Feeling Too Little and Addictions

In the previous blog I illustrated some of the symptoms following complex trauma, including  feeling too little, the topic of today’s blog. Today I discuss the role of addictions in helping people to survive or numb out emotional pain, and offer some ideas on how to support the healing of addictions.

Firstly, healing addictions requires a lot more than just stopping the habit or pattern. The work of healing addictions includes a developmental/behaviour component to be healed, for example the “Puer Aeternis” (eternal youth) first described by Jung over a hundred years ago, which from a structural dissociation perspective would include the “collapse” and “flight” fantasy self- state.

Mills and Teason (2019) report that a history of trauma is almost universal among people with addictions using AOD services. Some theories suggest that self- medication of trauma symptoms like anxiety may play a role in the development of addictions. Other theories suggest that addictions are part of the magical thinking and “flight” of the younger parts of trauma survivors, helping them to escape unbearable pressure or emotions. Another idea (generated by observations within my work) is that sometimes the addictive habit or pattern is an unconscious attempt by a younger part to find an idealised “attachment” figure, (the addiction for example to cigarettes or alcohol) perhaps offering an alternative or fantasy “friend” to relate to, where they can have a special relationship, gain significance, or just find solace from everyday life. Some of these ideas are contained in the Puer Aeternis character pattern described over a hundred years ago by Carl Jung.

So if the addiction offers the fantasy escape from pain and suffering, it stands to reason that people with addictions will need to add other supports and skills to replace the “escape hatch” of the addictive substance or behaviour. We cannot expect people to give up substances and habits which they believe are vital for their survival. Addictions may be the best method the person has for surviving at first! Janina Fisher illustrates why additional “scaffolding” is needed below.

The worst part of addictions are that in the long term they damage the relationships that could powerfully help to heal trauma symptoms, cause health problems and shorten life expectancy. Worse, over time the addiction can become a “substitute relationship” while real relationships are sidelined, making the person increasingly cut-off and lonely.

 

Whatever the reason for the addiction, recovery from addiction and feeling too little takes time and work. Simply stopping the addictive pattern eg via willpower is not enough, although its a start. Significantly, work is needed around the trauma and the individual factors that hold the addiction in place, as well as building more supports and skills. This work is best done with a therapist or group that is well trained in contemporary trauma theory as well as addictions. You can also contact organisations like Odyssey for more information.

 

Changing Patterns and Habits

Neuroplasticity can help solve a lot of problems, but it can also create problems! Some patterns or habits of thinking, feeling or responding can start off as helpful but because of  stress and neuroplasticity become rigid, harder to change, or simply less helpful over time. Patterns or habits such as overworking, avoiding certain things, irritability, or always putting the needs of others before your own can become “set in stone”. Because these patterns have happened thousands of times, they may feel like “this is the truth “or “this is who I am”.

 

But all patterns and habits are neuroplastic and so can be softened, changed, or even eliminated if that is what we want. To modify any habit, we need commitment, but with persistence we will ultimately be successful!

Let’s start by identifying some common mental patterns and habits that may start off innocently but take on a life of their own and cause problems:

Common mental habits or patterns:

  • worry or rumination
  • problem solving orientation, including problems that haven’t occurred yet
  • wishing things were different
  • idealising others or yourself
  • needing to control how others see you
  • rigid or black and white dogmatic thinking
  • unexamined beliefs eg
    • believing things because you were told them as a child (introjects)
    • believing things because you wanted them to be true (magical thinking)
    • believing things because someone you liked or looked up to believed it
  • catastrophizing
  • automatic advice giving
  • allowing the mind to be busy all the time
  • avoidance eg spending excessive time in a fantasy world or day dreaming
  • harsh self-attack or self-criticism
  • perfectionism
  • fuzzy or magical thinking instead of clear thinking when faced with problems
  • justifying or defending habits that aren’t good for you!
  • other mental patterns or habits not listed above, that in some way cause pain, stuckness or distress to yourself or others.

Reflections:

Looking at the list of mental patterns, do any stand out for you?

What sort of commitment or small steps would it take to soften or change this pattern?

How long would you have to persist with new patterns for them to become established?

I would love to hear from you if you are trying to change habits or patterns now.

 

 

 

 

Co-Dependence and Addictions

In Codependence, relationship and life problems become worse over time.

These roles of victim, rescuer and persecutor are often caused by intergenerational trauma or unfairness. What holds these three roles together is denial. At some level, Persecutors have convinced themselves they are right to do what they do to the Victim and refuse to see their actions as abusive or manipulative. Victims wonder how they ‘always end up in this situation’ and feel both powerless and blameless. Rescuers tell themselves they ‘are just trying to help’ and are ‘good people’, when really they get to control by keeping Victims helpless or feeling needed. Davis and Frawley discovered that there is also a fourth position called the passive or neglectful bystander. All of these roles are interchangeable, and none of them are healthy.

