Complex PTSD Read online

  4. Feeling: Passively Working Through Grief

  Feeling Can Heal Digestive Problems

  The Emotional-Physical Connection

  Balancing Feeling And Emoting

  Learning To Feel

  An Exercise In Feeling

  Techniques To Invite And Enhance Grieving

  Chapter 12 The Map: Managing the Abandonment Depression

  Cycles Of Reactivity

  Abandonment Depression Fear & Shame Inner Critic 4Fs

  The Layers Of Dissociation In The Cycle Of Reactivity

  Parental Abandonment Creates Self-Abandonment

  Deconstructing Self-Abandonment

  Depressed Thinking Versus Feeling Depressed

  Mindfulness Metabolizes Depression

  Somatic Mindfulness

  Somatic Awareness Can Therapeutically Trigger Painful Memories

  Introspective Somatic Work

  Dissolving Depression By Fully Feeling It

  Hunger As Camouflaged Depression

  Pseudo-Cyclothymia

  Separating Necessary Suffering From Unnecessary Suffering

  Recovery Is Progressive

  A Swiss Army Knife Approach To A Flashback

  Chapter 13 A Relational Appoach to Healing Abandonment

  The Relational Dimension Of Psychotherapy

  Relational Healing In Complex PTSD

  1. Empathy

  2. Authentic Vulnerability “Realationship” Makes Healthy Relationship

  Therapeutic Emotional Disclosure

  Guidelines For Self-Disclosure

  Emotional Self-Disclosure And Sharing Parallel Trauma History

  3. Dialogicality

  Meeting Healthy Narcissistic Needs

  Psychoeducation As Part Of Dialogicality

  Dialogicality And The 4F’s

  4. Collaborative Rapport Repair

  Moving Through Abandonment Into Intimacy: A Case Study

  Earned Secure Attachment

  Rescuing The Survivor From The Critic

  Finding A Therapist

  Finding An Online Or Live Support Group

  Co-Counseling

  Chapter 14 Forgiveness: Begin with the Self

  Chapter 15 Bibliotherapy and the Community of Books

  Especially Recommended Reading

  Chapter 16 Self-Help Tools

  Conclusion

  Toolbox 1 Suggested Intentions For Recovery

  Toolbox 2 Human Bill of Rights

  Toolbox 3 Suggested Internal Responses to Common Critic Attacks

  Toolbox 4 Tools for Lovingly Resolving Conflict

  Toolbox 5 Self-Gratitudes/ Gratitudes about Others

  Toolbox 6 Flashback Management Steps

  Bibliography

  ACKNOWLEDGEMENTS

  I am grateful to all my lovely clients who, over the last three decades, honored me with their brave vulnerability and authenticity. Their stories verified to me that there is an epidemic of poor parenting, and their inspiring work proved to me that the effects of it could be largely overcome.

  I am also grateful to the readers of my first book and to my website respondents whose generous feedback greatly alleviated my performance anxiety about writing another book and putting my words out there for public viewing. Their overwhelmingly positive support ameliorates the fear that my words will be used as weapons against me as they so often were in childhood.

  I am grateful to my good friend Bill O’Brien who gave me invaluable editorial assistance.

  I am grateful to all those writers listed in the Bibliography, and those unlisted, whose ideas have fertilized my mind and helped me to write this book.

  I am grateful to my friends in recovery with whom I have shared the process of mutual commiseration. We have aided each other greatly in our journeys of recovery.

  DISCLAIMER

  I am not an academic expert on Complex PTSD [Cptsd]. I have read and studied a great deal, but by no means exhaustively, and I do not make it a point to religiously keep up with all the latest developments. What I bring to the table here is almost 30 years of treating trauma survivors in individual and group settings. What I describe here is a pragmatic, multidimensional approach to recovering based on what I have seen work with my clients, my loved ones and myself.

  INTRODUCTION

  If you’re in immediate distress, please turn to chapter 8, and read the list of 13 steps for reducing Cptsd fear and stress.

  Forty years ago, I was riding on a train in India travelling from Delhi to Calcutta. I was at the end of a failed, yearlong spiritual quest in India. Instead of enlightenment, my salvation fantasy had only netted me despair and amoebic dysentery. The latter cost me thirty pounds of flesh, and left me looking like an emaciated monk.

  Even worse was the absolute loss of the hope that had been inflamed by reading Walt Whitman’s “Song of the Open Road.” This hope had supported me through five years of world travel after I was unceremoniously kicked out of my family home.

  But, back to the train. I was sitting in my cramped second class seat with the untouchables, chickens and goats, reading an English version of an Indian newspaper. The paper informed me that my destination, Calcutta, was now inundated with 100,000 refugees from Bangladesh who had just fled their flood–swamped homes. They were all apparently sleeping on the downtown streets in the recesses beneath the protruding second floors of all the buildings that lined the streets.

  I came in late at night and sure enough, sleeping bodies wrapped in sheets, shoulder to shoulder, lined the streets everywhere. I checked into a twenty cents-a-night hotel that a fellow traveler had told me about. I slept unevenly, dreading the sight that I would behold the next morning. How would I handle viewing masses of desperate people, especially when I had nothing to give? I doubted that I even had enough money to make it to Australia where I could hopefully replenish my wallet.

