Archive | September 2014

The trials of trauma

32. Holding on when it hurts

weathering heartache

For medical doctors, trauma means any life-threatening physical condition, but the mental health definition is wider, interpreting trauma in the more classical theatrical sense of unusual events that would induce major stress in most people. When applied to real cases, this description is vague and doesn’t take into account variations in interpretations, individual sensitivity, resilience and other salient factors. Symptoms showing that trauma has set in include extended feelings of being overwhelmed, afraid and unable to function as before, sometimes to the point of immobility.

Draining behavioural sensations such as constriction, hyper-arousal and dissociation are commonly reported. Early trauma, according to many studies, can mutate into more sustained neurosis and psychosis if not checked in time. Judith Herman’s 1992 book, Trauma and Recovery, broke new ground by confronting social antecedents of personal trauma and charting recovery through six stages.

According to Peter Levine, energy failing to discharge from the nervous system as it does in wild animals escaping predators, leads to sustained tension, re-enactment, and re-victimisation in human beings. In his classic book on trauma, Healing The Tiger, Levine outlines how healing can occur by consciously re-directing unconscious physiological instincts, that have gone awry and got stuck, through a natural creative process that allows nervous-emotional self-regulation to be restored. The topic of post traumatic growth focuses on the character gains that can rebound to survivors after enduring terrible pain.

An increasing amount of theoretical attention is being paid to trauma pathways. Dr Anne De Prince and others associate re-victimisation with betrayal and an interpersonal cognitive schema resulting from, and subsequently attracting, harmful relationships. Recent reports suggest that hostile dispositions alone, such as racism, inflict trauma. So does combat.

Ahead of her time, Alice Miller demolished Freud’s dismissal of childhood traumas, and pioneered the championing of the child’s arduous battle against endless manipulations by parents, who are inexorably inclined to foist outstanding unmet needs on their offspring, impeding the child’s progress with a sense of self intact. “Experience has taught us that we have only one enduring weapon in our struggle against mental illness:  the emotional discovery and emotional acceptance of the truth in the individual and unique history of our childhood,” she said, in one of her best-selling books, The Drama Of The Gifted Child. Her work continues to be respected, while undergoing some criticism for row-backs, hypocrisy and re-assessment.

When someone is severely provoked, anger is a natural response, but there are good arguments to replace an urge to punish with non-violent transformation and understanding. This approach diverts the energy of destruction and can effect decisive change. Liz Roehmer, a long-time trauma researcher, co-wrote, The Mindful Way Through Anxiety. It outlines strategies to alleviate chronic worry states which sometimes feature in post-traumatic stress syndrome.

In Jon Kabat-Zinn’s blockbuster on mindfulness, Full Catastrophe Living, sections elaborate on various kinds of stress, anxiety, panic, emotional pain, and getting stuck in cycles of uncontrollable horrid reactivity. The clarifying healing power of the present moment, the only real time available to take in what’s going on, is promoted, instead of letting things happen on autopilot. Instructions on practices are set out in detail to help readers regain the energy to dance in the face of assured catastrophes likely to be encountered just by virtue of being alive; not only the big crises and losses but the little infuriating incidents, the weight of everything. It’s no small matter to keep going through daily uncertainties and disappointments.

In coming to grips with the difficulties though, there’s potential for growth and wisdom, especially, it is argued, if seven favourable attitudes are fostered: non-judging, patience, beginner’s mind, trust, non-striving, acceptance and letting go. With improved insights into the effects of post-traumatic stress, many different tactics have been tried and tested to help people lighten the baggage that usually trails in the after-tow. Knowing what’s available, after prevailing through the worst of the unwelcome maelstrom, is the first step in selecting the best option to safely reach the far side.


Emotional messages

31. Courage to accept feelings

Soothe the mood

The definition of emotion has not advanced much in aeons beyond perception and evaluation of bodily sensations, either reactively or as more enduring sentiment. When preliminary thought in the form of attention comes to bear on feeling, emotion, conscious or unconscious, results, as discussed in Keith Oatley’s book, Emotions: A Brief History. As signals they both guide the behaviour of the one having them, and reveal something to watching eyes. Understanding them happens in this space of interaction. They are integral to self-image and to community, and scholars are now flocking to study their multiple aspects and come up with new hypotheses. Charles Darwin and Paul Ekman had prominently and consistently linked emotions to facial expressions, although the conclusion of universality still justly attracts scientific challenge.

