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Why We are Where We Are
I’m a new mental health counselor. I saw my first clients three years ago. Nothing in my training prepared me for what I saw. Client after client told me stories of torture, humiliation, exploitation, witnessing death up close, and feeling trapped through all parts of life. These stories would have been shocking for the 11th century. As best I can tell, it’s like this in community mental health clinics everywhere–what many clients suffer from most is growing up in a secret warzone hidden in quiet neighborhoods and on streets that we drive down every day. Like almost every other therapist who is starting out, I discovered unspeakable trauma. Client after client, complained of depression or anxiety or panic attacks, but they really suffer from trying to survive long after prolonged exposure to horror.
How did I not know it would be this way? Why did my graduate education in counseling–which prepared me to do many things well–not prepare me at all for the one thing that I would see the most? What I’m starting to figure out is this: trauma is everywhere. It happens to almost all of us in various degrees, but we all go out of our way not to see it, as though our happiness depends on not seeing it. [But we’re not happy.] And that’s part of the reason why we are where we are. But, give me a moment and I’ll try to show you… because there is a way to see it that lets you get above it. First, let’s try just to see it at all.
When we’re kids and terrible things come at us, we have the impulse to fight or flee. But, we can’t fight because we have no real power. That’s just one of the things that really sucks about being a kid. We can’t flee because there is no place to go and we’re already with those who should be protecting us from horrible things. And, this is the only thing we know. Many of us learn to take the option that remains–we go away on the inside. The things that come at us continue to come. We don’t know what to think, or feel, or do.
We find ways to container that hot stuff in a box with lid on it. We don’t choose to do this, but we can’t hold this stuff loose inside our bodies and inside our heads. It’s too hot. Life keeps coming at us and we have to go to school, we have to smile and pretend like we’re okay, and we have to figure out how to stay safe right now. As more things happen, we throw them in that box and slam the lid. Sometimes, it may not take a lot of energy to keep that lid sealed. Other times, all the energy of the universe cannot seal it and we have little left for whatever of us is outside that box. Life itself can rattle us and rattle that lid. Things seep out. Everything in that box is lava–the temperature of shame. Seeping is horrible: red hot memories, body memory, trauma-related dreams, time-travelling panic, and every hot and cold emotion. Things seep out when they want to–in classrooms, in movies, in familiar places, in strange places, even in times when we feel okay and can start to feel our own feet beneath us. When things seep out a lot and in certain ways, we call that PTSD. When they seep out just a little, or a moderate amount… well we don’t have a word for that at all. So, for the sake of convenience, let’s just call it trauma. And trauma, when it’s not making a mess all over the place, is mostly invisible. Often, when it is spilling out all over the place, it’s still invisible, even to many mental health clinicians. It has been this way for a very long time. Before we’re done, we’re going to put our finger on why.
For at least 100 generations, except for the past three, women from all segments of society were vulnerable to becoming hysterical. For centuries, hysteria in many Western countries was nearly as common as depression is today. When not viewed as simple demon possession, it was understood as a disease of women’s reproductive organs, specifically the uterus. The uterus, as they understood it, could be fickle. It could sag too low or it could ride too high. A common cure was prescribed as frequent dispassionate sex with her husband and being pregnant as often as possible. Other cures, as we will see, were worse. Symptoms of hysteria were wide-ranging and included: fainting, shortness of breath, anxiety, loss of appetite, irritability, loss of interest in sex with her spouse, or switching between body paralysis (dissociation) and intense emotional and physical responses to seemingly meaningless triggers (flashbacks).
