The World Health Organization (WHO) has developed an international version of the Adverse Childhood Experience Questionnaire, the ACE-IQ. I think this is a wonderful development. The already substantial evidence linking diseases and mental disorders with adverse childhood experiences suggests the connection is a global phenomenon. Yet the questions are very specific about potentially traumatic experiences. I suspect for many, just answering the questions can be triggering. For example, question 4.7 asks “Did you see or hear a parent or household member in your home being slapped, kicked, punched or beaten up?” The participant grades such memories as “many times,” “a few times,” “once,” or “never.” Such a question—and the need to quantify the experience—could be profoundly overwhelming for a person who habitually dissociates memories of family violence.
The WHO gives guidelines for administering the test that emphasize respect and tact towards participants. Even so, when collecting data from trauma survivors, I think there is a responsibility to avoid activating traumatic defenses.
In our efforts to generate evidence for a trauma-informed health care system, we must balance getting supportive data with the possibility of re-traumatizing people. This won’t be an easy task and may require trained health care workers being present to support those who feel overwhelmed by recalling childhood traumas.
Few of us make it through childhood without getting the wits scared out of us by a nightmare. Michel Jouvet, professor of experimental medicine and author of The Paradox of Sleep, theorizes such dreams may be behavioral rehearsals for survival, connecting emotions with corresponding actions. The dragon chasing you in your childhood dream is Nature’s version of virtual reality, a zero-consequence environment teaching the emotion blood-curdling fear naturally accompanies the behavior run like hell. The jolt that jerks you out of sleep makes sure you’ll remember the connection. Screaming for Mom reinforces using your attachments (and tribe) as a secure base.
You’ve got to hand it to Nature–nightmares are an ingenious way of cultivating survival.
Nightmares arising from trauma may also be opportunities to learn life lessons. Yet it’s hard to imagine looking for the meaning of a nightmare when it is about the most horrific moments of one’s past. What lesson could be learned from such terror and suffering?
Psychology researcher Matthew Walker and Dr. Murray Raskind suggest using the drug prazosin to end nightmares associated with PTSD. Prazosin, a drug originally marketed to treat blood pressure, also makes people less sensitive to the stress hormone noradrenaline. In our more benign dreams, when noradrenaline drops off, emotional intensity also diminishes. And emotional intensity is what makes nightmares feel real and frightening.
While recognizing the importance of emotions, Walker believes repetitive nightmares are a sign that traumatic stress has lasted too long. From an interview with Amy Standen of NPR:
“But I don’t think it’s adaptive to hold onto that emotional blanket around those memories forever,” he says. “They’ve done their job at the time of learning, then it’s time to hold on to the information of that memory, but let go of the emotion.”
I agree with Walker in principle. It’s best to learn life’s lessons and get on with the business of living. Yet I also have faith in two million years of human evolution. And I believe medicating the symptoms of distress can interfere with natural and evolved capacities for overcoming trauma.
John Briere, a psychologist at USC, looks to “ethnocultural” beliefs to augment the Western understanding of trauma. An ethnocultural lens examines both how cultures address trauma and what is perceived as traumatic experiences. According to Briere, many non-Western cultures equate soul loss with what the West calls PTSD. Similarly, Peter Levine wrote about a culture that described trauma as rape of the soul. Universally, trauma can lead to isolation, and isolation leads to soul loss. We need meaningful connections to keep soul alive.
Soul loss also occurs in the West, even though the word soul is avoided, especially in medicine. Yet you know you are at risk of losing your soul if after a traumatic event (or series of events) you spend a great deal of time hypervigilant, looking for signs the traumatic event might recur. Over time, the unrelenting fear and anxiety become too much, and solace is sought, often in addictions. Behavior is also inhibited to avoid being triggered. Without intervention, the habit of avoiding reminders of the original trauma leads to an isolated existence. For some, this may mean literally shutting out the world. For others, not letting people get to know them becomes the primary defense. For many, addictions create a wall against humanity.
For millions of years humans lived in close-knit groups in which everyone played a vital role in the clan’s survival. It wasn’t an option to have someone cooped up in the house, isolated, watching TV, drowning distress in alcohol—or whatever a traumatized caveperson might have done to avoid reminders of trauma. That would never happen, and not because there weren’t TVs or houses. Survival was too precarious for our hunter-gatherer ancestors to feed and shelter a traumatized person unable to contribute to daily needs. (In US history, one of the original appeals of mental institutions was the opportunity to house family members who couldn’t work and thus drained family resources.)
