|The End of Innocence|
The End of Innocence
Reconsidering Our Concepts of Victimhood
Whether delivered by hand grenade or by hurricane, by fist, machete, or burning plane, traumatic experiences are universal across cultures, and so are attempts to heal them. How well those attempts succeed depends in part on the stories a culture tells itself about victimizers and victimhood--about recovery, wholeness, and resilience. This is particularly true of intimate family violence, which broke into the light in the late 20th century, casting ripples that continue to this day.
As a systems therapist, incest survivor, and recovering alcoholic, I've lived through several stages of our culture's attempt to come to terms with child sexual abuse--as a victim in the silent 1950s; as a therapy client in the oblivious 1960s and 1970s; and as a psychotherapist in the 1980s and 1990s, when once-dismissed accounts of abuse filled my therapy practice (and my television screen) only to be partly discredited within the decade during another swing of the cultural pendulum.
We clinicians are still feeling our way toward a middle path, one that avoids the extremes of disempowering pity and "buck-up" denial. Our clients (and if we're survivors, we ourselves) still struggle to negotiate what sociologist Ervin Goffman called "spoiled identity": the isolating experience of being cast outside the circle of "normal" life, along with gays, paraplegics, and madwomen. Helping a client move from subjugation by the worst thing that ever happened to me to a nuanced and effective life has turned out to be more complex--and oddly enough, more commonplace--than I imagined when I first sought help.
One in a Million
The simplest version of my own story begins with my father. After he came home from World War II, he led at least three separate lives: one in Manhattan with his German mistress and her mother, who followed him to the States; one with my mother and me in Northampton, Massachusetts; and one in my bedroom at night, with my mother seemingly oblivious and asleep at the other end of our house.
Photographs of me at 3, before that secret life began, show a cheerful little girl, eyes full of delight, almost always smiling at the camera, smiling at the man taking the pictures--her father. In my kindergarten picture, taken two years later, my body expresses what none of us would put into words for 20 years. Around the kindergarten table the children sit, posture-perfect, hands folded in front, eyes gazing alertly at the photographer, all of the faces smiling--except one. Thin and awkward, my arms and legs sprawled weirdly over the little chair, my mouth hanging open and my eyes staring vacantly off into space, I'm the only one not looking at the camera.
The year was 1950, a time so different from the present as to be almost another country--a postwar, post-Holocaust world, cocooned in a vast cultural silence about victimization and the aftereffects of victimization. In this world, bleached of any reference to trauma, alcoholism, or child sexual abuse, there was no such thing as Megan's Law, Battered Child Syndrome, the Betty Ford Center, or Post-Traumatic Stress Disorder.
According to a leading psychiatric text, incest was something that happened only once in a million families. No child I knew ever told me she'd been repeatedly struck in the face (as I had) by a father who at other times was playful, loving, and kind. Until I was 17, I didn't try to tell anybody--not even my beloved godmother--that my father forced me to perform sexually. Nor before I was 24 did anyone believe me.
In 1962, as a frightened freshman at Cornell University, I made my way to the college counseling center. I was 17 and an excellent student, but I was already drinking heavily, sleeping around, and generally confused by my sexuality. In my initial interview, I wasn't explicit about my father's incestuous abuse. But I talked about my unhealthy closeness to him, my fear and loneliness, and my feelings of being "different" from others my age.
I began counseling with the head of the center. He asked me endless questions about my relationship with my mother . Although I kept trying to talk about my father, this man said it was because of my "overclose" mother-daughter attachment that I was experiencing the plague of bisexual attractions and recommended that I spend the summer with my father in his one-bedroom apartment in Manhattan. I fled from my would-be helper and waited seven years to try to speak again.
Thoreau once said that it takes two to tell the truth: one to speak and one to listen. The first person to listen to me was Florika, a bright young Romanian immigrant whose father had not only sexually abused her but had begun force-feeding her amphetamines at 13, when she faltered as a virtuoso child violinist. I met her when I was 24, living in New Haven, Connecticut, after graduating from Cornell. I was drinking a lot at the time, working in a women's carpentry collective, practicing karate, learning to run the printing press at a radical newspaper, and playing drums in the New Haven Women's Liberation Rock Band, where Florika was the bass player. Many were the nights we roamed New Haven together, spray-painting buildings with graffiti urging women to smash the patriarchy.