  When I finally nudged myself down the stairs late the next morning, I was aghast at the transformed scene on the streets. Sheets had been spread out like picnic blankets and each hosted happy families. Little portable stoves produced meals and cups of tea. People bantered with incredible vitality and enthusiasm, and children...children [this was the part that emblazoned on my memory] crawled all over their parents, especially their fathers in affectionate playful gymnastics that their fathers seemed to love as much as they did.

  I was flooded with a mélange of feelings unlike anything I’d ever experienced before - a strange cocktail of relief, delight and anxiety. The anxiety I wouldn’t understand until ten years later when I realized that envy had been percolating below the surface of my awareness.

  I was deeply envious of this gorgeous buffet of familial love that I had never experienced or even witnessed before. The family sitcoms – even the syrupy sweet ones - that I had watched growing up came nowhere near creating such an authentic, tactile representation of healthy bonding and attachment.

  When I realized what this was years later as an anthropology and social work student, I positively flashed back to other non-industrial countries where I had seen similar scenes on a less grand level: Morocco, Thailand, Bali, and an Aboriginal reserve in Australia.

  These memories also viscerally informed me about the kind of relational love I had never seen in my own or my friends’ families. As I digested this experience over the years and used it to overcome my denial about what I had missed out on as a child, I began the decades long quest that has lead me to write this book as well as The Tao of Fully Feeling, which precedes it. The Tao of Fully Feeling is a companion to this book and elaborates many of the foundational principles of this book.

  This book then is my hopeful effort to create a map that you can follow to heal the wounds that come from not enough childhood love. If I am a bit repetitive at times about issues like shrinking the critic and grieving the losses of childhood, it is my attempt to find different ways to emphasize the great importance of engaging these themes of recovery work over and over again. If you find yourself
lost and not sure of how to get back onto the map, these themes will always be key portals for reentry.

  I sometimes recommend that readers view the table of contents and start with whatever headings most strike a chord. Although the book is laid out in a somewhat linear fashion, everyone’s journey of recovering is different, and journeys can be initiated in a variety of ways.

  Journeys of recovering may begin when a death or great loss brings up an emotional storm that opens up a hidden reservoir of childhood pain; or when a friend shares something about his or her recovery process that strikes a chord; or when a book or TV show triggers a more serious consideration of what really happened in childhood; or when something gets “opened up” in couple’s therapy; or when a healing crisis in the form of panic attacks or a nervous breakdown requires some outside help; or when the self-medicating strategies developed to soothe depression and anxiety get out of control and also require outside help.

  I hope that readers will be able to use this book as a textbook for recovering, and that certain sections will call you back or forward to them repeatedly, as over time and with effective work, certain themes continue to take on ever deepening meaning.

  In this vein, you will find that the Table of Contents is quite comprehensive, and sometimes the best way to use this book is to browse through it and then read the sections and chapters that most capture your interest.

  Moreover, this is not a one size fits all formula for recovering. Depending on the specific pattern of your childhood trauma, some of the advice contained herein may be less relevant or even irrelevant to you. Please then focus on the material that seems applicable and helpful to you.

  I also hope this map will guide you to heal in a way that helps you become an unflinching source of kindness and self-compassion for yourself, and that out of that journey you will find at least one other human being who will reciprocally love you well enough in that way.

  Finally I have illustrated this work with many real life examples. All names and identifying information have been changed to protect client confidentiality.

  PART 1

  AN OVERVIEW OF RECOVERING

  THE JOURNEY OF RECOVERING FROM CPTSD

  I wrote this book from the perspective of someone who has Complex Post-Traumatic Stress Disorder [Cptsd], and who has experienced a great reduction of symptoms over the years. I also wrote it from the viewpoint of someone who has discovered many silver linings in the long, windy, bumpy road of recovering from Cptsd. I have also seen this type of recovering in a number of my friends and many long term clients.

  First, the good news about Cptsd. It is a learned set of responses, and a failure to complete numerous important developmental tasks. This means that it is environmentally, not genetically, caused. In other words, unlike most of the diagnoses it is confused with, it is neither inborn nor characterological. As such, it is learned. It is not inscribed in your DNA. It is a disorder caused by nurture [or rather the lack of it] not nature.

  This is especially good news because what is learned can be unlearned and vice versa. What was not provided by your parents can now be provided by yourself and others.

  Recovery from Cptsd typically has important self-help and relational components. The relational piece can come from authors, friends, partners, teachers, therapists, therapeutic groups or any combination of these. I like to call this reparenting by committee.

  I must emphasize, however, that some survivors of Cptsdengendering families were so thoroughly betrayed by their parents, that it may be a long time, if ever, before they can trust another human being enough to engage in relational healing work. When this is the case, pets, books and online therapeutic websites can provide significant relational healing.

  This book describes a multimodal treatment approach to Cptsd. It is oriented toward the most prevalent kind of Cptsd, the kind that comes from growing up in a severely abusive and/or neglectful family. In this vein, the book describes a journey of healing the damage that occurs when you suffer traumatizing abuse and abandonment. Traumatizing abuse and abandonment can occur on verbal, emotional, spiritual, and/or physical levels. Moreover, sexual abuse is especially traumatizing.