In a society that listens for the meaning of dreams, nightmares might alert the group to the presence of threats too big for one person to handle. Traumatic stress is by nature communicable. In psychotherapy we have a term for the contagious quality of trauma: vicarious traumatization. I have come to believe the infective quality of trauma is part of its so-called symptomatolgy. Traumatic stress may have evolved to be somewhat “contagious” since any experience that is traumatic to one of us is potentially a threat to us all.
Perhaps in our isolated and medicalized society, prescribing drugs for nightmares is the most humane response. When traumatic stress results in a life lived in isolation, it can be daunting to get back in the world, amidst all the potential triggers. Having a drug to dampen traumatic defenses is not an unreasonable initial form of support. Yet ultimately, we need opportunities for collective responses to trauma that keep the traumatized person from becoming isolated in the first place.
Research shows that when people find meaning in traumatic experiences they can recover (and often without professional help). Survivors of Pearl Harbor who interpreted their nightmares as reasonable responses to the bombings were able to get on with their lives. Yet knowing that responses are reasonable often requires talking to others about our experiences.
If isolation is the downward spiral of trauma, then perhaps nightmares are the phoenix’s call from the ashes. Even in trauma, nightmares have a lesson to teach. Yet deciphering their meaning may need the entire tribe’s attention. In the case of returning Veterans, nightmares of war may be a call for Americans to collectively address war’s scourge on the souls of young soldiers, along with the intergenerational impact of war, which as a nation we have a long history of ignoring.
If you would like to support Veterans who could benefit from someone listening to their stories, visit When Johnny and Jane Come Marching Home.
I spent a good part of my youth in San Antonio, Texas, where Bihl Haus Arts exhibits the work of artist Debora Kuetzpal Vasquez. My grandfather owned a couple of Mexican curio shops on the River Walk. As a child I was given piñatas on birthdays and sugar skulls on the Day of the Dead. Like many, I am drawn to the bold colors and whimsical nature of Mexican folk art. Kuetzpal Vasquez’s exhibit translates the vitality of this tradition into a message about healing domestic violence. In an article for MySanAntonio.com, she calls her show “a healing exhibition.”
Debora Kuetzpal Vasquez also teaches art that heals. From the article by Elda Silva:
In an art class she teaches, Debora Kuetzpal Vasquez asks students to write down a bad memory in a journal, then paint over it in white. The last step of the exercise is to “paint something beautiful over it,” Vasquez says. The idea is not to gloss over the past, but “to try to move that memory into something different.”
Keutzpal Vasquez takes a similar approach to her multimedia show at Bihl Haus Arts. The exhibit was inspired by interviews with women about their experiences of domestic abuse. The installation makes up different rooms of a house. Like the art her students create, abusive words inscribed on walls leave traces in the paint that covers them.
Keutzpal Vasquez describes her exhibit as a “safe place,” and adds in her interview with Silva, “I always say if there’s anywhere in the world that you should be safe, it’s in your home.”
So true.
Last spring I reviewed research conducted by Robert Miller and David Johnson that showed PTSD correlated with higher levels of creativity. Recently the New York Times shared the story of Sgt. Matthew Pennington, who is healing PTSD in part through acting in a film. You can learn about the film, “A Marine’s Guide to Fishing,” here. The NYT article about Pennington begins a series of profiles of wounded Veterans.
Ideas about the nature of “healing” are regularly batted around the culture of psychotherapy. The word ”transformation” also comes up, which feels sympathetic with a depth psychological perspective, but can also sound somewhat grand and mysterious, although not in the following poem by Stephen Dunn. I like how Dunn highlights the resistance to change that is a regular part of psychotherapy, along with the felt sense of being on the other side, after the transformation, when we can see we have “healed.”