To handle and apply emotions effectively, at least in contemporary Western culture, developing the five qualities of self-awareness, self-regulation, internal motivation, empathy and social skills, has been proposed by Daniel Goleman, who popularised the idea of emotional intelligence. Thought combines with emotion to create attitudes on which action decisions are based. This sequence as governor of much behaviour is why so much time is devoted to tuning into body and mind. Accepting whatever comes up without holding or rejecting, but clearly observing and letting pass, inviting all-over joy, is the practice. The fickleness of feelings, their relative aspect, is one of the first things usually noted, and conditions for happiness are often rediscovered in what was resented or ignored. Raphael Cushnir offers a similar primer.

While the body-scan included in mindfulness programmes acts as a physical check-in, it can also double as a means of alerting to emotions arising, noticing whether they’re pleasant, unpleasant or neutral. They can spur to destructive or wholesome deeds. Tracing the root nature of habits and circumstances using physiological and psychological messages from deliberating on feelings, side by side with knowledge,  empowers the practitioner to modify actions as appropriate. Calmly breathing, feelings, that constitute parts of the self, are befriended and not repressed, leaving to insights, wider comprehensions and equanimity, one of the Four Immeasurable Minds advocated in Buddhism.

The defining tone of a personality, a dominating mood, can be caused by an accumulation of past occurrences drawing more on one often negative emotion that doesn’t get to be resolved but stays unconsciously stored. Triggers of that emotion during similar incidents are likely to set off the combined bad internal experiences felt before, forming a chronic reactive pattern. As prolonged painful emotional traits are associated with mental and physical illnesses, releasing repressed emotion is important. There are different ways of doing this. Psychoanalysis can take decades; counselling , years; and brief interventions, like Timeline Therapy, Emotionally Focussed Therapy, Neuro-Linguistic Programming, Hypnosis, memory re-consolidation techniques and others, days or weeks to bring about useful change, ideally when done with a qualified practitioner.

This is how anchors, negative or positive stimuli, work, by persistently evoking a compulsive emotional response. An example is Thich Nhat Hanh’s Pebble for your Pocket exercise. Instead of being controlled by their arbitrary development and influence on behaviour, the state management approach involves cultivating the skill of producing constructive moods on demand, through a simple physical gesture, most commonly by joining thumb and little finger together while inhaling sharply. Anchoring is quick and easy to learn, and depends on strength of feeling, timing of gesture and repetition. Instead of remaining bogged down in despondency, gradually building up inner resourceful with such cues creates stepping-stones to recovery and a stable emotional life which is one of the best foundations for dealing with fate’s surprises.

The plague of depression

30. When the cloud is heavy,

change tack

Depression has often been described as anger turned inwards. It’s also viewed as a hiding place to go when things become unbearable, just as animals retreat into dark quiet corners when they’re weakened. Some sadness after a loss or traumatic event is normal; when it doesn’t lessen, intervention to prevent it getting worse is timely. This state, when prolonged, can monopolise thinking and energy, and drain emotional and physical resources needed to recover from existing hardship.

Suppression of deep dark secrets, such as those scandalous back-stories leaked from time to time about famous people, can strain the unconscious mind where they are stored away, frozen as lived unless processed. Powerful unresolved feelings can block recovery and ease, perpetrating disproportionate levels of horror dating back to the precipitating incident(s).

An internet search reveals how common it is for depression to concern people. At least 10-15% of populations in the Western world are diagnosed with it, a huge increase over recent decades, forecast only to rise further.  Endless check-lists of symptoms and help-tips can be retrieved at the click of a button, prior to face-to-face professional confirmation. Visitors are urged to talk, with a therapist or friend. This works well half the time, but often words feed or compound the problem, or services aren’t available or affordable or therapeutic. Along with mainstream offerings, there are other options.

Tackling depression with its negative effect on the immune system, is essential one way or the other to prevent debility and slippage in quality of life. Depression is frequently triggered by internal conversations and habitual internal questions, often self-critical,  which in turn consist significantly of remembered external remarks. There are methods to re-adjust these but first, relax because as Nietzsche and others have observed, it’s hard to be sane in a world where madness is the norm!

Quitting obsession with the other’s need to defeat in order to defeat them is the starting point to enter the game of non-zero-sum winning. Paul Watzlawick enlarges on this and other ways people contribute to their own psychic misery in his witty book, The Situation Is Hopeless But Not Serious. But when children are taught in school, at home and everywhere they look, to win above all, who can blame them/us? Better to create a new space to look at the world differently and begin to draw happiness from more reliable sources. Many guides in circulation, such as From Sad To Glad, are worth consulting.

