On Trauma: A Conversation with Dr. Virginia Demos
How would you describe trauma in a clinical context?
Trauma can be defined as any inescapable event that overwhelms the psyche with terror to the point of helplessness. It often happens suddenly and involves a massive violation of expectations. And the effects can be devastating, whether a person is directly impacted or looking on as a witness. It’s listed in the DSM-IV under post-traumatic stress disorder (PTSD), when the aftermath of trauma has continued to affect the person’s ability to function.
Trauma is a grave condition, but has it always been taken seriously by mental health professionals?
It actually has a checkered history. In the psychoanalytic writings of Freud, he describes how he originally believed he was seeing actual sexual abuse of children. But he changed his mind and decided the symptoms could be traced to their Oedipal fantasies.
Trauma began to be taken much more seriously when veterans came back from World War I and World War II. It was initially called shell shock, and eventually labeled as PTSD. Believe it or not, there is still a lot of argument in the military about whether solders are faking —whether they have really been traumatized and need help. Many people believe one should just “get over” such experiences and forget about them. And others take them very seriously. At Austen Riggs, we take traumatic histories very seriously, because we see how the aftereffects can be quite debilitating. When a soldier sees someone next to him blown to bits, or when a child or adult experiences abuse —sexual, emotional, and/or physical abuse —or they witness such things, they can be tortured by the memories.
Do some people experience horrible events, and come out unscathed?
That is an interesting question. At Austen Riggs, we see the people who haven’t been able to recover. There’s a lot of debate about what makes some people more vulnerable than others to trauma. For example, do they have earlier experiences that prime their psyches somehow? Are they more sensitive and feel things more intensely? Was the trauma repeated again and again? Did they not get help soon enough, so that the experience was magnified in their minds over time? Or perhaps some people are more highly defended and just don’t let things in, even though they’re horrific. There are lots of ways to think about this issue and I don’t think we have all the answers.
We do know that the sooner someone can talk through the trauma and get help with it, the sooner they will be able to recover from it. We also know that the farther away a person is from the traumatic event, e.g. a school shooting, or 9/11, the less traumatic it may feel. We often see people for whom the trauma has happened a while ago, when there was no help available. If it happened in childhood, and involved a parent or someone trusted by the child —first of all that makes it more likely that the trauma happened more than once. And it creates a wretched dissonance. A child’s mind just can’t put together how a trusted adult is supposed to behave with what that adult actually did to them. Their trust has been shattered and the world is no longer a safe place, so a vertical split occurs in the psyche, to ward off the painful experience. The child then has to build up very powerful defenses against the part of the self that was hurt by a trusted adult and that felt so terrified and helpless. But such defenses come at a high price for the psyche. The child has to become vigilant — both toward external events and internal states. They can’t engage spontaneously with others, lest that other suddenly change and become hurtful. And they have to protect the contents of their mind. For instance, they can’t think certain things, lest a stray thought evoke a memory of what happened.
Often when they come into treatment, they may not remember a trauma that actually occurred, even though they know something is wrong. They know they’re not normal. They know they’re different. But they can’t quite name it. Sometimes people know, but they don’t trust their memory, so they don’t take seriously what they know to be true, because they desperately don’t want it to be true. So even when they remember it, they will often say, “It really wasn’t that bad,” or “I must be making this up,” or “No one would believe me.” These things are just not supposed to happen.
We associate trauma with early childhood, but can it happen at any age, any time?
Yes, war veterans illustrate that, although some would argue that the ones who suffer from trauma have a vulnerability to it. We don’t have detailed developmental histories on soldiers who go to war, so it’s hard to assess. I’d say that our vulnerability depends on the massiveness of the event itself, the degree of disruption in the expected reality, and the degree of helplessness and humiliation involved, in the inability to escape. There have been studies, for instance, on a town destroyed by a tornado, when people not only die, but where survivors find the whole fabric of their lives destroyed. We saw this after Hurricane Katrina. People’s lives were shattered by that event. They had to re-construct their whole lives, because every aspect of their daily routine ceased to exist. That was a kind of trauma, which can happen at anytime.
How do people suffering from trauma present themselves to a clinician —or how would a family spot it?
Of course, here we are speaking about people we’ll assume have had actual trauma. We need to be mindful of the problem of false memories—even those that can be implanted by clinicians. But, in general, how a family would spot it depends on where they are in the process of knowing what happened to them. If the trauma is buried somewhere, they can appear quite disconnected from themselves. They might disavow their desires or wishes, and think they don’t deserve what they want, or can’t get it. Some people with trauma hate themselves, but they don’t know why. Trauma is so inexplicable that children come to believe the abuse happened because they were bad in some way. You see, the child needs the parent , other trusted adults, or older siblings and needs to believe that such people can take care of them. So, as a child, it’s more horrifying to believe the older sibs or adults are bad or incompetent than to believe that you’re bad. The child, in order to try to make sense of what has happened, tries to figure out why they were so bad; often their anger at what has happened, or their increased neediness for caretaking is proof enough of their own badness. This deep sense of badness or inadequacy often makes it difficult for them to get close to other people, because that person might discover this “badness.” Thus they often come with histories of avoiding intimacy, or walling themselves off from others.
If the trauma is closer to the surface, they may be struggling with dissociative moments, during which they lose time, or have recurring flashbacks that leave them feeling confused and frightened. Or they may be hypersensitive to sounds or other stimuli. These sensations can leave them feeling that they don’t have control over their lives or their minds. They may have sleep disturbances. They may fear they’re going crazy. They may have substance abuse problems, and/or eating disorders. They may present as borderline, by which I mean highly volatile. There’s a very high correlation between the diagnosis of borderline and a history of abuse. They can come with a variety of somatic complaints, as well. Often they don’t know exactly what the trouble is. And when they do know, they have become overwhelmed by the terror and lack of control over their minds and their lives. Usually, over the years, they’ve developed a variety of coping strategies. But they come to us because those strategies have broken down and their lives are no longer manageable.
People with trauma can also be extraordinarily accomplished. We saw a patient who had a history of physical abuse from a close relative. She was a very bright young woman and drove herself academically. She got into a very good, Ivy League college and began pushing herself and pushing herself, until she fell apart. She was taking extra courses, and was running faster and faster. But she had this underlying despair, and felt the only alternative was to die. Often people who get to us have tried to kill themselves because of this deep sense that something is terribly wrong with them but they can’t quite let themselves know what it is.
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