This article from the Utne Reader is fascinating:
Trauma: Get Over It
When to let go. How to heal.—
By Joseph Hart,
Utne magazine
July / August 2006 Issue
Every life has at least one crisis-an avalanche that reshapes its emotional landscape. For Hector Aristizábal, this cataclysm came in 1982. At the time, Aristizábal was a passionate student at Universidad de Antioquia in Medell’n, Colombia, consumed by the innocuous diversions and immersions of a collegian: He was working toward a psychology degree, studying theater, and frequently marching for political causes.
In Colombia, though, behaving like a "typical" student is perilous. This is a country where the days are often punctuated by gunfire; where over the past four decades billions in U.S. aid and countless acres of coca plants have funded a well-armed, violent conflict among guerrilla factions, drug cartels, and U.S.-backed shock troops. Violence, paranoia, and fear are, by design, daily companions for everyone. "In my community of intellectuals and my family, we knew that when you dissent, the police can capture you and disappear you and torture you," Aristizábal says.
A zealous priest, suspicious of the family's progressive politics, tipped off the army. Soldiers raided their home and found literature that landed Aristizábal and his brother in jail. After the arrest, Aristizábal spent three days and three nights in a torture chamber. Members of the Colombian army beat him and held his head underwater until he was on the brink of passing out. They applied electric shocks to his genitals. Hog-tied him and hung him from a pole. They also subjected him to sadistic mind games, including a mock execution.
Like most acts of war, torture is not random. "Torture is a political tool, and its effects are intentional," explains clinical psychologist Andrea Northwood, acting director of client services at the Center for Victims of Torture in Minneapolis. "There's a general psychology to torture wherever it is practiced. It's designed to destroy the person's sense of integrity and identity."
Torture manipulates the mechanisms in the brain and body in a way that results in trauma. And while it is an extreme act, unthinkable to most of us, the physiological effects can be virtually identical in people who face less dramatic situations. Even witnessing something ugly or frightening can trigger the same physical mechanisms. In fact, while the word trauma (or traumatic) is often used to describe an event like a car crash or a beating, psychiatrists and social scientists use the term to describe what takes place inside after these moments pass-a physically taxing, soul-wrenching process. Most of us seek to avoid this sort of pain at all costs, but if we learn how to live with and learn from trauma, there's a good chance that in the process we will better understand both what it is to be human and how to gain access to our best selves.
The human brain developed in layers, like a pearl, over thousands of generations. The outermost layer is the neocortex, where language and abstract thought take place. Nestled inside the neocortex is the much older limbic brain, which governs emotion and memory. Seated in the front of the limbic brain, in the temporal lobe, is the amygdala, a sensitive, almond-shaped region that sounds a warning note when we experience a threat. The source of our "fight or flight" instinct, the amygdala is an organ of fear.
These layers are in constant communication. Suppose a fist hammering on the door startles you from an afternoon reverie. You are not expecting guests. But the hammering continues, and with it you hear shouting. Immediately, the amygdala takes control of your body. (In fact, it might even take action before the neocortex registers sound. Studies show that the amygdala can make emotional judgments using sensory data long before our minds can make rational judgments.) Your heart rate and respiration automatically increase, tensing your muscles to attack or flee.
Only then does the neocortex get involved. If you open the door to find your husband who forgot his keys and is late to work, the neocortex orders your amygdala to stand down; if you find masked soldiers with rifles cocked, the amygdala stays hyperactive. Among other things, it will signal the hippocampus, the structure in the limbic brain where memories are processed and stored, to stab this moment deep into the tissue of your brain. You will never answer a knock on the door in quite the same way again.
It is these "flashbulb memories," as Northwood explains, that contribute to the powerful effects of trauma on memory. Theoretically, remembering the cause of a threat can help you avoid it in the future-a useful trick when you're avoiding predators. Unlike animals, which can literally shake off the physical response to fear, however, humans accumulate their fears. Our hippocampus can become so illuminated by flashbulb memories, in fact, that we become blinded to the difference between real and imagined threats. As a result, we tend to see predators everywhere we look.
"When people are in this state of hyperarousal, we encode memories very differently," Northwood says. This is why the emotional memories of an extreme experience such as torture, not the actual physical pain of the moment, often leave the most stubborn and crippling wounds.
