Book Review-An Autobiography of Trauma: A Healing Journey

Peter Levine is candid in An Autobiography of Trauma: A Healing Journey.  He shares about himself, his pains, and his family dynamics as well.  I’d previously read In an Unspoken Voice and Trauma and Memory.  (I’ve not read Waking the Tiger, though it is the book for which he is most well-known.)  While I don’t frequently read biographies, I wanted to understand how Levine was able to develop his theories and to understand his back story.

Capacity to Heal

Whether reading Peter Levine’s story, Marsha Linehan’s Building a Life Worth Living, or the stories of others who have been Transformed by Trauma, I’m in awe of our capacity to heal.  People with unspeakable traumas have found ways to recover and to be happy.  Once you’ve read or listened to a few stories, two things become apparent.  First, people learning to heal from trauma is not rare.  Everywhere you look, you will find people who have learned to survive and thrive after traumas that you’d not believe were survivable.

Second, there’s no one path that leads people to discover their capacity to heal.  For each person, it seems like the path is unique.  The only constants are the awareness that there is the capacity – if they can find it.

Generational Trauma

While we may not be able to track every mechanism that allows for stressors and trauma to be transmitted from one generation to the next, we’re clear it’s happening.  Owing to careful research, we know that some cues are being transmitted genetically from generation to generation.  The precise mechanisms for genetics and epigenetics aren’t important for this conversation.  What is important is that the traumas you carry with you can influence your children – and their children – for generations.  While the studies are most frequently performed with smell recognition, the results have much broader implications.

In the United States, we’ve had a shameful history with slavery and, even after slavery was abolished, oppression of Black Americans.  (See A Class Divided for more.)  It’s impossible to know how much this has shaped Blacks of today – in addition to the continued societal inequalities.

The Meetings with Einstein

Levine recounts meetings with Albert Einstein.  These meetings did a great deal of good for Levine.  They helped him solve problems and accept his situation.  However, the meetings were likely not real in the physical, tangible sense.  They were dreams or imaginations.  However, as Levine points out, whether the meetings were real or not misses the point.  The point is that these meetings helped him.

Various forms of guided imagery have been used, including writing and burning letters to people who have been harmful and are no longer reachable either due to death or because contact with them wouldn’t be productive.  Trauma patients use various forms of reimaging their trauma to help them cope with it.  Meetings with someone who can provide wisdom and advice doesn’t seem all that different than the “WWJD” bracelets signifying What Would Jesus Do?  In this case, Levine asked, “What Would Einstein Do?”

Vulnerable Child

One of the types of imagery that appears to be particularly valuable – and one Levine appears to support – is imagining coming back as an adult to support your younger self.  Marsha Linehan in Building a Life Worth Living recommends it as well – even though she admits feeling disconnected from the scared little girl.

Grief is Love with Nowhere to Go

Levine asserts that grief is love with nowhere to go.  This takes a bit of unpacking.  First, grief is coping with loss.  It’s our response to the loss regardless of the reason for the loss.  One powerful loss is loss by death, because it’s a final loss.  This necessarily removes the relationship that had some value to the person left behind.

It’s this relationship that Levine is referring to as love.  Some suggest that it may be healthier for people to view the death of someone as a change in relationship rather than a total loss.  For instance, Handbook of Bereavement makes the suggestion that the relationship becomes more internal.  In my own world, I can imagine conversations with people who I have lost—and it can make it a little bit easier.

Self-Generating Wellbeing

Levine speaks of his growing capacity to self-generate wellbeing.  While the entire book can be taken as a framework for the kind of self-acceptance and acceptance of the world that leads to self-generating wellbeing, there’s not a clear sense for exactly what creates that capacity.  I’ll share a few of my thoughts from other books.

The language I use most to describe the sense of self that I believe leads to this capacity is “integrated self-image.”  (See Braving the Wilderness.)  Brene Brown (and Harriet Lerner in Why Won’t You Apologize?) describes it as “wholeheartedness.”  (See Daring Greatly.)  At its core, it’s a sense that you know who you are.  This makes you less likely to be swayed by those around you – and better able to resist the forces that would pull you from wellbeing.

This happens by knowing who you are and how you’re motivated.  There are a number of tests that are purported to tell you about yourself – DISC, Myers-Briggs Type Indicator, CliftonStrengths (see Strength Finder 2.0), Enneagram (see Personality Types), Reiss Motivational Profile (see Who Am I? and The Normal Personality), and Values in Action (VIA) to name a few.  While I don’t believe that any one of these tests can nail people, I do believe that doing several of them can help you understand different ways of seeing yourself.