  I believe that we have an epidemic of traumatizing families. Current estimates posit that one in three girls and one in five boys are sexually abused before they enter adulthood, and recent statistics from The Kim Foundation report that 26% of Americans over 18 have been diagnosed with a mental disorder.

  When abuse or neglect is severe enough, any one category of it can cause the child to develop Cptsd. This is true even in the case of emotional neglect if both parents collude in it, as we will see in chapter 5. When abuse and neglect is multidimensional, the severity of the Cptsd worsens accordingly.

  Definition Of Complex PTSD

  Cptsd is a more severe form of Post-traumatic stress disorder. It is delineated from this better known trauma syndrome by five of its most common and troublesome features: emotional flashbacks, toxic shame, self-abandonment, a vicious inner critic and social anxiety.

  Emotional flashbacks are perhaps the most noticeable and characteristic feature of Cptsd. Survivors of traumatizing abandonment are extremely susceptibility to painful emotional flashbacks, which unlike ptsd do not typically have a visual component.

  Emotional flashbacks are sudden and often prolonged regressions to the overwhelming feeling-states of being an abused/abandoned child. These feeling states can include overwhelming fear, shame, alienation, rage, grief and depression. They also include unnecessary triggering of our fight/flight instincts.

  It is important to state here that emotional flashbacks, like most things in life, are not all-or-none. Flashbacks can range in intensity from subtle to horrific. They can also vary in duration ranging from moments to weeks on end where they devolve into what many therapists call a regression.

  Finally, a more clinical and extensive definition of Cptsd can be found on p. 121 of Judith Herman’s seminal book, Trauma and Recovery.

  An Example Of An Emotional Flashback

  As I write this I recall the first emotional flashback I was ever able to identify, although I did not identify it until about ten years after it occurred. At the time of the event, I was living with my first serious partner. The honeymoon phase of our relationship came to a screeching halt when she unexpectedly started yelling at me for something I no longer recall.

  What I do most vividly recall was how the yelling felt. It felt like a fierce hot wind. I felt like I was being blown away – like my insides were being blown out, as a flame on a candle is blown out.

  Later, when I first heard about auras, I flashed back to this and felt like my aura had been completely stripped from me.

  At the time itself, I also felt completely disoriented, unable to speak, respond or even think. I felt terrified, shaky and very little. Somehow, I finally managed to totter to the door and get out of the house where I eventually slowly pulled myself together.

  As I said earlier, it took me ten years to figure out that this confusing and disturbing phenomenon was an intense emotional flashback. Some years later, I came to understand the nature of this type of regression. I realized it was a flashback to the hundreds of times my mother, in full homicidal visage, blasted me with her rage into terror, shame, dissociation and helplessness.

  Emotional flashbacks are also accompanied by intense arousals of the fight/flight instinct, along with hyperarousal of the sympathetic nervous system, the half of the nervous system that controls arousal and activation. When fear is the dominant emotion in a flashback the person feels extremely anxious, panicky or even suicidal. When despair predominates, a sense of profound numbness, paralysis and desperation to hide may occur.

  A sense of feeling small, young, fragile, powerless and helpless is also commonly experienced in an emotional flashback, and all symptoms are typically overlaid with humiliating and crushing toxic shame.

  Toxic Shame: The Veneer Of An Emotional Flashback

  Toxic
shame, explored enlighteningly by John Bradshaw in Healing The Shame That Binds, obliterates a Cptsd survivor’s self-esteem with an overwhelming sense that he is loathsome, ugly, stupid, or fatally flawed. Overwhelming self-disdain is typically a flashback to the way he felt when suffering the contempt and visual skewering of his traumatizing parent. Toxic shame can also be created by constant parental neglect and rejection.

  Early in my career I worked with David, a handsome, intelligent man who was a professional actor. One day David came to see me after an unsuccessful audition. Beside himself, he burst out: “I never let on to anyone, but I know that I’m really very ugly. It is so stupid that I’m trying to be an actor when I’m so painful to look at.” I will never forget how shocked and disbelieving I felt at first, that such a handsome person could feel ugly, but further exploration brought me understanding.

  David’s childhood was characterized by broad spectrum abuse and neglect. He was the last and unwanted child of a large family, and his alcoholic father repeatedly attacked and looked at him with disgust. To make matters worse, his family imitated his father and frequently humiliated him with heavy doses of contempt. His older brother’s favorite gibe, accompanied by a nauseated grimace, was “I can’t stand sight of you. You make me want to vomit!”

  Toxic shame can obliterate your self-esteem in the blink of an eye. In an emotional flashback you can regress instantly into feeling and thinking that you are as worthless and contemptible as your family perceived you. When you are stranded in a flashback, toxic shame devolves into the intensely painful alienation of the abandonment mélange - a roiling morass of shame, fear and depression.

  The abandonment mélange is the fear and toxic shame that surrounds and interacts with the abandonment depression. The abandonment depression itself is the deadened feeling of helplessness and hopelessness that afflicts traumatized children.