Anyone can publish on Medium per our Policies, but we don't fact-check every story. For more info about the coronavirus, see cdc.gov. Acute Stress Disorder, Small Joys, Fire trucks, and Lessons from Sufferring The firetrucks, ambulance, police cars, and other city workers came by for a surprise parade tonight for our twins.
We are witnessing a political scene experiencing confusion and anger about why and how people are unable to recall specific details after traumatizing events. Questions float: But she didn’t remember (insert __________?) She didn’t know where she was? Didn’t she know which house she was at? She remembered the bed or the hallway but not __________? Why didn’t she remember who turned on the lights or who drove her home? She remembered drinking one beer but didn’t remember_________?
It all seems obvious to a person who isn’t trauma-informed to make these conclusions. For those not understanding trauma, are curious about why the gaps in memory occur or are not looking through a lens of the brain this does seem sketchy at first glance. It sounds confusing at best and fraudulent at worst that a victim doesn’t remember parts of events that they “should,” in fact, recall.
Therapists working in the field understand hormonal responses, neurotransmissions including adrenaline and norepinephrine surges during an event along with the impacted neuropathways of brains following a traumatic event. We also have excellent supporting research from the Department of Veterans Affairs in the aftermath of the Vietnam War and adverse impacts from soldiers struggling upon their return home and why. We DO have a pretty good understanding of the gaps in memory and responses after trauma occurs and it really is a real thing. We also know it can be treated. Thank you to the Veterans who helped us understand what worked and what didn’t. I am deeply sorry to those who suffered so long before we knew what we know now about how to help.
We have a responsibility as a society to understand the science and stories of our survivors.
To a society first being introduced to these concepts this probably seems foreign. For someone who hasn’t experienced trauma or learned about why things stay online or offline in a brain, it might look like psychobabble or jargon trying only to take “sides” with the victim. I want to make an argument that is based in science and why this might be confusing for people who haven’t been educated or experienced trauma themselves to wrap their brains around. I hope your curious part sticks around for a minute if you're open to what I have to share.
1. After or during a traumatic event part of the brain goes online and parts go offline. Movies depicting “multiple personality disorder” haven’t helped to understand this phenomenon and people often think that you have to have very “split parts of the self” to have moments of what we coin “dissociation.” Dissociation is very common after a traumatic event and most of the time doesn’t lead to various parts of the personality “switching” over like the movies or dramatic TV shows depict. It doesn’t mean dissociation isn’t real and it is much more common than we think but doesn’t look like what mainstream media portrays. It does look like a person has disappeared emotionally. Glazed over, back to their experience or almost in a trance. It does look like time has stopped. They do often look frozen in the middle of a discussion, and it could be directly related to the trauma we are discussing, or a feeling state that suddenly rushed over them making them feel like vomiting Rarely do they "switch personalities" as we commonly see on TV.
2. Dissociation is a genuine part of the experience. An excellent book to read to understand it at a higher level better is by Dr. Bessel van der Kolk, M.D. – The Body Keeps the Score. It will go into greater detail than this writing about the hippocampus, cortisol levels, and what scientists have discovered as a result of adverse experiences following terrible events a person has witnessed or been a victim of. We can also see some of these same responses in other animal species experiencing threat watching them fight, flight, freeze, collapse, or surrender.
3. Our bodies often remember tastes, sounds, smells, feeling states, or random seemingly insignificant details after an event. Our brains were never meant to deal with horror and witnessing the worst of the human condition. Our minds do an outstanding job of going “offline” during these worst moments and frankly, we would not survive emotionally (or sometimes physically - think of John McCain's capture) if they stayed “online” during some of the very worst moments. Sometimes the brain stays online and occasionally offline and what the brain picks up on can be related to hormone levels and cortisol in the brain. For Post Traumatic Stress Survivors, we are certain levels of cortisol (the stress hormone) that modulates stress responses varies quite differently from those who have not experienced a traumatic event. The brain can become hypo-aroused (feeling numb) or hyper-aroused (feeling on edge producing re-creation or re-enacting of the experience.) Many times people experience both at different points.
4. Triggers. People can be triggered by reminders of the event.
Examples of triggers:
The smell of someone’s breath
the sight of a car where the trauma occurred or make/model of an accident
A feeling state that happened in the time of the event
Intrusive thoughts of rage or self-harm
The racing brain that just and can’t stop leading to insomnia
The brain will resort to “psychic numbing.” If the numbing doesn’t work, a person may turn to drugs, alcohol, or impulsive behavior to make this numbing turn-off or sometimes even to turn on. I hear people telling me “I just want to feel something again and alcohol lets me do that,” or more often, “I can’t get the sounds or smells out of my head and marijuana just makes it more bearable.” This makes total sense as a clinician, but they can be ostracized by others for their actions which don't see these behaviors as purely functional and how they are trying to stay alive. People experiencing this condition often feel a sense of shame and helplessness while also desperately wanting to run from these hauntings of their past. I hear “why can’t I control this? I’m so strong in every other part of my life?”
That is because you ARE strong in every other part of your life and you are not broken. Your brain has experienced events that you were not supposed to suffer from, and the mind does not know when or what to turn on and turn off at times it’s supposed to now. It’s not your fault.