Similarly, understanding your intrinsic motivations can help you understand why you’ll be pulled in certain directions.  Change or Die explains that changing behaviors is hard.  Immunity to Change identifies competing beliefs as one culprit for this lack of change.  However, more positively, Edward Deci explains that people are motivated by autonomy, mastery, and purpose.  (See Why We Do What We Do.)  Folks like Simon Sinek in Start with Why elevate the development of purpose.  The clarity of purpose and the alignment with the things that you’re motivated by is bound to help you integrate your self-image.

At a more tactical level, time spent in either flow (see Flow, Finding Flow, and The Rise of Superman) or meditation seem to have positive effects that extend well beyond the bounds of the time spent.  (See Altered Traits for more on the impacts of meditation.)

Some people would argue that positive thinking has an impact on this.  Certainly, Rick Hanson makes this point in Hardwiring Happiness and Resilient.  The How of Happiness and Positivity echo the general sense that you’ll be better if you work at being happy by being appropriately positive.  While there are some criticisms of positive psychology, appropriate positivity can be helpful.  (See Bright-Sided for criticism.)

Finding Peace with Ourselves

Ultimately, Levine shares his gratefulness with being able to navigate the challenges of his life and to navigate it to the point where he could write An Autobiography of Trauma.

Book Review-First Responder Mental Health: A Clinician’s Guide

As a volume weighing in at 911 pages, First Responder Mental Health: A Clinician’s Guide isn’t a small book.  It’s a collection of 28 chapters written by a variety of authors, each with their own perspective on various aspects of first responder mental health.  From the outside in, all first responders are the same.  However, as the chapters explain, there are differences in cultures and receptivity to mental health within the different groups.  One of the valuable aspects of the book is the broadness it brings to first responders by including crime scene investigators and emergency communications operators (911 operators).  These important roles are first responders, too – even if they’re not always perceived that way.

On the Outside

One of the persistent problems I face when speaking with first responders is overcoming the sense that I’m somehow an outsider.  For many kinds of first responders, there’s a belief that if you’ve never done the “job,” then you have no way of understanding what it’s like.  There is a kernel of truth to this.  I can’t fully understand what it’s like, because I’ve not lived it.  However, this isn’t a world of absolutes.

It’s not that I understand nothing about the jobs – it’s that I don’t understand everything.  The truth is that a fellow law enforcement officer from Billings, Montana, will have little in common with the New York City Police department detective.  Some basics are the same, but fundamentally, the job is different.

One of the objections is how can someone who has never done it understand what it’s like.  You can’t put that into a book.  (I read a lot of books and make no secret about that fact.)  The answer is, of course, that books don’t help you to understand.  Instead, they prepare you for the real learning that you get in conversations and ride alongs.

I have no illusions that I understand completely.  I know that I learn from nearly every interaction.  I know that I respect my lack of understanding and want to understand as much as possible.  For me, it’s personal.  Most of my children could be considered a first responder of one kind or another, and I don’t want their service to be the cause of their suffering.

I’m not advocating that everyone should immediately be accepted into the “in” group and trusted.  Instead, I’m highlighting that the degree to which there is a sense that others can’t understand anything about the job is exaggerated, and it’s harmful.  It prevents first responders from trusting mental health professionals who may be able to help them.

Stuck to CISM

There are several references to CISM integrated into the volume.  It’s no surprise given the prevalence in first responder organizations.  However, it doesn’t change the challenges of the approach.  Rather than address these concerns again here, I’ll refer readers to Critical Incident Stress Management and Opening Up.

Fit for Duty

One of the barriers to receiving professional mental health care is the concern about the implications – either formally or informally – in terms of fitness for duty.  While not every first responder is required to submit to evaluation for their psychological fitness, it’s required in most law enforcement contexts.

In my conversations with active military personnel, the SF-86 form is scary.  It’s the form for national security clearance.  Most roles inside the military require clearance so failing to receive the clearance is a big problem.  They’ve said that even though the form complies with the provisions of the Americans with Disabilities Act (and revisions) by only asking about mental healthcare that may impact performance, many members of the military are concerned that any kind of mental health treatment may be considered a disqualifying condition.  In the healthcare context, it’s the chief goal of the Dr. Lorna Breen Heroes Foundation – to ensure every healthcare worker feels comfortable getting help for their mental health concerns.

Whether there’s risk for being evaluated unfit for duty or not, the fear of being declared unfit makes mental health professionals sufficiently unsafe that many first responders won’t seek help.  This is true even if the things that they experience are beyond what any human should be able to adapt to.

The larger problem with all assessments is that there’s a falsehood inherent to them.  They’re there to predict future behaviors – particularly, unhelpful or harmful behaviors.  However, we’re pretty lousy at doing that.  In the suicide space, the best clinicians are slightly better than random chance at predicting short term suicide.  (Short term being defined generally defined as six months.)