Constantly judging and feeling judged to highest standards sends joy fleeing. Research confirms that perfectionism predisposes to depression. Always trying to do everything 100% right is often more stressful than adaptive. “The sage never strives for greatness and thereby has the ability to achieve great things,” states the Tao Te Ching. Doing jobs that involve intimidation and constant pressure to perform make pacing down very difficult without risking a confrontation, but when health and peace of mind are at stake, maybe it’s time for a change anyway.

Likewise with close relationships when they are more destructive than supportive. A popular well-regarded manual on shifting depression using mindfulness techniques by Mark Williams and three co-writers, is suitably entitled The Mindful Way Through Depression. Review the basics, of nutrition, exercise, hydration, sleep, and revise where necessary, as they profoundly influence mood. No matter what degree of help is required though, don’t be left alone looking into the abyss. Start here and now, try what’s already known, and ask people until something works to make the mood lift, as it does.

The question of suicide

29. ‘The story is old

but it goes on’

Suicide is regularly on the radar of anyone who socialises and consumes the media. It occurs and disturbs. Sometimes disturbing is its main purpose, as it was for the Vietnamese buddhist monk self-immolating in the picture, sacrificing himself to draw the world’s attention to the need for peace-keeping efforts in that country, in an act historically linked to public protest. Mass suicides that happened in Germany in 1945 were attributed to the public defeat of the the country and of its leaders.

Such contagion has been observed enough to earn a title of its own: the Werther Effect. This is not surprising, for issues brought to attention are what enter the mind. The trend is also mentioned in Gary Lachman’s study of literary suicides, Dead Letters, which received good reviews for its comprehensive and cautious treatment of famous casualties, both of writers and of the characters they created. The last section contains excerpts from relevant writings, such as Lord Byron’s quote that “I should, many a good day, have blown my brains out, but for the recollection that it would have given pleasure to my mother-in-law…”! G.K. Chesterton’s similarly-themed poem, A Ballade of Suicide, is also there, printed in full.

Others would argue that to be alive and possess a consciousness is to ask the question which is best: to be or not to be. Albert Camus, whose existential preoccupations in part inspired humanistic approaches in psychology, claimed that “there is only one truly serious philosophical problem, and that is suicide”. A more detached consideration of suicide recognises many different circumstances and causes as opposed to a universally negative view of it.  Social authorities have even encouraged it as the most honourable thing to do in certain situations, such as when spies or military personnel are cornered, which makes for drama.

While feeling bad frequently makes sense following terrible experience, especially when no end seems yet to be in sight, the problem with looking at suicide as a solution is that it eliminates all chances of improvement or accommodation. The true story of the kidnapping of teacher, Brian Keenan, in Beirut where he was held in harsh conditions for five years, is recounted in his book, An Evil Cradling . After suffering much he was finally freed and was ultimately able to put it all in context and even feel compassion for his capturers. Different gratitude practices are recommended to help overcome disappointment too, with the idea being that not only can something to be thankful for be found in any situation, but when a past horror is re-framed, it can often be transformed into a redemptive strength.

When trust, resources, or health has been shattered, start with the basics. A certain amount of effort will probably be needed to be prepared to enjoy anything again. The lucky ones have access to kind understanding people whose presences offer reviving and illuminating support, because the wrong words or attitudes can only make things seem worse. When safe sharing’s possible, try it; ‘giorraíonn beirt bóthar’ (two shorten the road)Whoever can breathe, drink, eat, move and sense life, though, has already got the basic conditions to receive some pleasure, moment to moment, from the immediate environment.

“Sometimes your joy is the source of your smile, but sometimes your smile can be the source of your joy.” So states Thich Nhat Hanh, who addresses how to handle difficult feelings. By tenderly nursing the injured self, a taste for living returns. It can take a while, though sometimes conundrums resolve amazingly quickly.

Life’s eternal dance with death

28. Being and non-being go together

No life without death

In the last post, Thich Nhat Hanh’s interpretation of the Satipatthana Sutta, the text on which mindful meditation most directly originates, in part concentrates unflinchingly at the processes of death and decay of the human being in its entirety. The ubiquity of death is a tenet of the First Noble Truth. The human ability to realise the pain and eventual degeneration inherent in the life span naturally arouses fear and sadness. Learning to accept such loss with more equanimity can make it easier to endure these passages and even mean valuing the precious ephemeral qualities of existence more than ever.

In No Death, No Fear, Thich Nhat Hanh explains comfortingly that life and death are only ideas, something that can be intuited with a calmer perspective. He teaches that there is no coming or going, that we all keep leaving and returning at source, that our eternal inter-connection is what liberates us from the terror of annihilation.

