Exploring the importance of connection and meaning in the healing of complex trauma

Elsa Voak (OHS)

What does terror do to a person?

‘Complex’ trauma is broadly defined as ‘a type of trauma that occurs repeatedly and cumulatively, usually over a period of time and within specific relationships and contexts’ (Courtois) and includes, but is not limited to: child abuse, domestic abuse and multiple military deployments in dangerous locales. Fundamentally, when trying to understand the multifaceted effects of complex trauma on an individual, we need to have a basic understanding of the concept of attachment. Bowlby (1988) saw attachment as the secure base from which a child moves out into the world; for most of us we carry a secure attachment - the emotional and physical synchrony we develop with our primary caregivers from the age of about 2-7 months (Schaffer and Emerson 1964) and then onwards throughout our development initiates a sense of pleasure and safety, which helps create the foundation for all future social behaviour. Bessel van der Kolk (2015) states ‘Our attachment bonds are our greatest protection against threat’. In situations of terror, people seek their first source of comfort and protection. Children are programmed to be loyal to their caretakers, even if they are abused by them : the terror inflicted on them increases the need for attachment which results in ‘disorganized attachment’; ‘fright without solution’. Vulnerable adults in situations of domestic abuse or traumatic military combat feel utterly abandoned and isolated, as no one comes to their aid and protection during their repeated, intense, unbearable distress - the vital connection and meaning fostered through attachment has been broken. Both children and adults thereafter commonly feel a sense of total alienation and isolation; indeed, many struggle with ‘alexithymia’ (Ancient Greek for not having words for feelings). They are compulsively and constantly pulled back into the past; their imagination and mental flexibility - the qualities that allow us to lead meaningful lives - fail. Van der Kolk comments ‘without imagination there is no hope, no chance to envision a better future, no place to go, no goal to reach’. Survivors may go into denial - their bodies sensing the threat, but their conscious minds refusing to accept it. Stress hormones send signals to the muscles to tense for ‘fight or flight’ or immobilize for ‘freeze’, and numerous unexplained medical symptoms such as autoimmune disorders and chronic pain arise. They may experience a sense of ‘dissociation’, where the world is full of triggers that create a life where the fragmented memory of the trauma is constantly present. Often, they cannot tolerate knowing what they have experienced or feeling what they feel - not talking, staying silent, acting and dealing with feelings through rage against others and the self, shutting down, becoming excessively compliant or defiant. Medications, drugs and alcohol may serve as a temporary sedative to these unbearable sensations and feelings; however, connection with others, belief in divine authority and sense of self all crumble. This state of ‘hyperarousal’ means that survivors are often not able to take in deeply what is going on around them: they cannot be fully alive in the present so they are trapped eternally in the past.

Joy, creativity, meaning, connection, recovery:

Disempowerment and disconnection are the markers of psychological trauma. Recovery, therefore, includes a return to self-determinism, self-confidence, intensely supportive and loving relationships, and finally playfulness, creativity and meaning. Complex traumas are, by their very name, complicated syndromes, requiring complex, comprehensive treatment and involving every aspect of human functioning from the biological to the social. In this piece I have decided to focus on solely the fundamentals of the later stages of recovery once a diagnosis by a professional has been initiated and the safety of the individual established. In addition, the second stage known as ‘remembrance and mourning’ (Herman 1992) which involves slowly reassembling an organised, detailed and verbal account of the trauma from the previously fragmented components of frozen imagery and sensation remembered, has commenced. The cutoff elements of the trauma are gradually integrated into the ongoing narrative of life. As with any psychiatric condition, the connection between patient and therapist (the ‘therapeutic

alliance’) and the deep faith of the therapist in his/ her client’s recovery is crucial if recovery is to be successful. This is especially key in the case of traumatic syndromes where survivors feel chronically unsafe in their own bodies, often have no internal sense of security and where capacity to trust has been profoundly damaged. There is no room for mistakes: no individual is just a list of symptoms on a diagnostic questionnaire - rather, as Herman states, ‘the therapist becomes the patient’s ally, placing all the resources of her knowledge, skill and experience at the patient’s disposal’, which involves consistent validation of the survivor’s experience and solidarity with him/her. This requires that the therapist him/herself have access to regular, experienced supervision. Attaining a grip on the terrifying outer world is very unlikely to be solely achieved solely by a pill-dispensing attitude, where only faulty biology and defective genes are to blame. Some patients on SSRIs (selective serotonin reuptake inhibitors) feel calmer, more in control and engage more readily with therapy, while others feel it blunts their emotions and interferes with motivation and curiosity - particularly vital in children to enable them to become well-functioning and contributing members of society. Van der Kolk approaches it as an ‘empirical question’: ‘Let’s see what works, and only the patient can be the judge of that’. Self-regulation is dependent on a friendly relationship with the body. Survivor groups exist for each stage of the recovery process, ranging from a source of validation and emotional support beyond the therapist’s room to groups such as Paul Griffin’s New York City Possibility Project where the ugly reality of our culture’s tendency to repress our deepest feelings is overcome by theatre - the poignant realities of the human condition are confronted and expressed. Mindfulness allows us to note our inner feelings such as annoyance, anxiety or pain without judgement, which helps survivors calm down their sympathetic nervous systems, convincing mind and body that they can finally let go by feeling safe at a visceral level. At a physical level, yoga and martial arts groups allow survivors to reconnect with their sensory world that they have felt such disconnection with and which is often subdued through compulsive or restricted eating and drinking and terror of social or intimate contact. The final stage of recovery exists in the continuous establishing of meaning and, ultimately, commonality. With a renewed sense of agency, the survivor is faced with the task of creating a life. Imagination and fantasy are now tools which have been liberated - the ‘specialness’ of the traumatised identity is set aside but never forgotten: the survivor is able to contemplate his/her story as one among many of especial tragedy in the wider context of the human condition. Those who forget the past are condemned to repeat it, and many survivors develop a ‘survivor mission’ or discover a vocation that deeply embodies the essence of what they stand for and will devote themselves to - a marker of the rekindling of the indispensable bonds of attachment which motivate us to do whatever it takes and believe that anything is possible. It is hard to accept a world where trauma in domestic and professional settings is so prevalent and urgent and its effects so devastating. In order to understand it, I believe we must breach our natural denial of its reality and confront it through the privileged positions we hold - through listening to the stories of survivors and in change through action. As van der Kolk so powerfully puts it: ‘Trauma constantly confronts us with our fragility and with man’s inhumanity to man but also our extraordinary resilience. I have been able to do this work for so long because it drew me to explore our sources of joy, creativity, meaning and connection - all the things that make life worth living’.

Bibliography

Lewis Herman, J. (1992), Trauma and Recovery: From domestic abuse to political terror, London: BasicBooks

Van der Kolk, B. (2015) The Body Keeps the Score: Brain, Mind and Body in the Healing of Trauma, Penguin Random House USA

https://www.psychologytoday.com/gb/blog/ compassion-matters/201207/recognizing-complextrauma

Images - ‘They Dance Alone’ (Ben Singleton) ‘Dance of Life’ (Vicki Cowan)