In fitness for duty, the goal is to look out years into the future to see if the professional might do something bad.  Of course, there’s no data that supports efficacy at this, but we do it anyway.  Too many people have bought into The Cult of Personality Testing, and that includes the standards bodies and judges that make determinations for agencies being negligent in their hiring practices.

Peer Perception

Sometimes, the problem isn’t the management concern of fitness for duty.  Sometimes, it’s the way that other members of your shift, house, or crew will see you.  The culture of some organizations is such that weakness results in teasing or worse.  The brave people who seek out mental health support are “rewarded” by a loss of trust.  Instead of reaching out for help being seen as a sign of strength, the perception of weakness follows them.

Until the culture changes so that discussing hard feelings – with the crew or with a professional – can be seen as a source of strength, it will remain hard for people to seek help.

Rub Some Dirt in It

The problem is broader than just mental health concerns.  There are stories of people injured on the job who are told to “rub some dirt in it” and continue on like a 1960s football coach.  Fortunately, some of those attitudes are reducing because of workers compensation legislation and the organizational risks for not providing appropriate support – but the sentiment remains.

It’s in this context that comments like “Shrinks are for the weak” make sense.  If you wouldn’t send someone for an x-ray to determine if they have a broken bone, why would you send them for tools to help them heal mentally?

One of my daughters is a physical therapist.  I’ve learned that, sometimes, just knowing how to exercise can make a huge difference.  The small adjustment about how you’re holding yourself during an exercise can create the right results.  We don’t have the same sense that the right mental exercises will lead to better mental health.

Protecting the Family

It’s chilly outside of Washington, D.C., when my wife and I sit down with a master chief and his wife at a tiny bar.  They’re lovely people and each hugely compassionate in their own way.  However, a comment catches me off guard.  He is justifying the silence that he has with his wife at times.  It’s not about operational security.  It’s about not wanting to share some of the trauma that he does – and did – experience in his career.  It’s an open secret.  There are things he will not share.

The master chief isn’t alone.  Many first responders believe that they are shielding their families from the realities of their job (or the world).  It may come not just from the desire to protect them but also because they view home – or their relationship – as a sanctuary.  They don’t want to let the things they see and do intrude on this safe place.

Many spouses admit they know when their spouse has had a bad day or a bad shift.  They often don’t press but a simple nod makes it clear that the master chief’s wife knows when he’s had a bad one.  Over the years, they’ve fallen into the pattern.  But the wall that protects the family can also keep them on the outside.

Before our son died by suicide, I had to find a language to talk to him about his work that didn’t compromise his clearance.  It took us years, and I finally could ask about how he felt – and even about his friends.  (Generally, first name only with only a handful of exceptions.)  We could talk about his world without the details in a way that helped him feel heard – but it was far from easy.

The Mission

Not for everyone, but for some, “the job” isn’t a job.  It’s a mission or a calling.  It’s their identity.  It’s the place where they feel the most themselves and the most in tune with destiny.  This can make them excellent at what they do.  It can also place first responders at risk.  There are the obvious “hero” types who aren’t able to separate risk from their need to be the savior.  There are also those who push away others because they have a different perspective and calling.

More troubling is that those for whom the job is a mission often have a specific way of looking at the work and aren’t always amenable to change – even change that can help them and their “second family” survive and thrive.

You Don’t Forget Elephant Events

If you ask a first responder about the call they can’t forget, you’ll get an answer.  It might even be a few answers. Every first responder I’ve spoken to has “that call,” “that patient,” or “that accident” they’ll never get out of their minds.  The reasons why it’s unforgettable vary – but they all involve some sort of trauma.  There’s some part of the event that’s not fully let go of the person and they know it can come back at any time.

Sometimes with work, these events can become less active in someone’s mind.  It may still be able to recall them, but they don’t leap to the front on their own.  However, that requires processing the trauma and coming to terms with it.

The Life You Thought You Could Save

The stories that seem to haunt first responders are those people who they’ve seen or heard die.  Even more troubling seem to be those where the first responder expected that the person would live.  Whether it’s a car accident or a violent attack, it seems like the gap between the expectations and outcomes complicates the processing process and makes them stick.  While this makes sense from a cognitive processing perspective, it doesn’t make it any easier.

The Righteous Mind and Mindreading both propose that we are creatures designed to predict.  We have survived and thrived by being able to predict what comes next.  What seems to happen with those we thought we could save is that we stack the trauma of the loss on top of the need to adjust our perspectives to account for the reality of the death despite our predictions.

Conditions for PTSD

The conditions for PTSD are somewhat narrow.  Getting recognition for trauma has had a long and difficult history.  From shell shock to finally being recognized in DSM-III, we’ve struggled to accept trauma as real.  (See A Sadly Troubled History and Trauma and Recovery for more.)  According to DSM-V, the criteria for PTSD are, in part: “Exposure to actual or threatened death, serious injury, or sexual violence…”  The fourth of the identified ways is, “Experiencing repeated or extreme exposure to aversive details of the traumatic event(s)…”  However, there’s a note, “Criterion A4 does not apply to exposure to electronic media, television, movies, or pictures, unless this exposure is work related.”