WHERE HE FOUND HIMSELF
The new man unfolded a map and pointed to a dark spot on it. “See, that’s how far away I feel all the time, right here, among all of you,” he said. “Yes,” John the gentle mule replied, “alienation is clearly your happiness.” But the group leader interrupted, “Now, now, let’s hear him out, let’s try to be fair.” The new man felt the familiar comfort of everyone against him. He went on about the stupidities of love, life itself as one long foreclosure, until another man said, “I was a hog, a terrible hog, and now I’m a llama.” To which another added, “and me, I was a wolf. Now children walk up to me, unafraid.” The group leader asked the new man, “What kind of animal have you been?” “A rat that wants to remain a rat,” he said, and the group began to soften as they remembered their own early days, the pain before the transformation.—Stephen Dunn, Everything Else in the World
“Healing,” “transformation,” whatever we call it, can be profound or subtle. Sometimes it’s a small shift in how one is in the world or how one sees oneself. That’s all that’s needed to right that feeling of somehow being all wrong (or wronged). But sometimes a big change is required, like a hog turning into a llama. When this happens, there is usually a need to drop well-honed “human” defenses–the stonewalling, the addictions, the slick arguments, the sly manipulations and passive aggressions–and trust the need for love and play that resides in all of us…and simply let go. Pain is an inevitable part of the journey. The pain lasts the longest when we resist acknowledging to ourselves that the best we can do is get out of our own way. The reward is great when we finally stop defending against pain. We become more human, more compassionate with ourselves and others.
Last week I visited SFMOMA, and on display was one of Sam Durant’s works, “History never ends, I hate to bother you”:
Sadie Coles HQ gives this explanation of Durant’s art:
“The show’s title [History Never Ends, I Hate to Bother You] may furthermore be read as a sardonic refutation of Francis Fukuyama’s famous postmodern thesis ‘The End of History?’, which proposed the end of ideological conflict after the collapse of the Soviet Union and advocated the spread of liberal democracy.”
I haven’t read Fukuyama’s thesis, but it would be hard to construe the latest round of globalization as an end to ideological conflict or the beginning of a liberal, democratic world. In the United States as well as abroad, our history of colonialism and exploitation continues to haunts us, and as Durant’s work implies, we continually try to escape it.
No doubt the mental health complex has been a globalizing force. Psychiatric diagnoses have themselves been described as part of our efforts to spread liberal democracy. As anthropologist Allan Young of McGill University remarked, the diagnosis PTSD “may turn out to be the greatest story of globalization.” With the appropriation of PTSD abroad come attempts to universalize the impact of disaster on both civilizations and psyches. Yet even the best intentions can be colonizing.
Perhaps trauma is a more value-neutral term than the diagnosis PTSD. Traumas, like tragedies, just about everyone endures at some point during the course of their lives. What is described as “tragic” often is determined as much by the event as the outcome, and this is also the case for traumatic events. What one person experiences as traumatic, foreshortening the sense of future possibilities, another person experiences as transformative and the foundation for a more meaningful existence. Even disasters have their bright spots. In her book, A Paradise Built in Hell, Rebecca Solnit chronicles not only the generosity and sense of community that emerges during disasters, but also the joy many experience at times of profound loss.
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I am looking for connections between the denial of history and the impact of psychotherapy on how we perceive our individual and collective histories. Durant’s work got me thinking perhaps it’s not history that is so bothersome, and which we hide from, but the way history has been portrayed, including how much we believe we can learn from the past. Walter Benjamin described history as “an angel blown backwards through time.” He drew inspiration from Paul Klee’s painting, Angelus Novus:
A Klee painting named Angelus Novus shows an angel looking as though he is about to move away from something he is fixedly contemplating. His eyes are staring, his mouth hangs open, his wings are spread. This is how the angel of history must look. His face is turned toward the past. Where we perceive a chain of events, he sees one catastrophe, which keeps piling wreckage upon wreckage hurling it before his feet. The angel would like to stay, awaken the dead, and make whole what has been smashed. But a storm is blowing from Paradise; it has got caught in his wings with such violence the angel can no longer close them. This storm irresistibly propels him into the future to which his back is turned, while the pile of debris before him grows skyward. This storm is what we call progress. 
Excavating the heap of history is at the root of the psychoanalytic method. The treatment plan more or less goes as follows:
• Support clients as they regress to the point of their childhood wounding (also described as digging in the dirt, but perhaps the notion “dumpster diving” would be more appropriate given Benjamin’s imagery).
• Create circumstances for “abreacting,” or releasing the emotions associated with the traumatic wound that were repressed, even silenced, at the time of the injury.
• With the emotions finally released, clients can begin to rationally interpret and sort out their histories rather than repeatedly react in the present moment as if still caught in the past. Hopefully, in the process clients also develop greater compassion for themselves and those who failed them.
