It May NOT Be Over

Several years ago, I consulted with a woman who complained of feeling “out of sorts”:  she felt tense much of the time, unable to concentrate, and was frequently irritable with her husband.  She reported that she would “drift off” for long periods of time:  she’d sit staring into space, but could not describe what she was thinking or feeling.  She said, “I don’t exactly feel depressed, but I know I’m not myself.  I’m usually pretty upbeat and able to manage working and my family.  I take care of myself, but lately haven’t felt like walking; I don’t enjoy going outdoors.  This is not me.”

She and I talked to try to understand what was happening with her. Indeed, she did not seem depressed, although some of her mood symptoms were depressive.  Nor did she seem particularly anxious.  In fact, she was poised, well-spoken and self-assured. 

As we spoke, she revealed that she had been witness to a car accident 6 months earlier where 3 people were killed.  The accident occurred about 100 feet ahead her, and she reported that the speed of the cars and their impact was such that she instantly knew someone had been killed, although she did not see the people in the cars.  She vividly described her husband swerving to avoid collision, the impact of the cars and her intense feelings of fear and horror at the time.  She did not know the people involved, but remembers her heart pounding and feeling afraid for her own life.  Following the accident, she reported that she felt tense and on edge for several weeks; she also had difficulty sleeping and reported that she had nightmares about the accident.  However, these symptoms abated after about a month.  She did not associate her current symptoms with what she had witnessed. 

She knew she had been traumatized.  But what she didn’t realize was that the trauma was still affecting her.

Trauma can reverberate for a long time.  While the most acute manifestations of trauma often abate over time, unless the trauma is dealt with, the effects can recur in a number of ways.  Some signs:

·         Insomnia

·         Headaches

·         Vague lower back pain, muscle weakness

·         Fatigue

·         Inability to concentrate

·         Feeling unable to eat, or, alternatively, wanting to eat even though you’re not hungry

·         “Drifting off”—moments of lost time when you can’t identify what you’ve been thinking or feeling

·         Difficulty concentrating on tasks at hand

·         Feeling tense, unable to relax

·         Irritability that you can’t explain

·         Alternately wanting to be with people and wanting to be left alone

·         Hypervigilance

·         Feeling “at loose ends”—restless, unable to focus, not knowing what to do

·         Feeling emotional, and not understanding why

These effects may occur days, weeks, months, or sometimes years after the trauma occurred.  It’s been my experience that many people experience these symptoms (and others) but don’t connect them with the trauma because the trauma occurred long ago.  Instead, they chalk the signs up to “stress” and try to power through the feelings.  Yet clients usually feel uneasy because they don’t quite understand why the discomfort is occurring.

I think it’s important to recognize these as signs that the trauma continues to linger.  They are signs that you have been traumatized.   Recognizing that you’ve been traumatized is an important first step toward healing.  And there are additional steps you can take to help yourself feel better:

·         Try to get rest and eat well.

·         Exercise:  vigorous exercise helps you rid yourself of the stress hormones and chemicals in your system.

·         Involve yourself in activities that distract your brain from ruminating on your feelings.

·         Be kind and gentle with yourself; turn down the volume on your inner critic.  After all, you’ve been traumatized.  Give yourself a break and a chance to heal.

·         Listen to soothing music.

·         Do things that increase your sense of safety and control.

·         Develop a routine, but undertake tasks at a slower pace.

·         Avoid using alcohol or other drugs to unwind.

·         Avoid blaming yourself for what happened or how you reacted.

And of course, it’s important to talk about what happened—WHEN YOU ARE READY.  (It’s not a good idea to try to talk about the trauma when you don’t feel ready.)  Therapy is a good venue to safely talk and heal.

There are many paths to healing and transforming trauma.  In fact, a number of therapies have developed to help people heal from trauma:  Cognitive therapies, EMDR, Somatic Experiencing, among others.  Finding a therapist who is trained in trauma therapies is key.  (Not all therapists have special training in the treatment of trauma.  It’s important to research and consult with a few therapists before committing to a therapy.)

Nonetheless, recognizing the signs that trauma is affecting you is a good first step toward healing.  

Hungry for Connection

Over the course of the past several months, I’ve written about self-medication—medicating those uncomfortable feelings that arise in response to life’s challenges. One of the feelings that often arises in psychotherapy, especially in the treatment of depression, is the feeling of emptiness. However, when I ask clients to try to describe their experiences of emptiness, their responses often reflect very different feeling states: numbness, the feeling of being overwhelmed, helplessness, paralysis. Indeed more often than not, the emptiness clients describe is not the absence of feeling. Rather, it is often quite the opposite: at its core, it is a painful hunger for emotional connection and nourishment. Emptiness signals a desire that has been subverted. Responses to emptiness, emotional hunger or deprivation can take many dysfunctional--even destructive--forms: addictions, compulsive behaviors (i.e., compulsive shopping or spending, gambling, compulsive sexual behaviors). Indeed, people with addiction often struggle with acute feelings of hungry emptiness—using substances or other compulsive behaviors to sate the hunger. Unfortunately, filling the emptiness with substances or compulsive behaviors usually fails because the substances (or compulsive behaviors) are poor substitutes for nourishing emotional connections. Indeed, there are never enough drugs (or alcohol, or sex, or money, or material goods) to satisfy the hunger.

The themes of emotional abundance and deprivation thread through psychotherapy sessions. Early family experiences with emotional deprivation reverberate throughout our lives, coloring our experiences of ourselves, our relationships, and the world. How our basic emotional needs were met (or not met) in early childhood form us and inform our beliefs about ourselves, our relationships, and our world. These beliefs are largely unconscious, but exert a powerfully out-sized influence on how we live. These unconscious dynamics inform the decisions we make for ourselves and drive a great deal of our behavior.

Moreover, the experience of deprivation brought about by prolonged confinements, profound losses, isolating illnesses, and other traumas magnifies the experiences of hungry emptiness, especially when the trauma puts you is in a position of having to actively suppress or repress your needs. When these experiences are coupled with earlier experiences of deprivation, the hunger--the need--can seem overwhelming.

One of the goals of therapeutic work is to identify and address unmet emotional needs--those gnawing hungers, the emptiness, the sense of deprivation. And as work on those issues progresses, other issues related to the theme of emotional deprivation emerge. Indeed, a question that will eventually arise: “what will be enough?” What emotional nourishment do I need that will ameliorate the pangs of hunger? How much emotional nourishment do I need? Will the nourishment I receive today be enough? Obviously, figuring out how to meet one’s emotional needs is also important, but the question of adequacy is one that also comes into focus.

Seeking emotional sustenance is really the whole of therapeutic work. And meaningful answers to these questions will vary from person to person and will probably emerge only over a long period of time.

It seems reasonable to start with the here-and-now. What can I do to meet my needs today? What will it look like to have my emotional needs met? How will it feel to have my needs met? To whom do I turn to meet my needs? Who do I trust with my needs? How can I meet my needs without engaging in an addictive or compulsive behavior, without getting hurt or without being betrayed? How can I manage when my needs are not met?

However at some point, the therapeutic work must turn to the past, looking at the origins of the addictive/compulsive behaviors and the feelings of emptiness/hunger that drive them. Approaching the search for origins with curiosity with a therapist can yield surprising insights, lead to the ability to accept your emotional needs, and even find new ways of addressing and satisfying them. Indeed, the connections made in therapy with the therapist and with yourself may open paths on to new connections that sate those hungers.