Observations on Trauma

 Trauma has such a profound and negative impact. The most common and insidious result of trauma, in my opinion, is the erosion of self-worth. Over the years working as a counselor and hearing the stories of trauma has led me to an understanding that so much of the internal anguish people suffer stems from some of the false beliefs that result when trauma occurs. 

The question I continue to puzzle over is “Why?.” Interestingly, that is the very question I have heard most often when speaking with people who have experienced trauma, “Why?.” Objectively, we know the “why” when we hear their story. Their abuser was unable to control their emotions or be able to manage their anger. The perpetrator engaged in a random act of violence without thought of how it would affect anyone else. The enemy combatant engaged in warfare. Whatever the case, objectively, those things that happened have no bearing on the value a person has as a human being. 

But, that is not how a victim of trauma typically responds to the question of “Why?.” The person who was abused will create a story that makes them responsible for the adult’s behavior. “It must have been my fault.” “I’m a bad kid.” Or the person who was sexually assaulted who says, “I shouldn’t have been at that place at that time, it was my fault.” Or the soldier who lives with a deep sense of guilt for surviving. 

All of these stories, false though they are, become the stories that, over time, begin to feel true. When they feel true, self-perception shifts from the objective to the subjective. They begin to believe the lie. Then, they begin to act and behave as if the lie is true. Their self-perception skews their perception of others and subsequent events and experiences. Their interpretation of others' behaviors or words and events in life are only seen through the lens of “I do not have value.” Relationships become difficult for them and for those who value them. They develop a tendency to disregard any positive experiences and accentuate the negative. It’s as if they can only absorb that which is congruent with how they feel and think about themselves no matter how much others in their life value them. 

Of course, coping with this lack of self-worth often leads to avoidant behaviors. Substance use, eating disorders, process addictions, codependent relationships, as well as increased depression and anxiety are all too common. 

It is my belief that part of my job as a counselor is to help the people I work with learn how to manage their avoidant behaviors and to help them understand why they believe the lie about themselves and help them come to understand the truth. The truth is, we all have intrinsic value. I can hold the people I counsel in unconditional positive regard, and, hopefully support them in seeing themselves the same way. 

When Someone Loses Hope

I was sitting with a woman recently who told me that she felt so hopeless. She was caught up in a binge and purge cycle of her eating disorder to the point that she was having a lot of difficulty stopping. We sat and spoke about various strategies she could use to disengage her behaviors, but I could feel the fear and anxiety in her that she wouldn’t be able to control herself when the urgency to purge began to rise. 

The question of what to do when the person we are working with loses hope is something that we are all likely to face at some point. It is a difficult question to answer. 

In reality it is possible the person we are working with who is struggling with an eating disorder may die from the disorder. About 10,200 people die as a direct result of an eating disorder each year (Website, n.d.). Over 25% of people with an eating disorder will attempt suicide (Arcelus et al., 2011). Suffice to say, the work we do helping people overcome their eating disorder is serious business. 

So the expectation we must have for ourselves is to sometimes hold hope for the hopeless without becoming overwhelmed. I have found that it is necessary to radically accept that I cannot make someone recover. I can only do my best to create an atmosphere where the individual I’m working with begins to feel empowered to recover. 

I have to monitor and manage my own emotions. It is unhelpful for me or for the person I’m working with when I express frustration or anxiety when suggestions of interventions are met with doubt and skepticism, or when this person repeatedly tries and fails to control those behaviors. 

For me, the key has been to be patient in consistently offering support, focused on the issue by not getting distracted from behavior change, and constant in the message that this person holds value. I also have to recognize that my sadness or frustration or fear are real and valid and need to be accepted and valued by myself. These emotions are not things I should avoid, but which I need to sit with and move through, just like I encourage the people with whom I work, to do. 

With this woman who felt so hopeless, her longing and desire has been that someone would give her a pill, or design a custom treatment, or identify a specific trick that would make her stop her behaviors instantly. She wanted magic. Sadly, there is no magic to recovery. For her, it must begin with eating a snack or meal, feeling the urge to purge and then not purging, no matter how urgent the feeling becomes, then repeating that over and over again until the thoughts and urges and emotions no longer have power over her behaviors. The hopelessness she feels is due to the fear of sitting with that discomfort and her intense desire to avoid it at any cost. 

So, I continue to hold hope for this person even though she has none. I continue to offer whatever support I can and try to find different support when what I’m doing is inadequate. I continue to allow myself to feel and work at balancing my own life with the challenges I face in every area of life. 