I would like to believe the story of history’s revision psychoanalysis provides. If only rationality and interpretation could put the past to rest (and no less, in such an orderly fashion). Are we really capable of rationally reflecting on the destruction left by progress? Does discharging overwhelming emotions set the foundation for forgiveness, or the transformation of the human psyche? Or does such an approach potentially re-traumatize, in effect recreating the psychological conditions of the original trauma? We now know that when remembrances of past traumas are triggered, the natural response of the body is fight, flight, or freeze—responses that impede rational reflection on the past. Given what we know today about how our bodies react to reminders of past traumas, what would it take for us to collectively address the wreckage caused by the US history of colonialism and exploitation? What does it take to turn the angel of history to face the future head on?
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Pierre Janet, a contemporary of Freud, was developing his own theories about trauma while Freud was devising the methods of free association and abreaction. Janet had a different take on the nature of trauma. He saw the body as central to relief from the repetition of traumatic defenses that keep people shutdown to the reality of present conditions. According to Janet, traumatic reactions are not only the result of actual efforts to defend against threat. Also recorded in the body are movements, images, and sensations that represent what the body wanted to do—so-called “acts of triumph” that would have led to a different history, one that involved facing down the threat. Yet, because of circumstances that impeded self-defense, the path out of trauma was also split off from awareness, or dissociated, along with the memories, thoughts, sensations, emotions, and images associated with the actual traumatic event. Janet said, “The patients affected by traumatic memory have not been able to perform any of the actions characteristic of the stage of triumph.” Thus, an event or situation is experienced as traumatic because it necessitates splitting off awareness of what did happen as well as what could not happen—escape from the trauma. Healing occurs by integrating all that was split off from awareness. According to sensorimotor psychotherapists Pat Ogden, Kekuni Minton, and Clare Pain,
“If, as Janet suggests, traumatization is a failure of the integrative capacity, then the first priority in the treatment of trauma must be to restore clients’ capacity to tolerate and integrate their own thoughts, feelings, and bodily sensations, to bear witness to their own experience, to be able to process significant life events—past and present, painful and pleasurable, ordinary and traumatic—within a window of tolerance.”
The notion of “window of tolerance” is key: to learn from the past, we must be able to tolerate what it brings up for us. I think of Durant’s text, “History never ends, I hate to bother you,” as meaningful because it witnesses our collective failure to grapple with past events that threaten to overwhelm us. There has also been a failure to create opportunities for “acts of triumph” that could literally transform both individual and collective repetitions of traumatic defenses that keep many emotionally shut down to history (and often caught in addictions).
Art is one way to initiate acts of triumph over histories denied. Art provides one avenue towards overcoming a colonizing rationality that enforces norms while implicitly silencing alternative possibilities and interpretations. By imagining the unimaginable, what once was split off from awareness is reclaimed.
In the light of creative efforts to form more integrated selves and a more integrated society, psychotherapy plays a humble role. And although Freud’s methods seem anachronistic today, he nevertheless was brilliantly observant, even remarking, “Everywhere I go I find that a poet has been there before me.”
From David Whyte's poem, "Sweet Darkness," in House of Belonging, wisdom to remember in the new year:
... The world was made to be free in. Give up all the other worlds except the one to which you belong. Sometimes it takes darkness and the sweet confinement of your aloneness to learn anything or anyone that does not bring you alive is too small for you.The holiday season is a season of longing. Some long for time with loved ones, while others long for loved ones to spend time with. Children and grown-up kids long for the coveted gift. Many long for a new life or new sense of self, hence New Year’s resolutions. Still others long for the holidays to end, with their traffic jams, long lines, and manufactured good cheer.
Longing runs deep in human nature. Both love’s companion and adulterer, longing points the way to the love we need, but also traps us in fantasies of perfect love and perfect lives that blind us to real possibilities. An exalted and sometimes treacherous force, longing draws lovers together against all odds and keeps love alive across the miles and years. Yet when love goes unrequited, longing can drive us to despair.
Across the millennia art, music, and the humanities have recorded the power of longing for redemption as well as destruction. The modern quest to scientifically validate our collective folk wisdom reveals the human brain and body are hardwired for loving and longing. If there ever was any doubt, human sciences have discovered love is as vital for our survival as food, air, and shelter—a basic need catalyzed by longing in the way hunger and thirst drives efforts to replenish the body. But modern science perhaps gives us more, revealing the role of longing for complicated grief, or how fantasy worlds spawned by interminable longing keep the emotionally neglected child alive to the possibility of love when love is absent, or at best, anorexic.