To heal this relationship pattern, we need to practice doing the opposite of what we normally do.  The opposite of the destructive-fuelled by control, guilt and enmeshment, as in the co-dependence pattern above, toward a better way of loving that honours us and the people in our lives.

An honest look at the behaviour patterns we’re engaged in is often helpful. But don’t expect those around you to want to change the pattern even if you do! This pattern is often called the Drama Triangle!

Things to be curious about

  • When you were growing up, what sort of role did you play in the family?
  • What aspects of self-did you or others -have to deny, in order to play that role?
  • Do you still play the same role today, or have you adopted other roles?

To escape the co-dependence pattern I suggest that you start by learning positive skills and boundaries for yourself and others as illustrated below.Interdependence the solution for codependence

I hope this blog evokes curiosity and perhaps even a moment of clarity and self compassion. More help with changing patterns is available through CoDA or Al Anon, or via a trauma therapist on sites such as the Blue Knot Foundation or addiction therapy groups via organisations like Odyssey. 

 

 

The Aftermath of Trauma

The infographic below illustrates why healing trauma is not “one size fits all”. The aftermath of trauma can vary widely. In coming weeks I will explore each section and discuss a little of what is needed to heal each set of symptoms.

 

An Alternative Framework for Mental Health

For many years I wanted a better framework for best practice than the current bio-medical model which pathologizes symptoms of complex trauma as a “disease” and “biological” state-without evidence! Apart from the disrespect inherent in putting labels on people who have already suffered multiple adverse experiences, it doesn’t make sense that this reductionist way of supposedly helping people is often causing more harm, leading to ongoing Royal Commissions that never seem to address the underlying structural problems in mental health care.

In Australia, the structural problems – including professional “language” and treatment approach for mental health- are driven by the DSM- the Diagnostic and Statistical Manual, revised and produced every few years by the American Psychiatric Association.  Within DSM criteria, people with complex trauma are often misdiagnosed or given labels like borderline personality disorder, Bipolar disorder, depression, generalised anxiety disorder, causing many kinds of mistreatment and mismanagement (Benjamin, 2019)

DSM started as a valiant way to understand mental health issues, developed by  Americans who didn’t like the flowery language of the existing International Classification of Diseases (ICD). However since then it has been largely taken over by white, middle-class US psychiatrists closely aligned with big Pharma. Since the eighties, Big Pharma has been gradually expanding the range of conditions classified as “disorders” in order to sell more drugs (Moynihan, 2018)

Hospital/service funding and practice now follows from these un-validated and unreliable labels, implying that one just needs to tip the right chemical into a brain to “sweeten” it. Those that can’t be “sweetened” chemically are called “outliers” by the system, or stigmatised for being “treatment resistant”, treated harshly in EDs or discharged prematurely even though very unwell or at risk. Psychotherapy is considered only as a last resort. Some of these people become the homeless that wander our street, mistrustful of the very services they have earlier turned to for help.

International trauma experts like Dr. Bessel Van Der Kolk struggle to be heard over the vested interests who find profit and convenience in the current DSM system. Multiple inquiries into mental health over decades show this system is not working. Marginalised groups such as mental health consumers seem invisible to DSM oriented practitioners. It is faster, easier and more profitable to offer drugs like “Quietipine” (to quieten the patient), than to sit beside those who are suffering or try to understand trauma systemically.

A huge shortcoming of the DSM model is that it locates the problem solely in the person, and ignores the systems and environment that created the problem in the first place. As identified by the Division of Clinical Psychology (DCP) of the British Psychological Society:

“The DCP is of the view that it is timely and appropriate to affirm publicly that the current classification system as outlined in DSM and ICD, in respect of the functional psychiatric diagnoses, has significant conceptual and empirical limitations. Consequently, there is a need for a paradigm shift in relation to the experiences that these diagnoses refer to, towards a conceptual system not based on a “disease” model.” (DCP, 2013, p. 1)

Indeed, the DSM system is so low in research validity and reliability that two of the largest international research funding bodies have stopped allowing DSM criteria as the basis for medical research. However organisations that promote DSM are very powerful and influential, with deep pockets and ongoing political lobbying.