"What do you understand?" I asked.
"That you're one of us," she whispered.
I don't remember exactly what I said next, but I'll never forget the relief that followed my first stumbling words of disclosure and our mutual recognition. For the first time, I heard that I wasn't the only one. In that era of denial, I don't think I yet realized that incest had ever happened to anyone except Florika and me.
Within 24 hours, Florika had also introduced me to the daily use of amphetamines--something that made me feel powerfully in control even though I'd never been more out of control. The pseudocloseness of shared addiction felt familiar, like the secrecy, stimulation, and shame I'd lived so many nights in my father's house.
My pattern of what we now call "trauma reenactment" went undetected for years by mental health professionals: our profession played a cultural role analogous to the Non-Protecting Bystander in the incestuous family system--like my mother sleeping at the other end of the house. Psychiatrists and psychologists repeatedly beat the bushes for any explanation rather than the obvious ones: that I was telling the truth about my sexual abuse; that I was desperately trying to soothe a neurobiology disregulated by trauma; and that my addictions were creating major physical, psychological, and practical problems of their own.
If this narrow story of trauma, rage, misdiagnosis, therapeutic mistreatment, and spoiled identity was all there were to tell, I'd be dead by now--as dead as Florika, who took a fatal overdose of heroin in her late twenties while working as a Hollywood studio musician. But my life, like most lives, included commonplace and counterbalancing experiences that had nothing to do with abuse: the emotional support of my godmother and many teachers; a wordless enjoyment of the natural world; and successful involvements in school, radical politics, work, and athletics.
In prayer meetings and rallies in small rural churches in the cotton fields, Jereldine and her neighbors faced poverty, violence, and racism together--with songs, testimonies, political action, and energetic joy. Everyone participated. Everyone, no matter how uneducated or beaten down, was assumed to have something to offer. In contrast to the isolated inner struggle of the abuse survivor, traumatic experiences among the African Americans I met in the South were confronted communally and held in a spiritual perspective, leading to something other than bitterness and despair. It was years before I could put into practice what Jereldine had shown me, and I returned home alone at the summer's end, still closely guarding the secret of my sexual victimization--except when I was drunk (which was often).
So it went until an early winter day in 1978, a year after my father's death, when I found myself in a car on an interstate in Connecticut, being driven back to my job (as a dorm counselor near my childhood home in Northampton, Massachusetts) by someone I hardly knew. After I opened the car door and tried to jump onto the freeway--it seemed like a good idea at the time--the terrified driver delivered me struggling and shouting to the emergency room of a hospital off the nearest exit.
Three days drunk, covered with blood from self-inflicted cuts, my hair disheveled, dressed in jeans and an old army shirt of my dad's, even my gender was unrecognizable. I was wrestled into submission by six emergency room workers, injected with a paralyzing amount of Thorazine, and transported by ambulance to a locked ward for violent women at the Connecticut state hospital in Waterbury. I was 34.
I don't know what diagnoses I'd been given by my well-intentioned New Haven psychologist, Dr. M., who'd minimized my alcoholism and repeatedly told me that my memories of incest were fantasies representing my disguised yearning for my father. But I suspect my bulging file contained references to borderline personality disorder or depression with psychotic features. Like thousands of other traumatically abused and misdiagnosed women, I was well on my way to developing the "spoiled identity" of a chronic mental patient. Dr. M. had led me to believe that I'd spend the rest of my life in and out of psychiatric units like the one I then found myself in at Waterbury.
Only my middle-class connections, I suspect, saved me from involuntary commitment. Two days after my arrival, three well-dressed, college-educated friends appeared in the middle of an ice storm and talked their way into meeting with the psychiatrist on call. "She needs to be in detox," said the psychiatrist, and released me to them.
It was the beginning of the end of my addictions.
Two months later, in another locked psych unit after another violent, drunken altercation, a psychologist suggested I move to the alcohol treatment unit one floor below. I agreed and for six rocky weeks, I self-consciously sat through 12-step meetings, heard about a Higher Power, and got used to the idea that I was powerless over alcohol and that my life had become unmanageable.
