God asks no person whether he or she will accept life. That is not the choice. You must take it. The only choice is how ~ Henry Ward Beecher
Trauma is a penetrating wound and injury, which threatens one’s life and arrests the course of normal development by its repetitive intrusion of terror and helplessness into the survivor’s life. When there is prolonged repetitious exposure to multiple severe traumatic events perpetrated by one’s caregivers throughout childhood, what results is referred to as complex trauma.
Although child abuse is the predominant catalyst of complex trauma I encounter as a trauma therapist, complex trauma can also result from emotional, physical or sexual abuse and neglect incurred through trafficking, domestic violence, hostage situations, medical abuse, refugee displacement, and war. All these conditions disrupt development and cause fragmentation of the overall personality.
Given that recurring trauma stymies cohesive identity formation, a reliable sense of independence within a connection is ruptured
Given that recurring trauma stymies cohesive identity formation, a reliable sense of independence within a connection is ruptured. Consequently, as trauma survivors attempt to negotiate relationships, the psychological defenses formed through trauma bonding become increasingly maladaptive. Intimate relationships are driven by a desperate longing for protection and love and simultaneously fueled by fears of abandonment and exploitation.
Essentially, as much as the complex trauma survivor struggles to deny, minimize, bargain with, and co-exist with the abuse, the impact of chronic trauma seeps into the deep recesses of the psyche and the body. Hence, long after the actual danger is past, the complex trauma survivor is consistently beset by painful symptoms and visitations of traumatic injuries on a mind, body, and spirit level.
Most significant are how the detrimental effects of trauma on the brain impact explicit and implicit memory.
Two brain structures that encode memory are the hippocampus and the amygdala. The hippocampus encodes explicit memory, meaning it creates a chronological perspective of the information that interacts with prefrontal cortex functioning (PFC). The PFC brain region consolidates a contextual understanding of the encoded memories so that informed adaptive emotional and cognitive responses can occur.
Meanwhile, the amygdala, the mediator of emotional stimulation and the fight or flight part of the limbic system catalogs past sensory experiences as implicit memories that are intrinsic to intense arousal. This function ensures that future threatening events will ignite sensorial signals, alerting one to danger.
However, when trauma is thrown into the mix the consolidation of encoded information is disrupted. The deluge of adrenal hormones that are triggered by traumatic events heightens the arousal state of the amygdala, sending it into overdrive. At the same time, the hippocampus shuts down, hampering the ability to distinguish past from present.
Additionally, the vagus nerve, responsible for regulating motor functions and arousal of the sympathetic nervous system, ‘freezes’ when stimulation is extreme. Known as a dorsal vagal state, this scenario paradoxically affords self-protection while impeding the possibility of feeling safe and regulated. This experience is akin to being so immobilized by fear that a full dissociative collapse ensues. One’s energy is depleted to the point of not being able to exercise basic daily activities or engage relationally.
What’s more, since hippocampus and cortical activity are impaired, fragments or traces of sensorial memory occurs. This results in memories becoming a schema of blurred images and details that are linked to physiological symptoms of fear. Moreover, these irregular flawed sequences of fragmented memories create an incoherent narrative and in some instances dissociative amnesia.
All in all, traumatized people relive the events as though they were continually recurring in the present
Furthermore, this complex neurobiological response to trauma elicits an ‘unspeakability’, as the horrifying events endured cannot be organized on a linguistic level (Bessel van der Kolk).
All in all, traumatized people relive the events as though they were continually recurring in the present. Events are re-experienced in an intrusive-repetitive fashion, themes are re-enacted, nightmares and flashbacks persist, and there is an unrelenting state of danger and distress. Exaggerated disproportionate reactions to perceived threats, in which the compromised prefrontal cortex is unable to sufficiently assuage the trauma response, is an omnipresent reality for survivors.
Stuck in time, the trauma survivor is challenged to differentiate the past from the present. This is a complicated and arduous task. Although there is no quick fix or easy anecdote, or even a definitive timeline, there is a pathway.
That said, before a trauma survivor can even conceive of ‘getting over it’ or ‘letting go’ of intrusive and repetitive reminders of traumatic events and coming to terms with the anguish of literal and intangible losses, they must first parse out convoluted memories of past traumas from present reality.
Distinguishing the past from the present entails identifying the cues that ignite trauma responses so that regulation techniques can be employed, projections can be diffused and the eventual creation of a cohesive narrative of one’s history can ensue. For this to happen safety must first be established. This is a necessary prerequisite to achieving stabilization.
Since the stimuli associated with the trauma are often avoided through denial and numbing, the survivor experiences restricted affect, no recall, diminished interests, and an overall sense of detachment. A formidable collaborative therapeutic alliance characterized by an empathic reparative bond is the foundation for trauma-informed treatment that encourages the retrieval of suppressed affect and memory.