A Plum Village lyric conveys the freedom of letting be in the present moment:  No coming, no going, no after, no before./ I hold you close to me./ I release you to be so free./ Because I am in you and you are in me,/ because I am in you and you are in me.

Sogyal Rinpoche’s Tibetan Book of Living and Dying showed the world how traditions differ in preparing for and understanding dying. Another possibly more accessible yet pure interpretation of those customs, deriving from the older Tibetan Book Of The Dead  won acclaim for its author, scholar and teacher, Bob Thurman, in his Liberation Upon Hearing In The InBetween .

Such approaches have been extensively explored in the West but are far from routinely incorporated in any form as yet. Coming into prominence in the late 60s, Dr Elizabeth Kubler-Ross appeared as the go-to guru for grief and dying, especially with her book, On Death And Dying, which offers insights into the social and emotional experience of dying. She painted the stages in more familiar terms, in one of the first major attempts to comprehend the agonies often bound up in bereavement, and she stressed how much the dying can teach those left behind. Not everyone agrees; James Green expands the scope towards uniqueness and variety of deaths. Christian rituals continue and bring their own relief. The Rules and Exercises of Holy Dying, written by Jeremy Taylor as far back as the 1600’s, outlining soul cleansing during life and a memorial service for a loved one, is a parallel guide to those already mentioned.

In the book, The Top Five Regrets Of The Dying, Australian palliative care nurse, Bonnie Ware, wrote about the primary concerns that emerge when awaiting death. People wished they’d allowed themselves to be happier, to express their feelings, and to keep in more regular touch with their friends. Even more people regretted wasting their lives working so hard, but the top regret was about lacking authenticity, having too much regard for others’ perceived opinions and expectations instead of being true to themselves. Considering the countless beings who have existed and passed away, the odds of just being alive for however long is somewhat miraculous.

“Death,” by Rainer Maria Rilke

Before us great Death stands
Our fate held close within his quiet hands.
When with proud joy we lift Life’s red wine
To drink deep of the mystic shining cup
And ecstasy through all our being leaps—
Death bows his head and weeps.

For more sublime and oddly refreshing meditations on the inevitable experience of death,  try the large menu spread on offer at the blog, Death Deconstructed .

Access the right knowledge

27. Homework required.

Time to wise up

Sourcing balanced accurate pertinent information isn’t always as easy as it sounds. Not alone is the self-help market glutted, but doctors, dentists, therapists and other health care operators have become more competitive and market-driven. Business ploys including advertising for clients and devising more treatment products have become par for the course, as if, in many instances, continuing where the snake-oil salesmen left off.

Interviewing chosen professionals politely at the first appointment to gauge trustworthiness and competence is a good idea, while bearing in mind personal recommendations, qualifications and other desired qualities. Instead of hype, you want them more interested in your well-being than in their gain from you. At the same time, take extra responsibility on one’s own behalf for researching whatever the threat is. Get active, seeking out treatment adjuncts and options proven to be relatively safe and effective. Carers frequently do the same, acting as advocates for friends and family.

What follows is a tiny sample of useful resources accessed after weighing up several alternatives discovered while investing hours in data trawls. Whenever symptoms give cause for concern and/or for a consultation, it’s worth taking the trouble to retreat and study about the particular dilemma being faced. This reduces the strangeness of the development being worried about, and improves cooperation and communication with professional helpers, putting interactions on a more equal footing. Many genuine references have already been furnished throughout earlier blog posts for, After A Terrible Time.

Using a very immediate example, easy-to-follow targeted yoga exercises were sought, to practise and obtain relief from the common skeleton-stiffening effects of writing and sitting at the computer. Deepak Chopra calls sitting ‘the new epidemic’ and makes further great recommendations to alleviate adverse effects.

For those who suffer from hay fever, sinusitis, asthma and other forms of nasal congestion, the Buteyko breathing programme taught by Patrick McKeown in his books, including, Close Your Mouth, has helped people.

There’s an endless supply of how-to books about all kinds of exercise, for example 15-Minute Pilates invalidating any excuse of ignorance. Live classes and active associations are generally accessible almost anywhere in the world now.

The onset of arthritis concerns many people and Dr Mark Wiley’s empowering book, Arthritis Reversed, is worth a look, while where osteoporosis is concerned, Gillian Swanson’s book, The Myth of Osteoporosis, is recommended.