It is also not your responsibility to convince naysayers of your story or why it’s valid. Your account is valid because it just is and how you experience symptoms are probably similar to others and also different than others. No two people are the same. Gaps in memory are common and feeling states you attempt to avoid is probably your brain’s way of trying to make sense and coping with what shouldn’t have happened to you.
I’ll be writing a bit more of a treatment called “Eye Movement Desensitization and Reprocessing” soon and why we think it works and I have asked a few of my clients to share some of their examples (with names and experiences changed to protect identities) and how it has been helpful on their journeys. Some treatments can help center the brain, so the numbing, agitation, reminders, and triggers become a memory and not a current state of panic or numbing.
However, before I write about the components of this treatment and as a therapist who provides it, I wanted to establish something else:
A. It is not your fault that your memory processing network was disrupted by an event that happened to you that you did not choose. Any painful memory is worth discussing and just because your experience may not have "been as bad as _______ (I hear this a great deal) this doesn't mean it shouldn't be treated. If it's bothering you and creating the above symptoms, treatment can likely help you.
B. Your brain was doing (and probably is doing) the best it could and hasn’t learned it doesn’t need to go offline or to overdrive at the most crucial times for you. Be nice to yourself. Your brain and parts of your personality are doing the best they can with the circumstances they were dealt.
C. You deserve to be believed, and it isn’t your fault that society doesn’t understand what clinicians know.
D. It can get better with appropriate help and care. We know this. We have research supporting this.
Jill Lehmann-Bauer, LISW, ACSW
Clinical Social Worker, Central Iowa Therapy Solutions, LLC.
A concept from the DBT skills manual I have found particularly useful mirrors an old 12-step slogan in the serenity prayer. "God grant me the serenity to accept the things I cannot change and the courage to change the things I can." Many models of treatment all encompass similar philosophies but present ideas in different terminologies. In my experience, clients have found "radical acceptance" a little easier to grasp and something helpful with practice.
Many people are aversive to the language of "God" and "radical acceptance" removes this as a criterion. Accepting life on life's terms is another catch-phrase that mirrors radical acceptances..
But that's really what it is about. Accepting life on life's terms. It doesn't mean agreeing with it. It doesn't mean liking it. It doesn't even mean you won't kick and scream initially about the unfairness, or lack of justice. Radical acceptance is for YOU and not for the situation or the other person. Marsha Linehan says "suffering is optional, pain is not." Being human is to have and experience pain. Suffering occurs when pain continues based on the lack of accepting the pain. It takes practice, it takes being mindful, it takes courage.
It also takes practice. A lot of practice.
It can be very helpful for a person to begin by learning to "sit with themselves". Slowing down, reminding yourself that in this moment you're alive, you're breathing. The thoughts you have are exactly them - thoughts. The feelings you have are exactly that... feelings.. Work on noticing and describing them, non-judgmentally. Sit with your breath and open your palms to the world. Let whatever needs to come in move through you and notice. You can feel any amount of pain, any amount of annoyance - notice your thoughts.
Mindfulness is simple but not easy and it takes practice. Digging your heels in and "cutting your nose off to spite your face" is what causes misery. You can't change pain but in time, you can learn to sit with yourself and notice without judgment.
This is a good article explaining more on "radical acceptance" and defines exactly what it is and how to use it.
Medications = hope
Many people cringe at the thought of having to take medications. I get it - along with the stigma from society implying that taking medications means weakness along with an over-medicated population that panics when any pain is felt equates to many needing psychotropic medications questioning their value.
That being said, I also know how powerful some of the new medications to treat a wide range of mental health and addiction related problems are. I previously worked in a clinic that offered methadone maintenance. With all of the ups and downs, medications save lives if used appropriately and are closely monitored. Medications + psychotherapy produce the best outcomes. Medications alone are generally less effective. The mind, body, and spirit are all connected and need healing.
We are on a great path on the medical path to treat both alcohol and opioid dependence. Medications to reduce cravings and produce a non-euphoric experience following use are evidence-based and a tool.
Some medications are "agonists" - meaning they actually provide the addicted substance in measured and longer half-life doses to avoid the pain of withdrawal. Some medications are "partial agonists" - they provide some of the medication to occupy the receptors while also having a blocking effect to avoid euphoria if a person slips with use and some that completely block and occupy the receptor eliminating any euphoria that comes from use. Antagonists completely block a brain receptor and "fills" it so that getting high is not rewarding because it is bypassing the pleasure centers of the brain that likes addiction so much.
Some of the medications I've seen people significantly helped by:
I have seen many people who also have a significant mental health concern that needed medications to help tackle their addiction. Some clients have had an untreated bipolar disorder which cycled into mania making them more at risk for use during these cycles. Because of the delicate balance for both addiction and mental health, treating both at the same time along with psychotherapy results in the best outcomes.
Interested in learning more? Come see me and we can talk about your options and I can refer you to a physician or psychiatrist specializing in both areas. Let's tackle this together.
Jill Lehmann, LISW, ACSW
Clinical Social Worker. Photographer. Enneagram studier.