Arcelus, J., Mitchell, A. J., Wales, J., & Nielsen, S. (2011). Mortality rates in patients with anorexia nervosa and other eating disorders. A meta-analysis of 36 studies. Archives of General Psychiatry, 68(7), 724–731.

Website. (n.d.). Deloitte Access Economics. The Social and Economic Cost of Eating Disorders in the United States of America: A Report for the Strategic Training Initiative for the Prevention of Eating Disorders and the Academy for Eating Disorders. June 2020. Available at: https://www.hsph.harvard.edu/striped/report-economic-costs-of-eating-disorders/.

 

Get off the LEDGE

When we experience difficulty in life and find ourselves unable to cope it can feel overwhelming. When we are overwhelmed, we may feel compelled to do something… anything, to avoid that pain. However, in most cases, the avoidance of pain (and here I’m talking about mental and emotional distress) only tends to make matters worse, especially when those avoidance behaviors are unhealthy and destructive. If I engage in an eating disorder to try and manage the fear I feel of gaining weight, I will, inevitably, damage my body. If I drink to stop my racing thoughts or try to manage my social anxiety, I can become addicted and eventually be unable to stop by myself (not to mention the adverse health consequences). Whatever the avoidant behavior, in the end, I still experience that internal pain. 

I worked with a woman who was engaged in both of those behaviors desperate to avoid her thoughts and feelings. Her resistance to her internal pain led to deep suffering and, eventually, thoughts of suicide. She told me that, one day, she decided to drive to the top of a parking garage, get out of her car, walk to the ledge of the building and jump. As she stood on the ledge she experienced fear and doubt about ending her life in this way. Eventually she decided not to follow through with her plan and went to get help. 

Her aborted attempt put me in mind of a question. What do we do when we find ourselves on the ledge? I came up with an acronym for some advice that I have had to follow in my life using the word “LEDGE.”

L - Look at your pain

Instead of avoiding and turning away from the pain that you may be feeling, look at it. See it for what it is. Notice the history, the causes, the impact and the power this pain has over you. Name that pain. Put a label on it. Choose to stop turning away from what hurts. Realize that your pain is a human experience.

E - Embrace your pain

In your mind, imagine that, until this moment, you have been trying to push your pain away or run from it. Now, instead, imagine that you are putting your arms around your pain and choosing to feel it. Claim the pain as yours. Decide not to push it away or run from it any longer. Say out loud, “This is my pain and I will feel it.” Notice how it hurts and choose to endure it. 

D - Describe your pain

Put words to your experience. Use language to create a deeper understanding of your pain and to take away the mystery of it. Being able to put into words the feelings and experience of having our pain decreases the power that pain has over us. 

G - Get off the ledge

Make the choice to stop allowing your pain to control your behavior. That might mean seeking out help or starting a process of recovery or healing. Getting off the ledge means determining to let go of the impact your pain has had on you.

E - Engage in living

It is entirely true that we can hurt and live at the same time. Both can be true together. Once we get off the ledge we need to engage in the here and now, staying connected with life and people, and arranging our actions in purposeful ways. We should look for ways to be grateful and use that gratitude to see beyond ourselves and our pain.

In the end, as we engage in living again, we eventually move through our pain and come out the other side. The hurt and ache diminishes and we are left only with the memory, a memory that no longer overwhelms us but causes us to feel more empowered and whole.

This is what I had to do at a very dark time in my life. My pain threatened to swallow me up. Although I never considered suicide, there were many days that I wanted to just give up. But, with help, I looked at my pain, embraced it, described it to myself (quite a number of journal entries, actually). Then I got off the ledge and started engaging in what turned out to be a new life for me. 

Do you want to know something? In the end, I realize now that through that and other difficult experiences, I grew. Now, as I look back, I truly am grateful for those trials.

How Does Trauma Impact Self-worth

I have been doing some research about the impact of childhood trauma in the lives of people who develop mental health problems. My interest for this is due to the high number of people I work with as an outpatient provider of counseling services who exhibit some pretty severe impairment in their daily lives and also reported childhood trauma. When they come to me and my colleagues they are struggling with depression, anxiety, substance use, eating disorders and self-harm. Most of them have real difficulties in relationships, as well. Here are some of the things I have come to understand about these individuals.

• Almost to a person, they see themselves as unworthy of love and mistrusting of others.
• They engage in some type of self-destructive behavior which, when you do some digging, seems to be a result of trying to avoid feeling something or thinking something. 
• Most of them are able to point to an event or events in their lives (usually their trauma) where they passed judgment on themselves and started to believe their abuse or trauma was their fault, or that they deserved it because they were "bad" or less valuable than those around them.