There’s so much wrong with the definition.  First, people can feel trauma when their sense of identity or their sense of how the world works is threatened – not just physical life.  Second, it’s incredibly clear from decades of research that the brain doesn’t have an “on-off” switch for work.  It can’t even tell the difference between a movie and reality – that’s why our hearts beat faster when watching an action-adventure or horror movie.  Recently, Renzo Bianchi published, “Most people do not attribute their burnout symptoms to work.”  It supports one of the things that we say in our Extinguish Burnout work while highlighting the broader point that we can’t distinguish between work and non-work when it comes to what we experience.  (The World Health Organization classification only supports burnout as an “occupational phenomenon” – which we believe is clearly incorrect.)

The problem with the definition with so many challenges is that many suffering people who are impacted by what they’ve seen, heard, and done don’t meet the criteria for PTSD where they might be able to find treatment.

Cumulative Trauma

There is another definition for posttraumatic stress disorder – but it’s complex.  Complex posttraumatic stress disorder (C-PTSD) is recognized by the World Health Organization in ICD-11 – but the APA, who publishes the DSM, has not yet recognized it as a disorder.  C-PTSD requires repeated exposure to trauma – which is part and parcel to the work of most first responders.

Because of the inconsistencies around recognition of C-PTSD, it’s often difficult to get recognition that it’s a real problem – and the result may be that first responders will give up before getting the care they need.

After Disconnect

During a visit to a 911 center, the operator I was sitting with disconnected the call after the arrival of the emergency medical staff.  He sighed slightly and, in a hushed voice, said that he’d never know the outcome of the person he’d spent a few minutes talking to during one of the scariest times in their lives.  He’s not alone.  First responders are, by definition, first, but unless there’s a negative outcome while they’re with someone, it’s unlikely that they’ll know the outcome.

There are, of course, those people who reach out to thank the operator who was their lifeline, but that’s vanishingly rare.  Most of the time, whether it’s the 911 operator, the emergency medical staff, or the ER staff, the outcomes aren’t known.  Live or die, they’re unlikely to know.

The problem with this is one of burnout.  Burnout is about not feeling effective.  Feeling effective requires knowing that you’re making an impact – in this case, that people are living or thriving because of your intervention.  One of the biggest suggestions for first responder organizations that want to reduce burnout is to do what is possible to increase visibility of outcomes.  (See Extinguish Burnout for a long list of burnout related resources.)

Alcohol Abuse

In the US, we tried banning alcohol.  The broader societal outcomes were so bad that we repealed an amendment to our Constitution – the one and only time we’ve done it.  It’s an open secret that many first responders – and other professions – leave work and go home for a drink or more.  It’s estimated that about 25% of police officers drink to detrimental levels.  The same is said for about 50% of firefighters.

When I was trying to seek details about the relationship between suicide and mental illness, I noticed that included in the list of mental illness for suicide was substance use disorder (of which alcohol use disorder is a sub category).  The problem with this inclusion was that the rates of excessive alcohol consumption are much larger than anyone wants to acknowledge.  (See Deaths of Despair.)

The Glass of Water and the Goldfish

There’s a goldfish gasping in need of water sitting right next to a glass of water, but the goldfish can’t make the leap to get into the water.  Such is the situation with those working for progressive agencies that make mental health and wellness curriculum available.  In many cases, they don’t even know it’s there.  When people do know that the curriculum is available, they can’t get past the stigma and barriers to take it.  Ultimately, if we could support the fish, it could get the water it needs.

Done well, agencies can help people get the tools and therapy they need to be their own therapist – for most things.  Until we can make the resources available and create the cultures to encourage the use of those resources, we’ll have to worry about First Responder Mental Health.

Book Review-Eye Movement Desensitization and Reprocessing (EMDR) Therapy: Basic Principles, Protocols, and Procedures

In the land of treatments that are validated to work there are a few that stand out.  Eye Movement Desensitization and Reprocessing (EMDR) Therapy: Basic Principles, Protocols, and Procedures is a guide to one of the most well validated: EMDR.  It’s validated for treating trauma and depression.  The book itself is written by the developer of the methodology, Francine Shapiro.  It’s a comprehensive tome for clinicians who want to know everything that can be known short of receiving direct training and mentoring on the treatment protocol.

I’ve read and reviewed Brainspotting, which is a non-validated derivative of EMDR.  As I implied in that review, staying focused on the core EMDR ideas seems appropriate for most people.