The Politics of Truth
Clean and sober, I returned to graduate school and shot like a rocket from chronic PTSD and rampant addiction to what seemed like the other end of the rainbow. Within six years, I was "Dr. Miller," a clinical psychologist doing postdoctoral work in family and narrative therapy at the University of Calgary Medical School in Alberta. On one memorable day, I visited a Canadian mental hospital as a consultant and expert on domestic violence and addiction. I'll never forget a social worker's giving me an enormous key, which opened all the wards, including a locked ward similar to the one I'd been committed to in Connecticut. Holding that key and remembering the movie King of Hearts , I was tempted to open every door. I was also irrationally terrified that my identity as a former mental patient would somehow be exposed.
As a family systems therapist, I loved drawing connections between a family's surface pain and hidden issues of addiction, patriarchal social assumptions, and domestic violence. I loved the "difficult" families, especially the mistrustful, mislabeled, and misunderstood mothers. I loved being mentored by iconoclastic family therapists who did battle with The System, personified by well-intentioned but oblivious social workers, psychologists, and psychiatrists like those who'd mislabeled and mistreated me.
Then one day in 1985, I sat behind a one-way mirror supervising a graduate student working with a father and his young daughter. Someone in the therapy room--I can't now remember who--said the word "incest," and it resonated through the microphone and into my observation room. A student next to me whispered a question, but I couldn't hear her words. Tears fell onto my hands as I twisted them in my lap.
But times had changed. If power consists in part in determining whose stories will be told and whose believed, the balance of power was shifting. Stories like mine were being whispered to a new generation of women therapists, spoken out loud in new 12-step meetings for adult children of alcoholics, and aired among feminists involved in the movement to stop domestic violence. The floodgates had opened. Control of the politics of truth had moved from the experts to the experienced.
After nearly a century in which the mental health field had dismissed reports like mine as fantasies, we victims lost patience with being spoken about and began to speak for ourselves. If our culture wanted to play Non-Protecting Bystander, we'd strip away the collective ignorance that had served as its shield. Like gay people and people of color before us, we defiantly embraced and began to dismantle the spoiled identity we'd been assigned. Oprah Winfrey, Maya Angelou, former U.S. Senator Paula Hawkins, and former Miss America Marilyn Van Derbur all said on television that they'd been sexually abused as children. By becoming vocal, we challenged the family and cultural role we'd been assigned: to suffer in silence, save everyone else from discomfort, and internalize the damage.
In the face of the carefree old public narrative--that incest was either imagined or consensual, and in any case, only occurred in one in a million families--we faced what lay in plain sight: that child sexual and physical abuse were real, damaging, and prevalent; and so were rape and other forms of family violence. If childhood and family trauma could be stopped and effectively treated, we figured, whole categories of the DSM --borderline personality disorder, dissociative disorders, substance abuse, cutting, sex addiction, other behavioral addictions, PTSD, and even some forms of anxiety and depression--might practically disappear. The elephant that had crashed unrecognized outside the windows of the consulting room for 80 years was finally seen and named.
By the mid-1980s, we clinicians were experimenting with hypnotherapy, cognitive-behavioral work, and psychodynamic approaches that sometimes fostered inaccurate recall, retraumatization, family cut offs, and regression. Exposure therapy (developed for combat vets), for example, had been used effectively to desensitize adult women who'd suffered a single incident of rape. But when incest survivors repeated their stories over and over, they relived their traumas physiologically, along with the complex relational wounding of betrayal by a close family member. The biologically based rage, terror, and helplessness that followed were then often turned against the self in the form of renewed cutting, self-destruction, and addiction.
I remember, for instance, an incest survivor in Northampton who was coping well and working in a responsible position at a local title insurance company. After entering therapy, she became grossly obese, stopped working, and, to my knowledge, has never worked again.
I'd reentered therapy myself in the mid-1980s and, for the first time, I was assembling a coherent life narrative with a clinician who believed me. But if this was the validation I'd sought, why did I feel worse after nearly every session? Helpless and enraged after reliving detail after detail of how my father had hurt me and my mother had abandoned me, I'd walk out of her office and end up in an expensive shop in Northampton, flipping out my MasterCard for beautiful clothes I couldn't afford.
I wasn't alone in my misgivings. In the early 1990s, I was frequently asked to consult with bewildered therapists, whose clients had entered therapy doing more or less okay and had then fallen apart. I particularly remember Frieda, a talented sculptor who'd been in therapy for seven years. She'd stopped working on her art, became a child instead of a partner to her husband, and was drinking too much and neglecting her children. In consultation, I asked why she was persisting with therapy that apparently wasn't doing any good. I suggested--much to her therapist's shock and dismay--that Frieda take a break from individual therapy, try a group focused on building present-time, real-life competence, return to sculpting, and go to Alcoholics Anonymous.
