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.