“I just can’t seem to stop my mind,” Linda told me. “I try relaxation techniques, but after a few moments, my brain starts to buzz again with invasive thoughts and feelings. I can’t seem to turn them off.” As she spoke to me during our second visit, she was visibly stressed. She had the pinched face and hunched shoulders of someone who felt at once threatened and helpless.
“Lots of times, it’s the same old thing, just the same old negative thoughts and worries and blaming myself,” Linda went on. “Sometimes I try to head them off by going out for a run, but they come back later. When they really get ahold of me, I get kind of shaky, dizzy, and sick to my stomach. If they go on long enough, I actually get a stiff neck, and eventually a headache.”
A client’s negative, intrusive thoughts are a therapist’s stock and trade. Ditto the accompanying roster of bodily complaints, from stomach pains and neck tightness to headaches and back problems. In my 20 years as medical director of a multidisciplinary chronic-pain program, I’ve found these intrusive thoughts---which hinder both the mind and body---to be a sort of generic marker for significant emotional disorders, including depression, anxiety, post-traumatic stress disorder (PTSD), and adjustment disorder.
But if Linda’s distress seems familiar, it isn’t just because we see this kind of client so frequently in our therapy rooms. It’s also because her complaint rings true for “healthy” people like ourselves. All of us have ruminating thoughts, bringing up the cud of old memories and unresolved problems, in the process experiencing a sinking feeling in the stomach or perhaps a tightening in the throat. As we well know, these experiences usually arise unbidden and often at inopportune times, such as when we’re reading a book, eating a meal, or even, God forbid, making love! And when we’re interrupted in this way, we basically lose it: we forget why we went into the bedroom, we lose track of our place in the book, and, if the intrusion is upsetting enough, we may even lose the wherewithal to continue with what’s going on right now. We’ve experienced that most insidious of insults to our mind–the corruption of the present moment by emotion-linked memory.
When we catch ourselves in this state of nonpresence, we’re likely to chalk it up to “mind chatter.” When a client reports these repetitive intrusions, we may wonder about a tendency toward obsessiveness or the possibility of depression and/or anxiety. While all of these interpretations may have some validity, I believe that much more is at stake. I propose that in many of these moments of body-mind intrusion, our brain is trying to protect us from mortal danger arising from memories of old, unresolved threats. In short, we’re in survival mode.“Ordinary” Trauma
To understand the meaning of these everyday emergency responses, and to transform them into opportunities for healing, we first need to rethink our fundamental assumptions about trauma. I propose that the sources of trauma are far more complex than the standard Diagnostic and Statistical Manual
(DSM) definitions. Under Criterion A, the DSM-IV
defines trauma as the result of having “experienced, witnessed or been confronted with . . . actual or threatened death or serious injury . . . to self or others” and responding to that event with “intense fear, helplessness or horror.”
This definition isn’t wrong, but it’s woefully incomplete. In fact, any negative life event occurring in a state of relative helplessness---a car accident, the sudden death of a loved one, a frightening medical procedure, a significant experience of rejection---can produce the same neurophysiological changes in the brain as do combat, rape, or abuse. What makes a negative life event traumatizing isn’t the life-threatening nature of the event, but rather the degree of helplessness it engenders and one’s history of prior trauma.
Let’s look at the first criterion---the person’s relative state of helplessness in the face of a threat. We can often avoid being traumatized by an actual life threat if we remain in control of the situation, either by effectively fighting back or escaping the situation. If we’ve adequately defended ourselves, our survival brain doesn’t need to store the body-mind messages of a trauma as an ongoing warning signal. But if we haven’t prevailed---if we couldn’t avoid the oncoming car or fend off the mugger---the brain remembers that experience as mortally threatening.
All of us, clients and professionals alike, will continue to set ourselves up to be retraumatized until we recognize that many of our negative intrusive thoughts and sensations are, in fact, symptoms of trauma. They may not be identified as such in the DSM-IV
, but these more commonplace body-mind invasions assume the same meaning, if not the intensity, as the trauma-related thoughts and flashbacks of full-fledged PTSD. In both PTSD and what we might call “ordinary” trauma, conscious and unconscious memories brutally intrude upon and corrupt the present moment. Not everyone suffers from PTSD, but each of us has sustained many of these smaller traumas, setting us up for being continually shoved out of the present moment into a frightening, helpless past.This blog is excerpted from “The Precarious Present.” Read the full article here. >>Want to read more articles like this? Subscribe to Psychotherapy Networker Today!