Tackling Trauma

Sometimes, simple quotes like, “It’s still an ugly picture, but not because I did anything wrong,” convey a profound wisdom.  One of the things that keeps trauma victims stuck is the sense that they own some or all of what happened to them.  When trauma victims realize that they have no need to take in guilt or shame because they’ve been harmed, it frees them to focus on healing.

A characteristic of unprocessed trauma is that it has the ability to intrude on the present.  Instead of being woven into the neat story of our life, the trauma falls out as a random negative experience that may be relived as if it were in the present moment at any time.  Any trigger can set off the chain of events that leads to the memory – a special pattern, a whiff of smoke or perfume, or something that looks vaguely familiar out of the corner of your eye.  Trauma can be retriggered until it’s fully processed – which may be never.  The good news is that even if trauma is never fully processed, coping skills can be developed to reduce the frequency and impact of the memory.  It’s not that the memory goes away, it’s that the traumatic memory doesn’t trigger as much of a physiological response.

Adaptive Information Processing (AIP)

EMDR works, but it’s not entirely clear why it can demonstrate results so quickly.  While some therapies, like cognitive behavior therapy (CBT), have been proven effective, they can take a long time to achieve results.  Other therapies, such as psychodynamic therapy, have been proven to not be effective at treating PTSD, though some of them remain in widespread use.  AIP posits that the way that we see the world is shaped by our prior experiences, and by reevaluating or improving our relationship with these experiences, we can see rapid changes in current and future behavior.

Bilateral Stimulation

Even though EMDR is founded on eye movement, the key seems to be bilateral stimulation – that is, stimulation of both the right and left hemispheres of the brain either through eye movement or through other senses such as auditory cues or even alternative kinesthetic stimulation.  (This refers to tapping, by oneself or a helper, on alternate sides of the body or a pair of electro-mechanical vibrators placed in each hand that alternate between the two.)  While other strategies for bilateral stimulation are clinically effective, eye movements, perhaps owing to their similarity to REM sleep, are more clinically effective.

The theory is that this bilateral stimulation causes different states that allow for better processing of information.  Neurology has long known that the corpus callosum is important for information processing.  (See Incognito, The Honest Truth About Dishonesty, The Blank Slate, and Noise.)  It’s quite possible that the bilateral stimulation activates the corpus callosum and may help to synchronize brainwaves between the two hemispheres.

Trauma Black Holes

One of the problems with trauma is that repeated, untreated exposure to triggers has the potential to intensify the trauma, making it harder to be processed and easier to be triggered.  We know that memories are associative.  The initial trauma triggers during another situation, and now both memories are attached to each other.  We remember our divorce and the moment we ran into our ex in the grocery store.  (I’m purposefully picking a very tiny example.)  It’s then possible that each visit to the grocery store will amplify the trauma because of the fear of encountering the ex again – and it was traumatic the last time.  Each memory adds to the overall “mass” of the trauma and makes it harder to process.

Leon Festinger, in A Theory of Cognitive Dissonance, explains that when concepts are in conflict, one will move – the one that is the less connected or important than the other.  If one trauma continues to be triggered and reexperienced, it will become larger, like a black hole.  Black holes are simply a region of space that is so dense that even light cannot escape the gravitational pull.  This is what happens to trauma left untreated – eventually, not even light can escape the gravitational pull of the trauma.

Over and Under Reactive

On the one hand, there’s no right way to respond to trauma just as there’s no right way to grieve.  On the other hand, there’s a sense that some people are overreacting to an event and this leads Shapiro to believe there’s a blocked memory network – a trauma that’s not been exposed.

In some respects, she’s right.  It’s an indication that something is going on.  However, I hesitate to say that it’s a blocked memory, because there are so many other options – many of which are unrelated.  (I had a similar criticism of Amy Edmondson’s assertion of a psychologically safe workspace in The Fearless Organization.)  The other, perhaps bigger, concern is that this necessarily puts the therapist in the position of being the arbitrator of normal.  That’s a bad place to be, as Carl Rogers explains in A Way of Being and Miller and Resnik address in Motivational Interviewing.

Negative Cognitions

The important part of working with people who have trauma isn’t the trauma itself but the impact it has on their perceptions and worldview.  One of the markers that is concerning is when people describe themselves with negative evaluations in the present moment.  There are two components to this.  First, the obvious positive/negative evaluation.  Here it’s important to separate which things are statements of facts – perhaps distressing facts – and which are evaluations.

The second, equally important consideration is whether the person is speaking in the past or whether they’re speaking of their current state.  For instance, “When I was in my early twenties, I was a bad person,” is a categorically different statement than, “I’m a bad person.”  (The implication being that they’re speaking of their current state.)  A negative evaluation in the past isn’t particularly problematic – but present moment negative evaluations can prevent recovery from trauma.  (See Compassion and Self-Hate for more.)

