When I think about healing from psychological trauma, my metaphor is healing from physical trauma. Consider a wound that breaks the skin and damages underlying tissues and deeply exposes them. How does a clinician aid the healing of such a wound? One way is to, after cleaning the wound, oppose the tissues on either side of the gash to allow scar tissue to invade the gap and ‘stitch’ the separated tissues together again.
After the bodily wound heals, it is likely that a visible scar will remain. And even if the person chooses at some point to undergo a cosmetic procedure to minimize the scar on the skin surface, they themselves will know it remains there, even if less visible to others. If it were a facial scar that they minimized through a procedure, they nevertheless would likely be reminded of the inciting traumatic event and the resulting wound every time they looked in the mirror to apply makeup or shave.
When I consider the consequences of psychological trauma I also think of a scar, a psychological scar in this case. But I see the good of it and not simply the bad. In what way is a scar both good and bad? Again, consider a physical scar. It is, after all, our body’s way of healing itself and reconstituting the integrity of the skin and underlying tissues. But most scars remain visible and are often considered unattractive. And it is likely some or much function of the tissues has been lost.
And so with psychological trauma and scarring – it has occurred and its consequences will live on forever. The clinician can help the person heal by fully acknowledging this. As I’ve written in the previous post, one of the most damaging aspects of psychological trauma is the sense of estrangement that occurs from one’s previous sense of reality and from others. The traumatized person may feel totally alone in their realization of the contingency of life, and of their personal and everyone else’s fundamental vulnerability. After all, each of us will one day die, from one thing or another.
A clinician who wants to play at being nice, trying to put a happy face on the patient’s experience and telling them something to the effect that “time heals all wounds,” is furthering the patient’s sense of aloneness and estrangement. They’re not buying it, at least, not yet. They will look at you and think, “You just don’t get it, do you?”
The fact is that the traumatized person will never be the same again. Their scar will remain, more or less visible, and more or less frequently thought about, but it will remain.
The traumatized person will have lost aspects of life of incredible importance and value: they will never again look out at the world through innocent eyes. They have seen the frame of reality that they and most of the rest of us live within, torn asunder. They have seen, perhaps, the horrors that lie below.
But through this very loss and suffering, they will have gained something also. They have gained a deeper understanding of the fragility of life, and of the meaning of happiness. They will better differentiate what is important in life from what is nothing more than shallow distraction. They will be wiser. They have born witness to a range of experiences that other have not. Their gaze will have a gravity missing in most people’s gaze. They will not be fooled again. These are aspects of what has been called posttraumatic growth.
Of course, coming to an appreciation of the potentially positive aspects of trauma comes later, if at all, and comes after the pain and the loss has been acknowledged first. Some scars are stronger than the tissue they replaced.
As a person continues to reintegrate their traumatic experiences and their consequences, and as they continue to reconceptualize and recontextualize the trauma, they may one day arrive at this deeper wisdom and growth. Of course, they are likely to always believe that the cost was not worth this new deeper perspective. And they are right to think so. But they will, partially and grudgingly, respect this very hard won new understanding.
The clinician’s job is not to short-circuit the grieving process for all that has been lost. It is rather to help the patient find ways of slowly, slowly reintegrating the trauma back into the fabric of their lives, back into their – now expanding – frame of reality, just as a scar stitches flesh together. How is this done? Many ways. Here are some ideas. I’ll expand on some of these in future issues.
- Connecting with others who accept and seek to understand: Group therapy or self-help groups can be useful to a traumatized person to be able to experientially understand that others also have suffered through terrible experiences and some, at least, have found a way forward. Re-establishing a sense of belonging (to the human race) is crucial. The new group participant should be allowed to adjust and actively participate at their pace.
- Managing one’s sense of vulnerability and risk: Often the traumatized person overgeneralizes risk and vulnerability. With therapies such as CBT the underlying beliefs can be assessed and re-evaluated. Although it is true that risk and vulnerability exist, it is not true that every place, person, or situation is inherently dangerous. Evaluating the specificity of the risk associated with individual persons, places, and situations is helpful.
- Finding meaning in trauma: one aspect of trauma that is traumatizing is that many causes of the trauma are senseless. There is often little or no benefit that the perpetrator or warring party achieves through traumatizing another person or nation. We are creatures who find senseless suffering unbearable. We will do anything, distort reality if need be, in order to find meaning within suffering. A person recovering from trauma needs to develop a personal narrative of a life of meaning, not one that pretends the trauma did not change so much in this person’s life, but rather one that incorporates the traumatic consequences into a new narrative, a more inclusive and resilient one.
- A new sense of purpose: as a traumatized person considers the consequences of their trauma, their sense of loss, guilt, shame, estrangement, and the shattering of their reality frame, their understanding of what is important will change. And ultimately, a new reality frame (or “assumptive world”) can come into view and a new sense of purpose can emerge. Many individuals will now seek to help others, to put to good use all that they have learned through their trauma. They may seek to be a peer counselor or advocate for other traumatized or marginalized persons or groups. If you work with persons living with trauma, an acknowledgement of the importance of developing a new sense of meaning and purpose, and a new personal narrative and reality frame should be a crucial part of your clinical stance. And consider together what steps the patient can take to reach their personal goals for healing and growth.
And that is the most we can hope for.
Until next time,
“The conflict between the will to deny horrible events and the will to proclaim them aloud is the central dialectic of psychological trauma. People who have survived atrocities often tell their stories in a highly emotional, contradictory, and fragmented manner that undermines their credibility and thereby serves the twin imperatives of truth-telling and secrecy.”
– Judith Lewis Herman, Trauma and Recovery, From Domestic Abuse to Political Terror
“That’s what trauma does. It interrupts the plot. You can’t process it because it doesn’t fit with what came before or what comes afterward.”
– Jessica Stern, Denial: A Memoir of Terror
“Trauma is personal. It does not disappear if it is not validated. When it is ignored or invalidated the silent screams continue internally heard only by the one held captive. When someone enters the pain and hears the screams, healing can begin.”
– Danielle Bernock, Emerging with Wings