The Power Threat Meaning Framework developed by members of the British Psychological Society offers a new and compelling alternative to the DSM, that appears to have a more valid and ethical way of making sense of trauma symptoms without “labelling” of symptoms including mental distress, unusual experiences and problematic behaviour. It was developed over a five year period in the UK, by researchers who looked for an evidence base for best practice in working with trauma – supported by what we know from decades of research about the causes of trauma, which are often transgenerational and systemic.

Trauma is exacerbated by disrupted early attachments and imbalances of power and the inherent inequalities that lead to abuses of power and privilege. They assert that the many symptoms of trauma are simply a survival-based adaptation to the original situation, for example hypervigilance or dissociation originating from having to survive an unpredictable or unsafe environment. This view is shared by many international trauma experts including Bessel Van Der Kolk, Janina Fisher, Pat Ogden, Lou Cozolino and Judith Hermann.

Recently the Australian Childhood Foundation sponsored the author of the new framework to speak to professionals and consumers about this model. More information about this model can be found here in power threat meaning framework intro 2018, written by the authors of the study.

The authors

Sexual Abuse-Healing the Aftermath

Healing and the Aftermath

Sexual abuse creates long term problems for many people, which may not show up until years after the abuse. Abuse can be open or subtle, can be part of a “special relationship” or secrecy. The victim may be blamed by the abuser for the abuse, or worse, be told that this is “love” or that they somehow  “deserve” the abuse.

ABUSE IS NOT LOVE!

Ross and Halpern (2009) describe many of the effects of  childhood sexual abuse. Abuse impacts the development of the sexual and personal identity of the victim in profound ways, even if the survivor can’t remember the abuse at all. Common problems include a sense of discomfort with one’s femininity, masculinity or other orientations, being uncomfortable in one’s body, hypersexual or hyposexual behaviour, alteration in how a person dresses or grooms, sexual addictions, anxiety, depression, dissociation, or confusion around sexual orientation.

On the emotional level, there is often self -blame, self- doubt or self- attack. People wonder if there is “something wrong” with them (shame or guilt). There may be fear of sexual arousal or the content of sexual fantasies. People often question whether their fantasies or behaviors are normal. Others avoid sexuality and intimacy to protect themselves. Others may dissociate from their body altogether and become a “walking head” as a survival based response.

Adding to this, any form of sexual contact, even sexual thoughts, can trigger anxiety, guilt, shame or flashbacks of past abuse. This can be frightening and distressing for the person. The situation may also be distressing for their partner who may be the unwilling, and often unknowing, catalyst for flashbacks, and who may be cast in the role of the perpetrator. This puts painful strain on both people in the relationship.

Some people do not have flashbacks but instead experience a range of problems with arousal, orgasm, or have other difficulties with sex. Boundaries with others may be confused. Intimacy or connection become complicated. Some experience gender dysphoria or gender identity confusion. Others may be fused with their partner and find it difficult to say “no” or to be an individual, while others convince themselves they don’t need anyone. Trust is often be a major issue.

Miraculously, I have seen many people with symptoms of trauma like this make changes, even late in life, that transform and heal many of the problems above. The journey to healing can be slow, but hope is always possible. People experiencing any of the problems above should seek professional help, from a trauma specialist or the Blue Knot Foundation.

Adapted from: Ross and Halpern (2009) “Trauma model therapy, a treatment approach for trauma, dissociation and complex comorbidity”, TX:Manitou Communications Inc.

Toward Better Care in Mental Health

Patients who have experienced complex (childhood) trauma or C-PTSD are frequently stigmatized by healthcare institutions, and ignored, misdiagnosed or worse if they attend clinics or hospitals (Benjamin, 2019). The very services they turn to for help often to treat them with disregard, disrespect, or contempt, especially if there are self-harm or suicidal symptoms, potentially re-enacting or repeating the original trauma which was relational. Often, patients report being treated like wayward adolescents, ignored, disrespected or at worst rendered powerless. Like a client of mine who felt suicidal and sought admission to protect herself from her own impulses, but then was discharged from hospital abruptly when she attempted suicide on the ward, with no clear safety plan.

Patients are effectively silenced with strong medications, ECT or other treatments which lack substantive evidence base, such as admission to hospital for long periods of time which has been shown to decrease positive outcomes in complex trauma( Fisher et al, 2015). While working as a nurse in the past I have observed many patients arriving at the hospital with large plastic bags filled with medication on admission. Instead of asking “what happened to you” as we should, many health professionals only ask ” do you have any risks?” or “do you want some seroquel?” There is little understanding of the long term impact of adverse childhood experiences(ACEs), the effectiveness or ineffectiveness of medications, the importance of a collaborative approach, or even the neuroscience of trauma and attachment despite decades of research. 