When people are evaluating themselves negatively in the present, they may not believe that they deserve to heal from the traumas that were inflicted upon them.  While this may not logically make sense, it can be a barrier to taking steps to heal.  Immunity to Change explains that sometimes these beliefs are hidden and can block the progress that the person consciously wants to make.

Barriers to Change

One of the challenges when trying to help people recover from their trauma is that staying in the trauma may be serving them in some way.  For instance, those on disability receive a check that may go away if they get better.  While it’s probable that the person can find a job that will be more rewarding and will pay better than the disability check, that logic isn’t persuasive if you’ve been on disability for a while.  It’s what you know, and it’s safe.

Another concern, beyond the financial impact of a disability payment, is how someone self-identifies.  If I identify as a wounded veteran, then what would it mean to be fully recovered?  Can I keep my identity, or do I need to form a new one?  Immunity to Change covers in detail how to discover what the barriers might be and what can be done to remove – or work around – them.

Mismatch Between Logic and Emotion

One of observations that can happen is that a person says one thing, and it’s clear they are not emotionally in the same place.  It can be an eerie feeling when talking to someone knowing that something is just not right.  It can be felt as an incongruency that can’t be ignored.  Someone says they’re “fine,” yet their eyes are watering like someone who just got hit with pepper spray.  These observations show the need to create space for the emotion to emerge (or recede) in its own time.

Another mismatch can occur when someone tries to recall an event that has a radically different affect associated with it.  For instance, the loss of someone you’re close to has a negative, sad affect, but there are times when the baseline affect is excited, rushed, or anxious where the recalled memory is insufficient to override the current emotion.  This typically happens as people are immersed in grief and try to recall happy times.  It’s as if these memories skip off the consciousness like a rock skipped on still water.

Waiting on the Other Shoe to Drop

Sometimes, people become afraid for things too good.  “If I’m too happy, I’ll be sorry.”  They believe that something bad will happen – or they don’t deserve happiness.  These dysfunctional beliefs may be constraining people in their current state and preventing them from growing.  It’s as if they’re constantly on the lookout for something else to go wrong to prove that they don’t deserve happiness.  Rational or not, this belief system can take hold and strangle off hope for improvement.

Dual Focus

If the point of EMDR (and other approaches) is to have the person go back through the trauma, how doesn’t this retraumatize them just like flashbacks?  The answer lies in the development of a skill that EMDR calls “dual focus.”  That is, the person recognizes both their current, objective, state and recalls the trauma simultaneously.  Progressive exposure is a proven approach to trauma harm reduction.  It basically increases the degree to which someone experiences the trauma.  EMDR does this by regulating the emotions and the rate at which the memories start coming in.

Dual focus on its own is a powerful skill that allows people to acknowledge the past, including their fear, hurt, and confusion, while accepting their safety.

Losing Memories

One concern that is sometimes expressed when people learn that their memories will no longer haunt them is the worry that they’ll lose them.  Even bad memories people don’t want to lose, because they believe to give up these memories would take away from who they are – and rightly so.  However, the other concern is the loss of positive memories.  They’re concerned that something will happen, and they’ll lose the good with the bad.

Reassuringly, there is no evidence that people will lose their good memories (or bad memories for that matter).

Retaining Appropriate Emotions

While EMDR targets unnecessary suffering due to trauma, it doesn’t help with healthy, appropriate emotions.  If someone is grieving a loss, EMDR won’t stop that.  It’s important to realize that while some emotions may be unpleasant, it doesn’t mean they’re not useful to us.  EMDR isn’t designed to remove our emotions – it’s designed to address the processing problems that keeps us stuck in inappropriate emotions.

Memory Consolidation

Peter Levine lays out a comprehensive view of the relationship between Trauma and Memory in his book.  James Pennebaker shares similar conclusions about how processing works in Opening Up.  In the end, we need time to take our implicit memories that were laid down during a trauma and convert them to explicit, autobiographical memories.  The need for a person-dependent amount of time to be able to process memories is one of the proposed reasons that CISM doesn’t work.  (See Critical Incident Stress Management).

The point of working with trauma is to assist this conversion, but intervening too early can interfere with the internal processing and make it harder to make progress.

It’s How You Deal with It

It doesn’t matter what happens to you.  What really matters is how you deal with it – or, said differently, what you do with it.  We’re all going to experience trauma of some form or another.  No one gets through life uninjured.  What decides how we’ll live the rest of our lives is how we choose to deal with what has happened to us.

Self-Blame the Victim

It’s wrong, but it’s better than the truth.  It’s the way that children of neglectful and abusive parents see themselves as the problem.  Rather than accepting that their parents are defective and incapable of being the kind of parents that they need, the child sees that, if they are just good enough, their parents will finally give them the love they deserve.  (See Trauma and Recovery for more.)