Frieda's therapy had been modeled on a psychodynamic approach influenced by British researcher John Bowlby, the expert on mother-infant attachment. The idea was to compensate for early betrayal and "insecure attachment" by providing clients with a dynamic, reparative, and trustworthy therapeutic relationship.
In practice, this often meant making excuses for destructive behavior and implying that nothing better could be expected of someone so horribly damaged. The focus was on the wounded child to the exclusion of the competent adult. To make matters worse, many therapists eventually became exhausted by the role of ministering angel and turned punitive with their clients.
This therapeutic quicksand was responsible for slogans, buttons, and bumper stickers like "It's got to get worse before it gets better" and "It's never too late to have a happy childhood." In Northampton, where I live, adult women walked around with teddy bears in their backpacks--and some, I hate to say, still do. Many became disconnected from any community but the community of survivors, and any identity beyond the spoiled identity of victimhood. Their lives consisted mostly of living alone, writing in journals about what had happened to them, and making the rounds of group therapy, individual sessions, support groups, and inpatient units.
That's why, when the False Memory Syndrome Foundation (FSMF) burst on the scene in 1992 and began challenging professional licenses and picketing therapists for "splitting up families," I felt ambivalent. On the one hand, they represented such a backlash. On the other hand, as I quietly said behind closed doors, they had a point. We were walking into dense fog where it was hard to tell what was real and what wasn't. Given the way I hadn't been believed myself for so many decades, I wanted the story told by victims about their victimizers to be always simple and always true. It wasn't turning out that way. Yet it was almost taboo among us to admit that much of what we were doing wasn't working. Anyone who criticized therapeutic practice risked being identified with the FMSF, whose members were presumed to all be Abusers and Non-Protecting Bystanders. A new elephant had entered the consulting room, and we were in denial all over again.
Nurturing the Competent Adult
In this state of unease and not-knowing, I reached beyond the incest recovery movement. In 1995, I drove to Burlington, Vermont, for a weekend workshop in "Just Therapy," a New Zealand approach connected to both the Narrative Therapy movement and indigenous movements for social justice. Led by a white man, a Maori man, and a Samoan woman, all from New Zealand, the group opened every session with chanting and prayer, challenging us bemused, secular Americans to do the same.
I thought variously of Gandhi's independence movement, of Alcoholics Anonymous, and of the Civil Rights movement, all of which had flourished rather than imploded. What had been their secret? Despite their enormous differences, all had transformed participants--and the culture at large--in a way I can only describe as spiritual. All had acted in the present moment--cognizant of, but not enslaved by, the past. All had faith in something bigger than themselves, and none demonized their purported enemies. Could the trauma survivors' movement do the same?
At around this time, I came across journal articles by the pioneering research clinicians Bessel van der Kolk of Boston University and Marsha Linehan of the University of Washington. Both turned attention from the psyche to the body of the trauma victim and hypothesized that self-harmful behavior like cutting could be an attempt to soothe chronic neurobiological disregulation. If this were true, our clients couldn't think, talk, confront, cathart, or "re-story" their way to wholeness. Their nervous systems were continually telling them that the past was the present. Rather than a prolonged version of the Primal Scream, they needed new ways to learn to reregulate their disturbed neurophysiologies.
At this point--please bear with me here--I took up tennis. I was in my late forties and out of shape, and I just wanted to get more play, joy, and exercise into my life. My tennis teacher, Deedie Steele, became such a model of encouraging and demanding realism that if I were still supervising clinical graduate students, I'd require them to watch her teach tennis.
Deedie thought anyone could become a competent tennis player, and her teaching reflected both kindly encouragement and a precise analysis of everything I needed to do to improve. Standing across the net from me on the public court in Northampton, she watched how I placed and moved my feet, knees, elbows, and wrists as carefully as if she were preparing me for Wimbledon. She showed me in minute, persistent detail how to make necessary changes. Good therapists, I thought one sunny day as I ran sweating around the court returning her serves and trying to pay attention to my right wrist, are like Deedie: they believe that each client can function as an effective adult, and they help them gain the skills necessary to make this happen.