The research I am reading seems to confirm that the underlying problems they face from day to day, including many of their addictive behaviors, stem from the residual effect of being traumatized. This residual effect is that they have come to believe they have little or no value. "I am worthless" is repeated often and with deep conviction and belief. The result of this often repeated statement is, in my opinion, at the core of why healing and recovery is so elusive for many of them. 

I have come to believe that the deeper work of helping them re-write the stories they tell themselves is the most important work. I have also come to believe that this deeper work really has to be done in tandem with skills training so they can successfully stop their self-destructive and addictive behaviors because these behaviors are helping them avoid their feelings. 

The Percussion Band

It is fascinating to me how sometimes the judgments we make about ourselves when we are young carry over into our adult life. One of those events for me happened when I was 4 years old. My parents took me and my sister to church every Sunday from the time I was born. I can truly say that I cut my teeth on the church pews.
It was Christmastime and the annual preschool percussion band was on stage to tap their blocks of wood, clink their metal triangles, and shake their tiny tambourines to "Away in a Manger," a shameless display of raw talent. My role in this lovely and ultimately memorable pageant was that of Band Leader. The Sunday School teacher stood me on a folding metal chair, placed a wooden baton in my hand, a top hat on my head, and had me wave my hands to lead this delightful set of 3 and 4 year olds.
Based on the response of the crowd, our cover of this famous Christmas Carol, had it been recorded, would have taken its place in the annals of 10 Best Christmas Recordings of All Time. There was clapping and cheering and, in the embellished memory of my mind, whistles and calls of "Bravo!" and "Encore!"
There I was, in my red blazer with the emblem on the breast pocket and my top hat, hearing for the first time the siren call of an audience's applause. The teacher asked me to take a bow (a novel experience for me as a 4 year old as I had never bowed before and needed instruction on how to do it), which I did, leading to even more applause and, at least in my mind, a standing ovation from the crowd.
The reality of the situation was that four year olds are adorable. The judgment about myself that I took away was that pleasing adults has incredible benefits and I need to please them to feel good about myself. Thus began a long period of time in which, through my perception of myself, I focused on pleasing people as a way to feel significant.
It wasn't until I was in my mid thirties that I realized how focused I had become on the validation of others as a way to feel good about myself. It was a shock that led to a painful but beneficial insight about how I viewed the world. Gratefully, I was able to recognize that I am significant by just being human, that my gifts and flaws and talents make me the unique person that I am. I no longer tend to try to seek validation from others through pleasing them (at least not as much as I did).
As a therapist, however, I see far more insidious judgments made by people who experienced extraordinary traumas leading to the beliefs that they have no value whatsoever, distorting their perceptions of self and of others and often living in a perceived reality that they have no significance and no worth whatsoever. These perceptions are things that are so often reinforced over and over again.
The truth? Every human being is significant. Sometimes horrible things happen to us. That doesn't change our significance. Asking "Why" is only natural. Making the judgment that "I must be bad" is false. We do not need to search for significance. We are significant by nature.

Patient in Affliction

As I work with people the one thing that seems to come up often is, "What do I do with my distress and discomfort?" For many of them, the answer is, "Make it go away." Making it go away is typically accomplished by some type of self-destructive behavior, Addictions, eating disorder, self-injury behavior, emotional reactivity, all tend to help people avoid their discomfort and distressing feelings. The answer is not to develop skill to make the distress go away; that is what the behaviors do. The answer is to develop the ability to be distressed without becoming self-destructive. The Bible gives insight into this by stating we should "Be joyful in hope, patient in affliction, faithful in prayer." Romans 12;12. Being "patient in affliction" as about learning to suffer well. Of course, this is easily said but not so easy to do. In fact, for many, it is one of the hardest things they will ever do. The one thing that seems to be true, though, is that the more you practice feeling distress and discomfort, the more you are capable of feeling it.

Seeing beyond the pain.

I just completed presenting at a convention of Christian Counselors talking about helping people grow spiritually through the pain of mental illness. What I have understood over the years that I watched people in the process of spiritual development is they tend to move from a self-centered existence toward a more other-centered and purpose-filled life. Experiencing the pain of mental and emotional problems tends to interrupt that process and pulls that persons eyes inward and away from any sense of meaning and purpose. I often think of ways to help that person see himself or herself in a new way, to overcome that tendency, to pull his or her eyes away from the pain and see things differently. In the end it is about helping one realize the value one has in the world and the purposeful life one can lead and the meaningful life that can bring.