This same phenomenon occurs across time when trauma survivors believe that they have some role to play in the trauma that was inflicted upon them.  Shapiro even shares a quote she used in therapy in response to a client blaming themselves for their trauma: “I’m confused.  Are you saying that a 5-year-old girl can cause an adult to rape her?”  The logic is the same.  If we’re not responsible for the situation, then we can’t control our behavior and protect ourselves from it happening again.  This is one of the foundations of Internal Family Systems (IFS), which says that we have internal protectors that are trying to prevent us from being harmed again.  (See No Bad Parts.)

Real But Not True

While listening, we can – and should – acknowledge the emotion and how those sorts of emotions may be understandable, even if we don’t accept them as objective truth.  Emotions are necessarily valid for that person.  It’s not a good idea to say, “You’re not afraid.”  It sounds nonsensical to even say it or write it.  Even in the less enlightened time I grew up, people didn’t say you didn’t feel that way, but they did imply that some feelings weren’t okay.  “If you keep it up, I’ll give you something to cry about,” was something that many children heard as I was growing up.

The problem is that even if we understand how someone developed an emotion or feeling, it doesn’t mean that it’s objectively the right – or best – feeling.  While many people love animals like dogs and cats, one wrong experience can make people very afraid of them.  We developed a good relationship with a delivery driver to the point we invited him to join us for Thanksgiving dinner.  He politely declined.  He was a lovely man who was deathly afraid of our dogs.  For context, our dogs can walk with us off-leash and wouldn’t hurt a fly, but that didn’t change his feelings of fear.

Hopefully, this illustrates that just because the feeling is valid – because he had it – doesn’t make it objectively best or right.  Said differently, it may not be adaptive to the circumstances.

Pay No Attention

There’s a famous line from The Wizard of Oz: “Pay no attention to that man behind the curtain.”  While it wasn’t effective in the movie, sometimes, we can receive signals from others that a topic that has come up isn’t important.  People try to minimize an aspect of their history or of their suffering.  They say it’s “fine” or it’s “done” or that they’ve “worked through it.”  While these are undoubtedly true in some cases, they’re not necessarily true in all cases.  Strong attempts to avoid a topic can be a struggle for power and control, or they can be a signal that there’s something lurking in the darkness – something that should be addressed.

My general rule is that if you push in, and people become more insistent that there’s nothing there, I get more curious and concerned.  If they move focus to other, seemingly productive, areas of conversation, it may truly be that it’s nothing and they simply want to focus time and attention in other areas.

The Monster Within

You can’t escape the monster within.  It’s the refrain of those who are scared of their emotions and what they may do – or they’ve decided that they are a monster, and they deserve the suffering they have.  (See Cognitive Behavioral Treatment of Borderline Personality Disorder.)  Deserving their suffering is a kind of balance to the scales kind of logic, where if they’re causing harm to others, they should have suffering themselves.  (See Compassion and Self-Hate.)

Addressing the sense that someone is irredeemable and therefore should be subject to suffering is work on changing the way they view themselves –and the process of redemption.  It’s about helping the person understand that they’re not permanently stuck in their past.

It’s understanding that there are no cosmic scales upon which our deeds are weighed.  There are no early transgressions that make us permanently bad, evil, or unlovable.  Everyone can make positive steps in their life.  Some of those steps may be coming to realize the tools that people have to manage their emotions so that they’re not as afraid of them.

One way to learn to control the monster within is through Eye Movement Desensitization and Reprocessing Therapy.

Book Review-The Trauma Beat: A Case for Re-Thinking the Business of Bad News

I didn’t know Tamara Cherry when she took the stage and presented based on her book, The Trauma Beat: A Case for Re-Thinking the Business of Bad News.  She has an impressive pedigree in journalism in Canada, and her years of trauma journalism eventually led to a change in her life.  The cumulative trauma of reporting day-after-day took a toll on her, and she realized how sorely needed training and coaching around trauma is.  Journalists are taught the tools of the trade – but rarely are they given even a token introduction to either of her two main thrusts.  First, in the push for the story, journalists sometimes inflict more harm on the victims of trauma – and that has to stop.  Second, journalists aren’t taught the techniques that can help them better process the trauma they experience – so that it doesn’t build up and take a cumulative toll.

“All I Could Hear Was Camera Clicks”

When Tamara went back to understand the impact that journalists had on the people they were reporting on, she found a complex story of both hurt and help.  Quotes like, “All I could hear was camera clicks,” are just one of many ways that victims reported the problems that journalists caused – on top of the trauma that brought the journalists in the first place.  Somehow, the victims were more focused on the media than their own grief.

It’s not totally surprising given the competition to be first to get the story.  After all, any idiot with an iPhone can get a scoop and post it on social media.  The rules changed since the days when journalists only competed against other journalists.  There’s no denying that the newsrooms are skinnier than they used to be, and the push to deliver on the best news first has only intensified.