In the late 19th century, Charcot in Paris turned hysteria into political spectacle. He claimed that genetics flaws alone account for hysteria and turned the Salpêtrière into a public theatre with hysterical patients responding “hysterically” when he touched them on their backs, stomachs, or sides. It’s in that context that a young ambitious Sigmund Freud started talking to his hysterical patients, spending up to 100 hours with some of them. Freud discovered that all of them had been sexually abused in early childhood. Like we see today in community mental health clinics across the country, he found that this abuse came from three sources: adult strangers in the community; adult family members that the patient had an ongoing family relationship with for years, if not decades; or older children in the family or community, who had themselves been sexually abused by someone else (with the children replicating almost exactly what was done to them). Many of Freud’s client’s had encountered childhood sexual abuse from multiple people through multiple routes. Freud published and presented his seduction theory–that early childhood sexual trauma was the key cause in the development of hysteria later in life before the Vienna Society for Psychiatry and Neurobiology in 1896. This was Freud’s first paper and presentation and the tone of it is jubilant–he clearly believes that he has discovered something that will transform everything. It was met with crickets. Within few years he publicly repudiated it, and eventually came to believe that his clients fabricated their claims. Rather than being victims, these patients were tricked by the emergence of their own early sexuality and longing. He later claimed: “The grain of truth contained in this fantasy lies in the fact that the father, by way of his innocent caresses in earliest childhood, has actually awakened the little girl’s sexuality.” Or, as he wrote in a later footnote, “at the time I wrote it, I had not yet freed myself from my overvaluation of reality and my low valuation of fantasy.”
The implications of Freud’s original theory, which modern trauma-informed therapist recognize as the more correct one, were as horrible then as they are now: 1) Hysteria was as common among the upper classes as the lower classes, so we can’t make this entirely about the wretched poor. If hysteria is caused by unspeakable violations, then how might the doctors of Vienna respond when their wives, daughters, or nieces were treated for hysteria? 2) If hysteria is caused by trauma, there must be a lot of people out there hurting children in this way. 3) If hysteria is caused by horrible life experiences committed largely by men against women, then the ways that the doctors in Freud’s audience had been treating hysteria for their entire careers is severely retraumatizing. For generations prior to the turn of the 20th century, hysteria was treated in asylums and doctors offices across the western world by doctors manually or mechanically stimulating the genitals of hysterical women, ideally to the point of orgasm, to remove so-called blockages or to realign the uterus. The modern electric vibrator was invented for just this purpose. Freud used baths and genital massages on all of his early hysterical patients, well after he claimed that being stimulated sexually by someone in power is what caused the hysteria in the first place. 4) What about all those unnecessary hysterectomies for hysteria, performed or referred by virtually every doctor in Freud’s wider audience. So, Freud retreated where many of us retreat when we encounter a truth too big to assimilate in one piece… he moved into fantasy… into the mind within the mind.
As the new century came, hysteria seemed to disappear from popular imagination and clinical curiosity. Some of this was due to better understanding psychological causes and partly due to improvements in public health and social supports. While clearly not safe from trauma, women stood a better chance than ever of having their children be born alive and surviving through childhood. The Progressive Movement provided some visibility to suffering and the growing instruments of the state and community (governments, police, and social service organizations) started to tentatively intervene in some places. As the 20th century progressed, men drank less than their fathers and much less than their grandfathers.
Then came the shell shock of World War I, with large numbers of men having symptoms virtually identical to hysterical women of the prior 100 generations. Treatments for psychological breakdowns for extended trench warfare were often shame, electric shock, beatings, or worse. Western soldiers were treated better during World War II for combat fatigue, often permitted to rest and recuperate in safe areas. The need for mental health services to be incorporated into the Veterans Administration was recognized and implemented just after the end of the war.
It took Vietnam and its aftermath for serious research to provide overwhelming evidence of the psychological effects of war in large numbers of soldiers, and the need to do something about it. The organizing by veterans themselves forced the problem into visibility. It wasn’t until 1980 that the formal diagnosis of PTSD appeared in the third edition of the Diagnostic and Statistical Manual of Mental Disorders.
Why? Why did it take so long for the helping professions to recognize that overwhelming life experiences affect us long after we have survived them… that the past lives and haunts from the inside. We might have learned this from classic literature… from Shakespeare… from art… or from our own noticing. Surely, 90% of the clients I have seen–even at first contact–understand intuitively that their depression or anxiety comes from all the shitty things that have happened to them… and their inability to reconcile those experiences in any real way. Life has always been hard. We all carry the wet weight of what we have survived. So, why do we have so few therapies that effectively target memories and the way that memories get stuck inside us?
It’s tempting to blame Freud for the first half of the last 100 years. He created psychoanalysis out of the rejection of trauma and the real lived experiences of his earliest patients. It’s easy to blame behaviorists or cognitivists for the second half, who sometimes struggle to understand that all trauma seeping is one form of exposure or another. The problem is not how they are thinking about what has happened to them. The problem with trauma is that traumatic memories are stored in precisely those places where rationality cannot shine. Maybe blame is the wrong word.
