPD patients did actually seem not to have a trauma history.  (van der Kolk/CAT/201)”