The problem is that editors are measured on ratings, which come with the juiciest coverage of the story.  That causes them to push journalists to find grieving spouses at the bar and interview them over the phone so they can say they got the story first.  (This is one of Tamara’s personal stories.)  Instead of grieving, they are giving some interview.

Tamara explains that what journalists want is the story.  The thing that trauma victims don’t have is a story.  They don’t have an organized narrative.  We know that from Peter Levine’s work in Trauma and Memory and James Pennebaker’s work in Opening Up.  It’s the journalist who shapes the story based on the pieces that the victim manages to share.

More Than a Story

The problem is that in the rush of constant news, sometimes the story gets mangled.  Sometimes, “known to police” gets thrown around, and it’s a convenient but incorrect way to attribute the trauma that happened to the victim themselves.  Tamara explains that there are many people who are known to police who’ve done nothing wrong.  Whether they’re known to police or not, they’ve the victims.  It’s not like they brought them on themselves.

It’s a form of blaming the victim, and while the story itself won’t say that it is their own fault they were killed, it may allow you to reach that conclusion on your own.  “Known to police” implies they’ve done criminal things that the police haven’t proved.  However, Tamara is known to police for her work – as am I.  The implication seems weird when it’s applied to a reporter or an educator when the reason for being known to police is professional.

My Loved One Didn’t Matter

One of the other things that Tamara learned in her research is that people often felt like their loved one didn’t matter.  Ironically, this happened whether their loved one’s story was covered or not.  Consider for a moment that your loved one dies tragically, and it doesn’t even make it to be reported on.  It can be deflating, and it can make you feel as if their life didn’t matter to others.  Getting some media coverage – particularly if you’re trying to find the perpetrator – can be frustrating.

On the other side, where media coverage is a given, the sense of being used comes up all too often.  Here are people in their most vulnerable moments being forced to grieve in public who can leave the interaction feeling as if they’ve been used.  The reporter needed the story, and they got it – but the victim is left to live in their trauma.

The truth is that we know premature telling of a story can cause additional harm – yet reporters are doing it every day.

The Bell Tolls for Thee

Earnest Hemmingway wrote the novel For Whom the Bell Tolls with the conclusion that the bell tolls “for thee.”  Journalists, first responders, healthcare professionals, and others encounter trauma every day as a part of their job.  That trauma builds up inside of these professionals and, if left unprocessed, becomes a burden that they must carry.  It’s perhaps one of the reasons why we find that the suicide rate of first responders and other professions with trauma histories occur at higher rates than the general population.

Tamara explains that she’s seen severed body parts.  She’s not talking about a horror movie or some fake Hollywood story.  She’s talking about being at the scene before all the disturbing things have been removed from public view.  She’s offering a glimpse into the things that most people will never see and those things that those who do will never unsee.

Hemmingway, like his father, died by suicide.  Hemmingway’s traumas, however, didn’t come from a life of service but more likely from his family.  The gun he used to kill himself was the same gun that his father used.  It was something that his mother thought that he would want.

Survivor or Expert

When you interact with a journalist, they have a tendency to put you in one of two categories.  You’re either a survivor with a story or an expert with an explanation.  It’s difficult to see you as both, because they so rarely run into people who are both.  When you report on an automobile accident, it’s rare that the victim or the family is an expert in vehicle safety systems.  Conversely, there are many experts who have no direct experience.

Suicide prevention is a bit different, but it’s a microcosm.  We’ve been asked to deliver survivor stories, and the confusion is palpable as we speak about the work that we’ve done to understand what is driving suicide and what can prevent it.  Standing in front of a room of researchers, I mentioned the then 60 suicide-related books that I had read.  A leading researcher turned the tables and asked me what I felt like the solutions were – a far cry from the beginning, when they were expecting yet another sad story about a family grieving.  He wasn’t a journalist but a curious researcher who was constantly trying to find different perspectives.

Perhaps a better question for journalists to ask themselves is, “What expertise does this person bring to their experience?”  It’s an interesting question that might just free the conversation to have both the pain and the perspective that can make a difference.

The Change

In the end, Tamara is calling for two changes.  First, she wants journalists to understand the harm that they are causing and learn how to mitigate it.  It starts with informed consent to planning follow up with victims, so they know that they’re not forgotten – and their loved ones aren’t as well.

Second, she’s calling for everyone exposed to trauma to examine the cumulative toll that the exposure has on their lives.  In doing so, there’s this hope that people will find a way to process their trauma and rid themselves of the burdens that they have surrounding them.  It’s a call to do the work on themselves and to care for their peers in ways that leave them less burdened and more alive.

If these two things can happen, it might just change the rhythm of The Trauma Beat.