Some of the torture survivors Northwood counsels replay their flashbulb memories in nightmares, flashbacks, and unbidden thoughts triggered by, for example, seeing someone in uniform, or entering a closed-in space. People often internalize the messages the torturers have fed them. Victims also might avoid reminders of the traumatic experience, or "dissociate," shutting down key aspects of their personality, such as emotional function. Together, these experiences manifest themselves in what has come to be called posttraumatic stress disorder (PTSD).
If you're searching your hippocampus for a flashbulb memory, dig yourself out from beneath the wars and elections, the rhetoric and cant, and the ossified political posturing of the past five years, and try to pull up an image of the World Trade Center on September 11, 2001. If you're like most Americans, it will be surprisingly easy to return to the blistering reality of that morning.
The shock waves of the terrorist attacks rippled out from those who stood below the towers and watched them turn to dust, to people who saw desperate people jump to their deaths on live television, to the tens of millions who watched the entire episode replayed over and over during the week that followed. And to varying degrees, all three groups experienced trauma. (One research study found the same level of PTSD among those who saw the attacks firsthand and those who watched them on television.) The warnings of further violence, along with rhetoric about retribution heard in the days following the attacks, were also deeply implanted in our collective memory.
Remembering the numbness and shock of those days and weeks in late 2001, imagine how that horrifying parade of death and disfiguration known as the nightly news affects us. Smoke over Baghdad, gunfire in Darfur, anti-American protesters chanting in Pakistan, leaving us awash in fear.
"We're a frozen culture," says author and neurologist Robert Scaer. "The country is traumatized and dissociated."
While Scaer was working as the medical director of rehabilitation services at Boulder (Colorado) Community Hospital, he discovered that people suffering from persistent physical diseases like chronic fatigue syndrome and fibromyalgia, which are notoriously difficult to heal, respond well to treatment methods normally reserved for those who suffer from trauma. A patient who had been in a car accident and was suffering from whiplash, for instance, finally found relief after Scaer reenacted the accident. His radical conclusion, articulated in his books The Body Bears the Burden (Haworth Medical, 2001) and The Trauma Spectrum (Norton, 2005), is that all chronic ailments and most mental illness can be traced to trauma, and that virtually everyone in a modern society is traumatized.
Scaer goes on to argue that the very institutions of our culture-schools, courts, and government, even the medical establishment-are traumatizing. "In the legal system, for example, if you're deposed, you come out in a shambles. You come out shaken and traumatized because it's so adversarial," he explains. "The physiology of that experience is identical to a car crash. Identical. It's the flight-fight-freeze response."
Our problem, Scaer says, is that we keep our fears, anxieties, and sadness bottled up inside us: "We don't throw ourselves on the coffin of our loved one or tear our clothes and wail, or really do anything to discharge our losses. So they stay in our unconscious and our bodies."
The good news is that trauma could be a powerful untapped force of cultural transformation. "When a woman is in childbirth she goes through excruciating pains, but after, there's a hormone that erases the memory of the pain," says psychotherapist Gina Ross, founder of the International Trauma-Healing Institute. "I have thought, 'Why didn't God do that for trauma?' But you need the pain and you need the screams and you need the cries to be able to work on fixing what created the trauma. The Jewish mitzvah tikkun olam calls on us to repair the world [through social action]. Trauma helps us to focus on that work of repair."
Last summer, the day after a tornado touched down in the small town of Viola, Wisconsin, my friends and I drove out to see if we could help with the cleanup. When we arrived, we discovered that folks from all over the county had had the same thought. Clumps of people gathered to tell stories and shake their heads. Guys brought their trucks and bulldozers to help drag trees off the streets; someone on a four-wheeler drove around with a cooler handing out bottled water. Even as outsiders, we all felt the charged emotional atmosphere of the town: grief at lives disrupted, awe at the power of the storm, relief at having escaped, and an almost euphoric excitement at a world turned upside down. We went home to dinners that tasted just a little better, with families that seemed just a little more dear than they had the day before.
These conflicting emotions point to one of the central paradoxes of trauma: In the midst of the deepest suffering lie the seeds of growth, change, and hope. In 1995 psychologists Richard Tedeschi and Lawrence Calhoun coined the term "posttraumatic growth" to describe the flowers of hope and renewal that can grow from the ruins of a catastrophic event.