The survivor is led to safely identify their plight through bibliotherapy, psycho-education, and the ‘borrowing’ of the therapist’s observing ego. The ability to create a modicum of predictability and self-protection is also crucial. Developing these life skills may entail the incorporation of medication management, addiction recovery, relaxation techniques, bodywork, creative outlets, and establishing a replenishing home environment and a responsibility towards basic health needs.
Given that the body speaks of the abuse through chronic hyper-arousal as well as through difficulties sleeping, feeding, and overall disruptions with biological functions along with states of psychological dysphoria, the goal is to help the survivor return to a ventral vagal state.
Likewise, moving out of dissociative numbness to conscious instinctual awareness and responsiveness leads to cognitions rooted in feeling. All these strategies and techniques help clients build neuro-pathways in their brains that assist with identifying and practicing coping skills. Furthermore, these processes foster self-cohesion (H. Kohut) in which fragmented parts that were disowned in the service of survival, can over time achieve unification.
When the survivor has enough ego strength to face the profound level of despair that would have shattered her in childhood, the mourning process begins along with the reframing of a history of systemic victimization.
At this stage, the therapist serves as a witness. The therapist and client emotionally immerse themselves in a prolonged collaborative passage through excruciating grief. Intangible misfortunes, spanning the entirety of a lost childhood and the subsequent hardships that follow, are endured. The loss of self, loss of life skills, loss of faith, loss of trust, loss of agency, and loss of dignity are but some of the diverse pieces comprising the wreckage. The survivor begins to reevaluate her identity as a ‘bad’ person, and in so doing begins to feel worthy of relationships that allow for authenticity and nourishment.
For many, just traversing this stage of recovery can take years
Here disintegration, exacerbation of symptoms, and nervous collapse are most likely to occur. During this stage of treatment, survivors need to prepare themselves for symptoms of psychosis, physical dysregulation, severe dissociative episodes, and flashbacks. Suicidal ideation and overwhelming feelings of despair and hopelessness may arise. Relapses may occur. Inpatient care might be necessary.
Those who persist and are willing to endure the repercussions of grieving a lifetime of tangible and abstract losses, need to be safely monitored. Effective pacing and leading necessitate accessing the resources established in the initial stage of treatment. Basic fundamental tools that facilitated safety and stabilization early on, are especially invaluable as deeper work is approached.
The mind and body begin to coalesce as awareness of one’s plight is recognized as having a legitimate context. The survivor faces what was done, and what the traumas led her to do under extreme circumstances.
Successful completion of this stage of recovery ultimately results in acceptance and renewal, inclusive of a comprehensive understanding of human nature and the shadow side of humanity. The stage of rebuilding can only occur when the horror of systemic abuse is sufficiently processed and a coherent and cohesive narrative of what one survived is crafted.
Much of the reparative work in the final stage of trauma recovery involves challenging nihilistic and fatalistic assumptions about the self and the world. The trauma survivor intent on thriving is challenged to give life to a perspective, a philosophy that goes against internalized beliefs, and to reconstruct a reality that makes room for the existence of faith and hope. She is motivated to attach to the abstract for a deeper transcendent meaning. Creativity, spiritual belief systems, philosophy, ethics, service, and personal integrity are all part of this exploration.
For the survivor turned thriver, this journey of healing and reclamation has a deeply complex metaphysical meaning and it informs one’s sense of pride and purpose. It is understood that the act of ‘letting go’ of a past steeped in trauma is the attainment of bittersweet acceptance.
In sum, the complex trauma recovery process takes extensive time and substantial patience
In fact, according to the organization Beauty After Bruises,“Survivors with C-PTSD and dissociative disorders often require therapy for more than ten years on average. An additional number of years (up to several more) are all too often lost on ineffective or harmful therapy and receiving several misdiagnoses before ever obtaining a proper one. Following the most intensive phases of therapy, with memory processing completed, many patients still find themselves needing some form of therapy or psychiatric care for many, many years to come.
I can personally attest to how navigating through the rigorous process of restoring and reclaiming a cohesive authentic self in the aftermath of systemic traumatic abuse, is an inconceivably huge task. It took me decades, and truth be told I doubted my suffering would end, that I could ever get past the pain of my existence.
So, to the critics who extolled ‘moving on and ‘shaking it off, I have this to say. The survivor’s drawn-out quest to access a sense of wonder and the inner resilience to make meaning out of despair and move towards a future of one’s making with certainty and conviction, is a noble feat. There is no greater achievement than transcending mere survival so as to restore one’s birthright and finally experience what it is like to fully feel and fully live.
With great pride, I look back and marvel at having stayed the course. It brought me full circle to holding that space for those who are brave enough to embark on their own laborious and lengthy odyssey of trauma recovery. Above all, pressing on showed me that nothing worth having in life will ever come easy. For all trauma survivors, this tenet is a guiding principle.
NYC psychotherapist & freelance writer. Survivor and thriver of Complex Trauma & Addiction. Dual citizen of the U.S. & Canada, traveler, lover of art and nature. I appreciate the absurd. Sheritherapist.com