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HC James is from London and worked as a teacher before switching careers to medicine. He currently works as a doctor in a south London Emergency Department and in his spare time visits family in California.   

 

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Trauma: the Living Dream

September 27, 2017

 

 

At a recent presentation one of the participants raised the issue of trauma. They challenged that it was very well to say that our mental well-being lay within our control, it being all in our mind, as in the Ways of Liberation (yoga, buddhism, mindfulness, etc.); that it was simply a matter of practice, of meditation, of realising the essentially illusory nature of the self, in order to be free from our anxiety, our over-thinking. Yet what about trauma; what about thoughts that we are simple unable to control? For the person who has been traumatised it is hardly helpful to say that it is just thinking, now go deal with it. Traumatic memories and thoughts - and coping actions arising from them - are often too powerful to understand or control. They can run like a malignant undercurrent throughout a person's life.

 

I have to admit wasn't really able to give a satisfactory answer other than that mental processes, no matter how powerful, are still just mental processes, so I thought I'd try to do more justice to the issue here. Trauma is by its definition not a normal experience that can be managed with a bit of reflection. It is a rupture in the normal trajectory of one's life. A traumatic event turns a person's life upside-down and profoundly shakes their identity. After a traumatic event things are not the same as before and often it takes many years before it is possible to feel 'normal' again. It produces a great deal of stress and anxiety; in feelings of irritation, dread, wild mood swings, depression, isolation, the sense that the world is not the friendly place it once seemed to be. Trauma tends to make one hyper-vigilant, on guard and obsessed with such a thing happening again, to the extent that a considerable amount of mental energy is poured into dealing with it, usually unsuccessfully. 

 

This is because trauma does not respond to rational thought. Traum means 'dream' in German, which is apt, because for those who have experienced trauma, it seems to lurk in the realm of the sub- (or pre-) conscious. One might try - if one is even prepared to talk to others about it - to describe the traumatic events, to reason them away, but of course the 'energy' of the trauma still remains. This is why the above title says the 'living' rather than 'waking' dream - because trauma really does seem to have a life of its own, one that seems to carry on independent of me, without my permission, intruding on and shaping my day-to-day life.  

 

Can one 'think' one's way out of trauma? Can one deal with an essentially dream-like state with rational mental processes? Perhaps surprisingly, the answer is yes. But it requires thinking that engages the whole mind - including the emotional, non-verbal, survival parts of the brain. Trauma creates a conflict between the survival and the new brain. Long after the events the new brain tries to make sense of them. My individual 'identity' - who I thought I was - has been shaken to the core and my new brain - home of my identity, an essentially social construct - struggles to incorporate this overwhelming information. In this struggle the survival instinct is re-activated, again and again. The perceived threats, the hyper-vigilance, the sense of 'if only I had...' triggers the survival brain: neuronal impulses and hormonal stress messengers are released and the body becomes a reservoir of tension. One essentially 're-lives' the trauma but does not learn from it.

 

One of the benefits of meditation/mindfulness/yoga, then, is in calming this re-activation. By literally placing the body and the mind in a state of rest one de-escalates the physiological stress response, giving one's body a much needed rest. It also enhances self-awareness. If trauma places one always within a hair's breadth of 'arousal' (fear/anger) then meditation widens that gap and gives one much needed thinking space. Even to be able to say "I am now re-living this event" is an important step in the right direction. With practice one can even effect the structure of the brain. Studies have shown how meditation - in as little as six weeks - can reduce the size of the amygdala - the part of the brain understood to be key in triggering fear responses.  

 

Being able to manage trauma like this is important: but it is also possible to get to the root of the trauma - to learn from and take the heat out of it. Here western-style 'psycho-dynamic' therapy has some useful approaches. In one, the therapist guides the 'victim' back to the crucial moments of the event/s and encourages them to state their 'need' which at the time was unmet - to essentially say what they wanted to say at the time but were unable to - and then to state that need again and again until they activate that emotional core of themselves to the point of screaming out/breaking down, essentially releasing all that energy. It is a highly effective way of liberating oneself from traumatic memories but it's not for everyone. It requires exposing yourself completely and should only be done with a trained practitioner. 

 

Another effective method was developed in the 1970s in America, as traumatised war veterans from the Vietnam war flooded the U.S. health services. This was called Traumatic Incidence Reduction (T.I.R.) and was essentially a method for 'schematising' traumatic memories - that is, placing unprocessed, overwhelming events into easily manageable memories, making them things that simply happened in the past and no longer had any hold.

 

This process involves the practitioner asking the traumatised person - the 'teller' - to go back to the very beginning of their traumatic event, then describe it in full detail. Only once the full event has been described are they then asked to describe it again ('Go back to the beginning and tell me again what happened'.) This process is to be repeated, and repeated, as many times as needed. Something interesting then happens; with each telling the story changes. Often details change, and almost always there is a change in the emotional content - a lot of feelings can arise, though there is a full awareness on behalf of the teller, there is no 'losing it', they are in complete control -  and eventually what happens is that the story loses its charge. Very often insights arise, previously obscured by the emotional turbulence of the memories. Often a state of compassion is reached, for oneself especially. The teller will often visibly relax, the eyes clear, the shoulders drop. At this point the practitioner will ask if there's anything else to say and the teller will usually say no - the traumatic event has been processed, a memory, perhaps not pleasant, but no longer charged and obscure. (When it rarely doesn't 'work', it is usually because there is a previous event which has not been appreciated before - this can then be uncovered, told and repeated using the exact same process above.)    

 

What is interesting about this process is how it integrates the various parts of the mind: the new brain, the survival instinct, the memory and learning areas, the limbic areas and so on. One reaches what in Zen Buddhism is called Big Mind: compassionate, seeing events as a process and not just 'I did this', 'I failed to do that', no 'this was done to me', no 'this was right', 'that was wrong', but seeing that things simply happened; no shame, no blame. This doesn't happen overnight; the above methods - yoga, mindfulness, T.I.R.* etc -  take practice and time, but it has been shown to be effective and gives the traumatised person a much needed sense of control back into their lives. (* I would also include martial arts in this list - many of which are embedded in liberation philosophies such as Zen - and which are particularly effective at rebuilding confidence). 

 

There is something else worth mentioning about trauma and that is its potentially positive aspect. As mentioned earlier trauma, whatever its form, shakes the individual to the real depths of their being. It is profoundly upsetting but, handled with compassion, patience and skill, it has the potential to transform. Precisely because it disrupts my 'idea of myself' so violently, it also gives me the opportunity to change that idea (or those ideas). According to the Ways of Liberation my identity is a construct, a fundamentally social construct at that: an idea developed over my life of who I should be, or who I am destined to be, what I am meant to do, what I am cut out for, my type of personality, and so on. These ideas form who I think I am. They can be encouraging, but they can also be very limiting. In either case, they come from outside - upbringing, society, culture etc -  and most likely we didn't have much choice in what they were. Moreover most of us go through our entire lives unaware of them. Trauma breaks up this story and forces the individual to rebuild 'who they are'. This can now be done on your own terms, consciously and with intention: you can be the person you want to be.

 

This is not to sugar-coat trauma. It is unwelcome and intrusive, and arises from bad things happening. The point is that one does not need to be defined by trauma, just as one need not be defined by the pre-existing ideas about oneself and the world before the trauma. It is a chance to see everything, and yourself, again and to ask what would you like to change. Ideally though, we do not need trauma to happen for us to realise this, and it is always better to avoid trauma. Prevention as they say, is better than cure.

 

HJ

   

 

 

 

   

 

 

 

 

   

 

 

 

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