Longing is more a mood than an emotion. It has a way of sticking around, unperturbed as reality is unceremoniously pushed aside in favor of imagining the longed-for person, object, or experience. Too much longing can result in a state of distress. Each of us has our own personal limit to the amount of distress our bodies and psyches can tolerate. Like the infant whose cries go unheeded for too long, eventually collapsing into a state of numbness, we adults eventually shut down too, often into a state of dissociation.
Having the capacity to dissociate is beneficial to survival. Mild to moderate levels of dissociation make possible continued functioning, albeit by ignoring emotional needs. The parts of us that still operate—thinking and rote interactions with the environment—benefit from a lesser-known advantage of dissociation: the release of feel-good endorphins. According to Peter Levine, author of Healing Trauma, dissociation, “’softens’ the pain of severe injury by secreting nature’s internal opium, the endorphins.” And really, what’s more painful than a broken heart?
For children who are emotionally neglected, longing for love is the norm. And for a person grieving, longing for the deceased can also become a way of living. For both the neglected child and the mourner, there is no real-world solution to their longing. With no end in sight, it makes sense to resort to living more from the head rather than the heart. Absorbed in thinking, we avoid emotions that might trigger longing and the painful recognition that the need for love goes unfulfilled.
By thinking, however, I don’t mean rational reflection on one’s internal states; though this can occur and lead to a way out of longing, or when judgmental in nature, a way into depression. Rather, I prefer John Dewey’s take on thinking:
“Daydreaming, building of castles in the air, that loose flux of casual and disconnected material that floats through our minds in relaxed moments are, in this random sense, thinking. More of our waking life than we should care to admit, even to ourselves, is likely to be whiled away in this inconsequential trifling with idle fancy and unsubstantial hope.”
With Dewey’s dynamic description of thinking, we witness the more creative side of human nature and why the expansion of the cortex—the thinking part of the brain—is believed to distinguish humans from all other life forms. Within us, we carry the possibility of inhabiting worlds of our own making, ignoring the conditions in which our bodies are embedded while nevertheless marginally functioning within them. When Dewey’s understanding of thinking is joined with what neuroscience has discovered about the relationship between dissociation and the release of endorphins, it is fairly easy to imagine how fantasies could become a comfortable hiding place from a seemingly loveless world. Fantasies certainly feel safer, and with endorphins swirling about, quite good, although I would venture to claim not as good as the real thing. Yet for a child who is emotionally neglected (and the adult that child eventually becomes), or for a person stuck in grief, trusting love can be a difficult thing to do.
I sometimes think all the distractions that characterize modern living—a zillion cable channels with round the clock programming, the Internet, the latest technology, the newest video game, the next best travel destination—are sometimes nothing more than a collective effort to keep longing out of awareness. In the United States, grief has turned into a short-term affair, something with stages that we supposedly go through, eventually reaching an endpoint, grief-free. In reality, grief is the continual act of remaking the relationship with the deceased as we go on living without them—a process that takes the length of our lives, although waxing and waning in its intensity over the lifespan. And emotional neglect is not an uncommon occurrence in our society. A majority of the population has histories of adverse childhood experiences, and broken homes are widespread, leaving children feeling unloved despite some parents’ best intentions. It’s not hard to see how a season of love like the holidays for many would feel more like a season of longing (and how a drive to profit off longing could be so lucrative).
The cure for longing is love. For many this requires a large measure of safety, someone reliable to meet them in relationship. Risking loving another person also involves acknowledging fantasies are a bridge to love and not the destination. Trusting love is not easy, especially when fantasy has been a longtime companion and stand-in for the real thing. No wonder we are so drawn to films, media, and images that can serve as fodder for our personal fantasies of love, if not dreams of perfection.
The way out of longing also involves awareness, both to painful emotions residing within and to the beauty of the world around us. The idea is to feel about life as Emily Dickenson once wrote, “To live is so startling it leaves little time for anything else.” Of course, advice is cheap when fantasy has become a well-worn suit of armor. But like any psychological defense, especially one used against the pain of grief or chronically feeling unloved, the remedy is found in regaining connection—to one’s soul, one’s body, others, and the environment. Just as longing is a natural experience, so too is healing from lost love, which is also potentially transformative, turning a season of longing into a season of joy.