There is even less recognition of the various dissociative conditions that accompany complex trauma, ranging from “structural dissociation” (Steele et al) to depersonalisation, derealization or DID. ( Kezelman & Stavropoulos, 2019)

Why is this? Well, one of the reasons is that the practice of medicine is supposed to be evidence based- that is- relying on scientific studies that are well designed and free from bias, to inform best practice. This means that as the science evolves, ways of treating conditions should evolve too. However, in Australia the Diagnostic and Statistical Manual (DSM) is a widely relied upon taxonomy of mental health conditions with descriptions. In the medical world, there is growing concern about DSM, and both national and international research funding bodies are no longer supporting research proposals linked to DSM criteria as they are not valid or reliable(Benjamin, 2019).

DSM categories and descriptions are simply based on the opinions of psychiatrists in the US, who do not always listen to the opinion of subject matter experts.  Concerningly, it has been reported in the BMJ and by many others that up to 75% of these contributors to the DSM are funded directly or indirectly by drug companies (Moynihan, 2015).  Further, the drug companies have a publication bias which ignores drug trials which don’t further their marketing of drugs! (Wampold et. al, 2013) Drugs may also be declared safe for long term use after a trial of only six weeks. The editor of the British Medical Journal resigned in protest at this publication bias some years ago, but as yet no government will curtail Big Pharma as they risk losing their substantial political donations. Moynihan points out that in 2015, drug companies sponsored 30,000 “education events”, and his research shows that drug companies are ever lowering thresholds for the definition of many diseases to sell more product, for example ADHD medication.

DSM classifications are widely used by government, health insurance funds, and health professionals to communicate information about patients. This framework favours medication as the promary and often only treatment recommended for many conditions that are in fact the sequelae of complex trauma.

Patients are stigmatised by labels like Borderline Personality Disorder, and this contributes to the problem of creating a health care system with appropriate care and treatment for people with complex trauma symptoms. The labels imply that the problem is caused by or located purely in the patient, instead of co-locating the problem within the family and societal system. Many concerned doctors such as Bessel Van Der Kolk have written about this distortion of the therapeutic lens, and Bessel has tried strenuously to influence the medical DSM panels in their description and understanding of trauma. However, the panels have so far rejected the evidence and maintain DSM categories which are pejorative and unhelpful for best practice in treatment of complex trauma.

Very few organisations have properly or even partially implemented the Guidelines for Trauma Sensitive and Trauma Informed Service Delivery published in 2012 by the Blue Knot Foundation ( Formerly ASCA ), and revised in 2019.

Also using drugs as first line treatment means that patients are never taught the skills and attitudes necessary to manage uncomfortable emotions like anxiety and depression, to manage flashbacks or panic attacks, or to deal with the shame, fragmentation and loneliness of their condition. Over time, they may become more dependent on medication and less self- trusting and self-resourcing.

Yet due to funding costs in hospitals and lack of real support for staff, many clinicians are under so much pressure that they can scarcely listen to, let alone respond to in a thoughtful, respectful and collaborative way, to the patients who are presenting for help. Literally, their stress levels are so high their brains are “off line” a lot of the time. This often creates a massive over-response to and focus on “risk” or “safety” rather than care, choice and collaboration.

To be fair, clinicians are generally taught little about complex trauma during their training, but there is such a negative response to symptoms such as self harm that much leadership, reform and education will be needed before mainstream services change (Benjamin, 2019). We also need to be aware of ethical boundaries that prescribe how organisations, governments and individual clinicians should best respond to outside attempts to influence, including gifts, overseas travel, education, wine, food, gratuities and other incentives from drug companies, and seek greater transparency in research on drugs with supposed efficacy. Some work has been done on this in Australia but not enough in my opinion.

In the meantime, those of us who work closely with individuals with complex trauma must do what we can to educate and inspire change, where possible in our professional networks or groups, in addition to educating our clients. This website is part of my desire to support change!

In the next blog, I will turn to what Clinicians can do to work more effectively with patients suffering from complex trauma.

 

Relationships that Work

Many of us want to have better, stronger or more connected relationships, but don’t know how to get there.

Dr. Stan Tatkin suggests that what we should be aiming for is secure functioning attachment. This means that the way the relationship works is to make each person feel more secure. We become more secure by building the trust and love between the couple into what he calls a “couple bubble”.

To do this, couples need to focus on what is best for the relationship rather than playing “me first” . Sometimes we need to step up and become the love we seek in others. Also, we need to be vulnerable and allow others to really see us. We may have to learn how to soothe and settle the other and ourselves at times. And perhaps give up addictions to technology and other “thirds” to become more present and available to each other. Sound scary?