Their work suggests that trauma upends our psyches in much the same way that the tornado tore up Viola. When an accident or disaster strikes, to say nothing of a deliberate act like torture, the old ways in which we saw the world no longer make sense. We ask, "How could this happen?" and "Where was God?" And by slowly struggling to answer such questions, we develop a new and deeper understanding. We grow.
"Trauma turns the internal world upside down, and afterward a new worldview is built," explains Amy Ai, an associate professor at the University of Washington who studies the interactions among faith, optimism, and trauma. By way of example, Ai describes a friend and colleague-a renowned doctor who had built a successful private practice and earned a prestigious appointment to a medical school. At the age of 62, he suffered a heart attack followed by a stroke. "He lost the capacity to drive; he couldn't handle his practice. He had lost his purpose. He felt like a useless person. He had a broken heart and a broken mind," Ai says. Eventually he was placed in a psychiatric unit under suicide watch.
The former healer found himself swept up in an existential crisis. His identity fell away and left him with no choice but to dig deep within. It was then that he bumped into a spiritual core that had long been dormant, rediscovered his faith, began going to church, and regained his desire to live. He turned his energies toward mentoring youth in faith and writing a book on spirituality. "This is a typical example of posttraumatic growth," Ai says. "He has found a new meaning and purpose in life."
This sort of clarity in the wake of trauma is widespread. Tedeschi and Calhoun show that people who have survived an astonishing range of trauma-triggered by events such as a death in the family, being held hostage, sexual assault, or medical emergency-all report coming out of the experience with positive results. Matthew Sanford, who at 13 was paralyzed in a car crash that killed his father and sister, puts it this way: "I think that I'm a better person than I would have been."
It's tempting to think of posttraumatic growth and posttraumatic stress as two opposite ways of coping with a crisis. But the truth is more complicated than that. Some behaviors fit both conditions. For example, some friends of mine who lived through the Viola tornado told their story over and over again-they couldn't stop talking about it. Psychologists call this "rumination," and it has long been linked to depression. It's also linked to posttraumatic growth. "You can have high levels of PTSD and still have signs of growth," explains Ai.
The bottom line is that trying to separate "positive" growth from "negative" stress is like trying to extract the yeast from the bread: What causes spiritual renewal is struggling with the effects of trauma. Gina Ross, in fact, calls trauma one of the "four paths to spirituality," along with prayer, meditation, and sexuality.
Yet most of us don't look at a tornado or a car crash and see spiritual renewal-our culture, and especially our medical establishment, focus almost exclusively on the negative side of trauma. According to the New Scientist (Dec. 3, 2005) psychiatrists at Harvard are even working on a drug to selectively erase flashbulb memories. Currently, doctors "pathologize" the victims of trauma, says Ai, as if the mental suffering that results from a sexual assault or a car crash were some kind of illness. Instead, she argues, "We should facilitate their growth. And spiritual growth is part of it."
Our cultural goal seems to be just the opposite: not to face trauma and heal it, but to avoid it altogether. Failing to grasp this element of renewal, we are increasingly ruled by fear and anxiety. Signs of this anxiety are everywhere: the requirement that we remove our shoes before boarding an airplane; hypervigilance over our children (padded playground equipment, metal detectors in schools); our overreliance on antidepressants. All these measures share one thing in common: They do virtually nothing to prevent us from experiencing trauma when things go wrong.
Underneath this anxiety lies a fundamental confusion about the facts of life. We mistakenly think that happiness and personal growth depend on a lack of threat, that safety equals a healthy body and mind. What trauma teaches us is that the exact opposite is true.
It's a lesson that Sam Keen teaches at an unusual school he runs on his Bay Area farm. Keen, whose 1991 book Fire in the Belly (Bantam) helped launch the men's movement, has for many years taught people-everyday people with no special gymnastic ability-how to perform on the flying trapeze. It's a skill that simply requires you to climb a skinny ladder 25 feet into the air, take a leap into space, and rely on the off chance that you'll catch hold of a little scrap of wood hung between two swinging ropes. Not surprisingly, many of his students are paralyzed by fear, even though there's a net to catch them when they fall.