In my own life, things were moving, too. I entered a long-term relationship with someone who helped me learn to play and have fun. We renovated a house together in Northampton with the help of our son-in-law, a contractor, and I became part of a family that included grown children and grandkids.
I also returned to 12-step meetings--and there, too, things had changed. Women participate more actively in the recovery movement now, and I felt freer to share my story. The time I spent in those church basement rooms opened a door to a deeper spiritual yearning. After years of dabbling in Buddhist books, I began meditating regularly and discovered, in Pema Chodren and Thich Nhat Hanh, the notion of impermanence. This basic Buddhist tenet--that the "self" isn't fixed and that all circumstances and states of mind pass was the perfect antidote to the sense of doomed identity that had brought me to my knees in that mental hospital in Connecticut. I became more solid--and yet, oddly enough, more open to friends and strangers. I was living a fuller life than many people who'd never been abused.
Leaving a church basement one night, I found myself rethinking the whole question of victimhood, healing, and wholeness. As much as my clients needed to understand the links between their victimization and self-destructiveness, I thought, they needed even more to take an ordinary place within the web of life.
In 1995, my graduate students at Antioch New England university suggested we incorporate what I was trying with individual clients into group therapy. Our first three-month group was held in the offices of a domestic violence program in Greenfield, Massachusetts. This notoriously poor, predominantly white area of northwestern Massachusetts is a landscape of played-out farms, abandoned brick factories, and tattered, triple-decker apartments lining the side streets of decaying, 19th-century mill towns. Unemployment is high, and so are heroin addiction, crack use, and domestic violence.
We opened the first session by teaching the women simply to breathe with awareness. Then we talked about the links between their childhood histories, their addictions, and the way they had internalized all three roles: Victim, Abuser, and Bystander. Each week, we asked how trauma had affected them, but we also asked about the roots of their resilience--their successful coping strategies and the people they remembered who'd been there for them, even if not consistently.
Over time, we taught them to turn to other members of the group for support rather than to the group leaders. They painted and drew. In brief guided meditations, we helped them connect to something bigger than themselves. That opened the door to developing a felt sense of Protective Presence, evoked from memories of protective adults, beloved pets, nature, and compassionate religious teachers like Jesus and the Buddha. They learned to reliably evoke this presence to remind themselves that even though they'd been victimized, they'd also been whole people all along.
In the last three weeks of the three-month group, we focused on how they intended to give back to the larger community. Some returned to Alcoholics Anonymous or Narcotics Anonymous. Others went back to school, college, or work. Others chose to volunteer in the storefront drop-in centers I'd helped organize with other therapists, community activists, a small order of radical Catholic nuns, and a visionary federal project dedicated to supporting innovative work with trauma survivors. Self-destructive behaviors diminished and, perhaps more important, participants created an identity for themselves that included, but wasn't limited to, their traumatic past.
Since then, I've trained more than 200 women with histories of trauma, most of them poor, with limited education. I call this program ATRIUM (Addiction and Trauma Recovery Integration Model) after the entry chamber of the heart. The metaphor is meant to suggest that the groups are just a starting point. Their graduates now lead similar groups in local prisons, jail diversion projects, AIDS programs, and the three drop-in centers for survivors. Many of these women--among them many welfare-dependent single mothers and grandmothers--have turned out to be more effective group leaders than some of the highly educated professionals that I've trained. They're helping create what may be the therapy of the 21st century: a blend of peer support, psychoeducation, interpersonal skills training, meditation, creative expression, spirituality, and community action.
I'm now close to 60--a middle-class, middle-aged professional living on Prospect Street in Northampton, Massachusetts--the same street I grew up on. I still occasionally see women in town with teddy bears in their backpacks and buttons saying "It's never too late to have a happy childhood." I want to tell them that their button is wrong: it is too late. Time is a river that runs in only one direction. Trauma survivors--be they Vietnam veterans, Cambodians, Holocaust survivors, sexually victimized women, or firefighters who escaped from the World Trade Center--never become people to whom trauma didn't happen. But the ripples that flow outward from every traumatic event don't have to sink us, define us, or assign us a single identity. "Victim," I want to tell them, describes a specific moment in time, not permanent self-definition. This is a comforting aspect of the impermanence that transforms every emotional state.