Maybe. But as someone who has walked this path, I can say it is really worth it! Secure functioning attachment can heal the past and make the world a really beautiful, magical place. And if children are involved, it protects them and benefits them in so many ways!

I would love to hear from you about this.

 

 

 

 

 

Healing Traumatised Parts

Healing is not all sweetness and light; or rather, the road to getting there is can be fraught with tribulations, pain, rawness or anxiety, and injury worst of all -from ourselves. Most people have parts that want help, while other parts want to run away, fight the therapist or deny the issues.

When we look at the legacy of past complex experiences including surviving many different kinds of trauma or neglect, we see all the things we have carried to this point in our lives. Healing is not a simple process. We may need to heal different parts of us that feel anger, hurt, grief, issues related to addiction, relationship or intergenerational unfairness issues, disowning of parts of ourselves including the body, certain emotions or thoughts; faulty beliefs that feel true such as the belief that we do not deserve love or belonging.

Then there are patterns or habits to heal- especially those that make us refuse to accept-or even perceive- the reality of life, or make us  live a life based on fantasy, ideals, perfectionism, or the need to control ourselves or others.  These sorts of patterns also have a sneaky way of making us very self critical and hard on ourselves, or makes it hard to get over even small upsets.

Through many years of working with people who want to heal, I would say that learning to accept and love all the parts of ourselves is central to healing.  Yet often it seems that people surviving trauma have an unspoken agreement with themselves that they will be kinder to themselves and look after themselves better only when and if they are healed. Paradoxically people continue to mistreat or neglect, criticise, drive themselves too hard , exhaust or hurt themselves in other ways, doing the things they have always done, instead of doing the opposite- loving, accepting and honouring themselves.

The truth is, if we want healing, we  need to first address the old patterns of how we relate to different parts inside.  This requires first finding a calm state then learning to be mindful or cultivate a dual awareness of what is going on inside- to unblend with old patterns and procedural ways of being in the world.

Here is a worksheet I used for trauma group sessions a few years ago which participants found useful. It is adapted from the ideas of Babette Rothschild, Peter Levine, Kathy Steele, Janina Fisher and many others.

Finding a good trauma-informed therapist or group to belong to and practice these skills is really important. Usually a safe place or a safe state is needed. Since the trauma was caused by relationships, relationships of a better kind are needed to heal the trauma. Remember. healing trauma is possible.

 

 

 

Compassion as the Core of Healing

What is Compassion?

A simple definition of compassion: Deep awareness of the suffering of self or others, and the ability to be with that suffering, with profound acceptance, and without pushing it away, labelling it or judging it.

Here’s another:

According to Pema Chodron (a Buddhist nun), “When we practice compassion, we can expect to experience the fear of our pain. Compassion practice is daring. It involves learning to relax and allow ourselves to move gently toward what scares us”. 

Chodron teaches that we must be honest and forgiving about when and how we shut down. In compassion, we draw from the wholeness of our experience- our suffering and empathy, as well as our cruelty and terror. It has to be this way. Compassion is not a relationship between the healer and the wounded. It’s a relationship between equal parts of ourselves. Only when we know our own darkness can we be present with the darkness of others. Compassion becomes real when we recognise our shared humanity. 

Reflection: To know our own darkness, is to allow ourselves to know the truth that we are human, fragile or imperfect. Yet many people with complex past experiences struggle to be compassionate with themselves. There may be a very harsh inner critic or a persecutory part that is quite relentless. Do you have an inner critic? If so, what are the most common beliefs or statements from this part? Would your best friend agree with what this part is saying?

So how do we learn to be more compassionate? It helps if we break compassion down into a behaviour or an action, so that we can get to know it as an experience, rather than just an idea which we might get around to “some day”.  Think of compassion as an action word. What attitudes and behaviours would go with compassion, what does it look like in action? For example, being compassionate to yourself could mean:

  • listening to your body
  • learning to be present
  • accepting or allowing difficult emotions or pain calmly
  • learning to accept life on life’s terms if this is the best or only option
  • being honest and gentle with vulnerabilities
  • healing old patterns that are problematic
  • finding balance
  • allowing yourself to heal
  • slowing down
  • letting go of excessive shame or guilt
  • being humble and soft instead of arrogant or rigid
  • allowing your voice to be heard
  • putting boundaries on those who dishonour you
  • backing yourself instead of undermining yourself
  • communicating frequently with inner parts to soothe and settle the system
  • giving yourself and others kindness instead of harsh judgements/criticism
  • all of the above
  • other things not listed?

Looking at the list above, which aspects of compassion stand out the most and which ones do you long for ? I look forward to hearing your thoughts and ideas on this.