A significant inspiration for this blog came from two books written by Sean Collins and Rhoda Draper, Tipping the Scales and The Key Model, which set out to equip those dealing with serious illness to tap into their own healing resources.

Thich Nhat Hanh quotes Buddhist texts in his book, Transformation and Healing, suggesting that mindfulness methods have providential application in all cases of hard knocks to mind and body, an approach born with the enunciation of the following building-blocks of practice so long ago

– “I heard these words of the Buddha one time when he was living at Kammassadharma, a market town of the Kuru people. The Buddha addressed the bhikkhus, “O bhikkhus.”
And the bhikkhus replied,“Venerable Lord.”
The Buddha said, “Bhikkhus, there is a most wonderful way to help living beings realize purification, overcome directly grief and sorrow, end pain and anxiety, travel the right path,and realize nirvana. This way is the Four Establishments of Mindfulness.
“What are the Four Establishments?”
1.“Bhikkhus, a practitioner remains established in the observation of the body in the body, diligent, with clear understanding, mindful, having abandoned every craving and every distaste for this life.
2.“He remains established in the observation of the feelings in the feelings, diligent, with clear understanding, mindful, having abandoned every craving and every distaste for this life.
3.“He remains established in the observation of the mind in the mind, diligent, with clear understanding, mindful, having abandoned every craving and every distaste for this life.
4.“He remains established in the observation of the objects of mind in the objects of mind, diligent, with clear understanding, mindful, having abandoned every craving and every distaste for this life.“‘

Free therapies

26. Helping faith along

after the healer

When invested with concentration, many ordinary everyday activities have significant effects for better or worse. Already the merit of a good diet, regular exercise, sleep and other basics has been flagged. Because everyone has only a certain amount of time, undertakings subscribed to need to be prioritised. This might involve cutting out, or down on, some activities and beginning, or doing more of, others. Expectations of spouses, children, parents, bosses, teachers and others can pose the toughest pressures to deal with when making changes necessary to create the new preferred way of life. Whether any sacrifices, with possible related confrontations, are worthwhile is up to each person to judge for themselves – it just could, however, be what tips the scales in the direction of regaining a vital sense of self.

Though often taken for granted, the strange joyous release channeled through laughter is easy to induce by seeking out more material, like videos, books, and situations  the individual finds funny, while avoiding the negative. Two very well-known accounts of healing by laughter come from doctors. Robin Williams starred as Patch Adams in a film telling the story of this doctor who doubles as a clown to deliver a type of healing he insists is as important as the medical kind. Norman Cousins wrote a book called Anatomy Of An Illness  detailing a critical illness he argues was mainly cured by prodigious efforts he made to keep himself as amused as possible while undergoing medical treatment. It may seem like a tall order to be asked to laugh after going through a terrible time, but it’s worth trying when ready. Those who carry out demanding jobs often develop what’s been called gallows humour: making the best of a bad situation, empathising with the victim’s plight.

The act of laughing causes helpful biochemical reactions in the body and counterbalances depression, stress and helplessness – all aspects of trauma. The number and actions of helper-T and natural killer cells, and salivary immunoglobulin A (IgA) increase, while baseline adrenalin and serum cortisol levels, and the inflammation response, fall; all reassuring indications of a robust immune system. Humour can reverse feelings of loneliness, anger, anxiety and discomfort that inevitably show up during a stressful event, such as hospitalisation, job loss  or divorce. When the mind perceives and processes humour it converts it into behaviour to cause a beneficial physiological reaction.

Such a trivial gesture so easily under-estimated but packed with such nourishing power! Similar opportunities can be exploited once it is understood that having health is about doing healthy things. This is partly captured in the counter-intuitive idea of hormesis , which somewhat resembles homeopathy, concerning the odd beneficial effect of limited exposure to irritants in the environment.

It could be argued that journalling achieves this indirectly as people relive and confess experiences and thoughts on the page. The Pennebaker Process, named after Dr James Pennebaker, who studied how expressing feelings has a measurable boosting effect on immune function, has been widely studied and has yielded consistently impressive results. Writing a journal alters coping for the better with feelings of neutral acceptance gradually overtaking strong negative ones through insights gained in the process. Instructions entail writing, for twenty to thirty minutes on five consecutive days a week in a quiet place without interruptions, about significant lifetime events, especially secret ones, and related themes, distinguishing facts and emotions, then and now. Though people may actually feel worse at first, bad feelings usually dramatically lift after persevering for a bit.

Many other routine tasks can be adapted like this to advantage. Meditation pauses, communication refinements and others will be returned to later.