As a culture, we're only just waking from sleep. It's long been easier to blame people covertly for their reactions to childhood abuse than to face what happened to them. We pay staggering public health bills for the addicted and traumatized, but we balk at spending on preventing that trauma in the first place. Protective workers charged with investigating crimes against children, for example, make less than half what we pay the police officers who investigate adult crimes.
There are a few hopeful signs that this may change. In the wake of the priest scandals and the collective public wounding of the September 2001 attacks, words like victim and trauma have enlarged their meanings beyond the mostly female holders of this particular spoiled identity. The psychic damage suffered by the firemen and construction workers of Ground Zero made it clear that not only Vietnam veterans and sexual-abuse survivors suffer from PTSD. Nobody's yet suggested that the "heroes" of 9/11 are part of a culture of complaint. As Jack Rosenthal put it last fall in the New York Times Sunday Magazine, "Before 9/11, trauma often referred to the horrible physical injuries seen on E.R. Now the psychiatric use of the term may just as likely be referring to the time bombs that 9/11 lodged in the minds of thousands."
Meanwhile, I'm continuing to play tennis. Thanks to expert coaching and hard work, our aging, ragtag team, The Courtesans, has progressed from dead last to a respectable standing in our local league. When I travel to Washington, D.C., these days to meet with the federal agencies that fund our grass-roots projects in Franklin County, I sometimes pass the Mall, where, during huge women's rights rallies, I played in the New Haven Women's Liberation Rock Band with Florika. I think back 30 years to that desperate, unconscious, distrustful, and enraged young woman, three days drunk and covered with self-inflicted cuts, who was shot full of Thorazine and bundled off to a state hospital in Connecticut. She'd be both contemptuous and amazed to see who she's become: a physically healthy professional woman who works inside the system without ever quite joining it. And although I still hold in my heart that wild young woman and understand how she came to be, the river of life has flowed a long way since then, and she's now only part of me.
Dusty Miller, Ed.D., is director of the Atrium Consultation and Training Institute in Northampton, Massachusetts. She's the author of Women Who Hurt Themselves; Your Surviving Spirit: A Workbook of Spiritual Resources for Coping with Trauma; and numerous other publications on trauma and addiction. She's also the codirector of the Willing Spirit Retreat Center in Cape Cod, Massachusetts. Address: 229 Prospect Street, Northampton, MA 01060. E-mails to the author may be sent to email@example.com.
Barrett, Mary Jo. "Healing from Trauma." In Spiritual Resources in Family Therapy, edited by Froma Walsh, 193-209. New York: Guilford, 1999.
Chodron, Pema. Awakening Loving-Kindness. Boston: Shambhala Publications, 1996.
Herman, Judith Lewis. Trauma and Recovery: The Aftermath of Violence from Domestic Abuse to Political Terror. New York: Basic Books, 1992.
Jordan, Judith V., et al. Women's Growth in Connection: Writings from the Stone Center. New York: Guilford Press, 1991.
Linehan, Marsha. Cognitive-Behavioral Treatment of Borderline Personality Disorder. New York: Guilford Press, 1993.
Miller, Dusty. "Incest: The Heart of Darkness." In Secrets in Families and Family Therapy, edited by Evan Imber-Black. New York: W. W. Norton, 1993.
----. Women Who Hurt Themselves: A Book of Hope and Understanding. New York: Basic Books, 1994.
----. "Challenging Self-Harm Through Transformation of the Trauma Story." In Sexual Addiction and Compulsivity, 3, no. 3 (1994): 213-27.
----. Your Surviving Spirit: A Spiritual Workbook for Coping with Trauma. Oakland: New Harbinger Publications, 2003.
Miller, Dusty, and Laurie Guidry. Addictions and Trauma Recovery: Healing the Body, Mind and Spirit. New York: W. W. Norton, 2001.
Najavits, Lisa, R. D. Weiss, S. R. Shaw, and L. R. Muenz. "Seeking Safety: Outcome of a New Cognitive-Behavioral Psychotherapy for Women with Posttraumatic Stress Disorder and Substance Dependence." Journal of Traumatic Stress, 11, no. 3 (1998): 437-56.
van der Kolk, Bessel, Alexander McFarlane, and Lars Weiseth. Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body, and Society. New York: Guilford Press, 1996.