"The object is not to conquer fear, but to become a connoisseur of fear," he explains. "We teach our students to identify fear-to be aware of the physical sensations of panic and fear. What happens to them when they finally do go off the platform is that the anxiety is translated into excitement. What was terror becomes joy."
It is precisely by sacrificing their safety, risking their lives, and facing their fears that Keen's students attain not just the thrill of flying on the trapeze, but also a sense of mastery, competence, and exhilaration.
As a nation, we are paralyzed on the trapeze platform, frozen by fear, unwilling to take a risk in the name of exhilaration.
When the Colombian army released Hector Aristizábal after three days of torture, he turned to family and friends for support and eventually resumed his studies, acting, and activism. "I was able to sustain myself because of theater and political involvement," he says.
Eventually he moved to California, where he helped found a branch of the Theater of the Oppressed, an artistic movement that seeks to bring about social change through performance. Today, he works with prisoners, with schoolchildren, and in hospice care with the dying and their families.
Over the years, he has come to think of having been tortured as an initiation ritual, a wounding that has marked his life purpose. "It's one of my many efforts to create meaning out of such an experience," he explains. "I was always interested in anthropology, and in trying to understand traditional wisdom and healing, I've come to see that trauma is an effort of the psyche to look for meaning and find truth and enlightenment."
In his work with young people in the poorest neighborhoods of Los Angeles, Aristizábal has incorporated elements of ritual and initiation to help them overcome their fears and transcend their culturally imbedded inhibitions. Even the simplest ceremonies, like passing an object around the group, or chanting words in unison, show him "the joy of the kids and their desire for this kind of experience."
Ritual, Aristizábal suggests, is one way of understanding trauma as a path to healing and renewal. "Most of us have lost our connection to our roots, but the ancestral wisdom is in our bones," he says. In fact, considering that the experience of trauma itself contains the possibility of renewal, it's worth noting that many traditional adolescent rites of passage include some form of physical wounding.
"No one says, 'Tra-la-la, we'll carry you around in a throne and make you king of the May Day,'" says clinical psychiatrist Vivian Rakoff, who made a study of the ceremonies while he was at the University of Toronto. "No: They cut you, perforate you, circumcise you, bury you." In many of these traditions, the initiation is looked upon as a ceremonial death and rebirth. "It's got to be a sacrifice, a giving up a part of the self. It's a mimicking of the pain of becoming," he says.
There are other paths, of course. Matthew Sanford, although he is paralyzed, practices and teaches yoga, and he says this work has helped him heal. "With yoga, I'm not processing psychologically or emotionally what happened to me, but I literally let the echoes of the traumas come out of my body, and let go of them."
The connections among emotion, body, and mind implicit in both ritual and yoga are key components of healing. "People have been using talk therapy to reach the trauma, and it is possible to do that," says Gina Ross, "but it's much harder. The reptilian part of our brain does not respond very well to talk."
Ultimately, the most terrifying result of our failure to embrace trauma in spite of our fears is what Aristizábal calls the American "cult of death." He has witnessed the disconnected and unnatural ways that people die-alone in the hospital, filled with tubes, a doctor checking vital signs, their families gathered in the waiting room. "Then you have two days to grieve. You read the five stages of grief, so you understand it rationally, and then you go back to work," Aristizábal says. "The absence of ritual around death has led this society to see death as a failure of medicine, not a part of life," Aristizábal says. Ignoring the trauma, we fail to grasp its meaning.
"It's not only economics and capitalism that continue creating war, but also the fact that our psyche is so wounded and we're not recognizing it," Aristizábal continues. Americans would do well to promote national healing processes that face trauma head-on, like the Truth and Reconciliation Commission in South Africa, as well as rituals like those in Sierra Leone, where child soldiers have received new names, along with forgiveness. Instead, he says, "We were told, 'Go to Disney World and we'll take care of the rest,' while the ashes of 9/11 were still falling on us."
Five years later, there are some signs that as a culture we are, as Robert Scaer puts it, beginning to wake up from the trauma of 9/11. But it's one thing to wake up and something else again to reach for the kind of spiritual growth that individuals like Hector Aristizábal have achieved.
"It's in the entrails of the earth, not on its surface, that you can find diamonds and gold," he concludes. "It's in going into the darkness that we find enlightenment."
posted by John Allore @ 9/05/2006 08:58:00 AM
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