Blame certainly doesn’t help us with where we are. And where are we? As many as 38 million women in the United States and 15 million men have been sexually abused, most of them in childhood. That’s roughly equal to the whole population of the 25 least populous states. Now, things get worse. We have been exploring mostly the long term effects of childhood sexual abuse. These are things that should not have happened that did. There is another category of trauma, developmental trauma, related to things that did not happen, but should have. As therapists, we see this every day in clients. Nearly 70 years of attachment research shows clearly the long term negative effects of insecure attachments in early childhood. The consequences of severely impaired parenting look very similar to sexual and physical abuse trauma decades later. As many as 40% of children were not raised with a mother or other central caregiver who was emotionally present. Many, many, people who were sexually abused as children also grew up in homes with no secure and stable emotional attachment. A large percentage of the population has survived childhood sexual trauma, adult sexual trauma, or developmental trauma. Nearly one third of Vietnam veterans have war related trauma to the extent that they currently meet criteria for PTSD. Add vehicle accidents, domestic violence, relationship trauma, families left in the wake of overdoses, families surviving suicides, deaths of children/siblings, families on either side of homicide, and prison violence. Add it up. We are a severely traumatized population, living in one of the longest stretches of peacetime seen in the history of the Western world. That’s where we are. And we got here because we don’t want to deal with or see any of it… not in ourselves or in others. Why? Because the same cultures that traumatize us fill us with guilt and shame that keep us silent. That’s where we are and I get a front row seat to it every day. And for a long time at the beginning of my career, as all of this became visible, things felt pretty hopeless.
So, I said that there is a way to see this that lets us get above it. Turns out, our minds have hard-wired mechanisms to quickly reprocess and incorporate traumatic memories. I work with my clients every day with trauma using EMDR. EMDR is a way to treat traumatic memories that doesn’t require a lot of talking. It asks that clients hold a traumatic memory and simply notice what comes on one of five channels: thoughts, body sensations, emotions, memory, and body memory. This process is paired with a method that stimulates the client’s mind on the left side, right side, then left side, over and over, using tappers that the client holds, eye movements, or beeps through a headphone. We do EMDR after spending a lot of time making sure that the client has coping skills in place to breathe through or tolerate the distress that comes from holding a traumatic memory. We also work together to make sure that we tackle one memory at a time and don’t access too much trauma in a way that will be overwhelming. It works astonishingly well. When reprocessing happens, it happens quickly and seamlessly across all channels: the adaptive thoughts related to the trauma appear automatically (I did nothing wrong, I deserve to be treated well, and I’m OK right here and right now); the body is clear and relaxed (even while replaying all parts of the traumatic memory); the intense emotions have passed and the client can replay the memory without any strong emotional response; the memory starts to feel like it happened when it did—it gets incorporated into autobiographical memory—and the client can start to interact with it and get real perspective on it. It becomes pliable. A single memory, which has seeped out as flashbacks or dreams 500 times might be permanently reprocessed in a single 53 minute session. All of these positive changes seem to hold for weeks, months, and years later. The targeted memories get fully reprocessed and can be recalled at any time without significant distress on any channel. I provide a safe, affirming, and validating context for the client to reprocess the memory, for the memory to become visible, be fully experienced in the body, and be reprocessed in an adaptive way. But, once the client is on the path, I mostly get out of the way. The mind knows how to heal itself, it just gets tripped up on one of the channels, usually when strong cultural messages of blame, guilt, and shame flood in. The same cultures that traumatize us, build obstacles to healing. EMDR has methods that allow these blocking beliefs to be targeted and removed. So, the good news is that the mind and body already know about healing. This capacity for healing is hardwired into us, it has just become covered with cultural crap whose purpose is to keep trauma invisible.
So, there is a way to see it that lets you get above it. It requires no forgiveness of abusers. It requires no magic. It requires that you become embodied enough to notice. And when you have reprocessed your trauma, that puts you in a better place than ever to become a real agent of healing in this world. We can together create spaces of healing, stripped of judgement and shame, where things that have always been stuck can find their way out of us and into sunshine. That capacity is inside you. Find someone who can help you find it.