Shirah Vollmer MD

The Musings of Dr. Vollmer

Trauma

Posted by Dr. Vollmer on July 17, 2015

 

Trauma, a word that is hard to define, in a mental health sense, and yet it appears to be at the root of many mental health issues. The problem with understanding trauma is that the environmental impact varies enormously based on the person’s biology. We return to the gene/environment interface. Genes load the gun, environment pulls the trigger, so to speak. Trauma, broadly speaking, is the upsetting experience, which the average person never has. Trauma, in other words, implies a major diversion from our basic assumptions. Losing a child is traumatic because in this day and age, we assume that parents will die before their children. A reversal of this order leads us to think that the heartbreak is enormous, and yet generations ago, losing a child was a predictable event in that many children did not survive to adulthood. So, trauma is contextual. The child who loses his mother when he is four, may experience a trauma, but at the same time, if that child is raised by a loving father, and perhaps a loving step-mother, then the child may not experience a traumatic loss, but rather a more “ordinary” sense of loss. On the other hand, if we let the patient define the trauma, then do we say that if the patient says that he had tonsillitis at age 6 and had his tonsils removed, then do we yield to him that this was the “traumatic” moment in his life, which now explains his job and marital difficulties. There are therapies which focus on “trauma” without a consistent definition of “trauma” making the therapy less rigorous, in one sense, and yet appealing, in another. The focus on trauma as an explanation for self-sabotaging behavior, lends itself to the reductionist notion that if the therapist and patient can “work through” the trauma, then the subsequent substance abuse and mood problems will resolve. Once again, I return to my thesis. If we can agree that trauma is a complex notion, shouldn’t we also agree that the treatment of trauma is also complex, and not amenable to limited duration cookbook kinds of treatment?

Clint, twenty-two, comes to mind. His mother committed suicide when he was five, on the fourth of July, “ruining my summer,” as he said with dark humor. His father re-married to a woman which Clint says “is OK”. After graduating high school, Clint has lived a life of homelessness and drug abuse. “Do you think that you would not have your current life if your mom did not kill herself?” I ask, wondering if he connects his current despairing life to the tragic death of his mom, sixteen years ago. “How would I ever know that, ” he says instantly, followed by, “probably, that is true.” He says, with tears in his eyes, and then mine too. “I never had anyone that was passionate about me and my development, and I think that really hurt,” Clint says with surprising candor. Suddenly, Clint has come to life for me. He is not the “homeless guy with a drug problem,” as he appears from the exterior, but rather, he is a little boy who really really misses his mom. Clint needs to feel valuable and important, a process which will take mentorship, and a deep therapeutic relationship. Losing his mom was traumatic, but the end result, put into the context of his life, was a deep feeling of worthlessness and hopelessness. Clint needs housing. He needs to live a sober life. Clint needs to feel loved. Short-term treatment is likely to reinforce his sense of hopelessness, as it will create another abandonment, the worst, most anti-therapeutic outcome. The theme, again, is constant. Complex problems require complex solutions. There is no way around that.

 

9 Responses to “Trauma”

  1. Ashana M said

    I agree that it is a complex problem. I don’t agree that Clint needs to feel or think anything in particular now in order to get better–I don’t think he needs to feel loved now unless he is loved now. Most childhood trauma occurs within the context of parents who were unable to parent effectively. Parents either have a decision-making problem or they have an empathy problem, and so their children have no one to help them learn how to process their own emotions or to make decisions. The children experience traumatic events without those emotional and decision-making skills and i think it’s that lack of skills that mostly creates other problems in adulthood. In the process of “working through” the trauma, people learn those skills–or they can. If they don’t, nothing in their lives really improves regardless of what is happening in therapy.

  2. Eleanor said

    I’d like to add a few thoughts (or maybe a bit more than a “few” 🙂 on this topic from my personal experiences. The idea of the combination of trauma (and as mentioned, this is so complex and difficult to define), our biology (ie: inborn “personality characteristics” and genetic history), our environment (ie: nature vs nurture…early parent child all too human struggles and difficulties) all come into play in regard to how trauma and it’s effects play out in our lives.

    I”m going to give a plug here for the psychoanalytic method (as usual) because in my case, as a young mother hit with the birth of my daughter..my second child….with the unexpected severe and complex birth defect of Spina Bifida (open spine), I went from a stable healthly adult who really had no idea what real anxiety was, to one with (at times) severe overwhelming mental symptoms. My “genetic gun” had fired… My daughter, a few hours old, premature at 33 weeks was whisked away with my husband via Air Force jet to Texas Children’s Hospital in Houston for emergency surgery, before I saw her or held her. And so my life of frequent traumas had begun. My daughter, by age 9 had 12 surgical procedures, 8 of those major, and a few were classified as emergency. Needless to say, this was only part of the whole picture as children with spina bifida face unbelievable medical challenges. More traumas. As mentioned, my inherited genetics gets turned on big time during this time in my life and some problematic early life experiences also came into play in a huge way tho I didn’t realize that until I got into analysis and realized how everything gets “woven and enmeshed together” present and past, and must be untangled through the analytic process.

    I can visualize someone like me going in for “counseling”…maybe the CBT type or similar. Many therapists would have seen my real life current traumas which could be overwhelming, and treated me only for that. Fortunately both my daughter and I eventually found our way into our own separate psychiatrist/psychoanalysts offices and the real long term therapeutic work began. It didn’t take my analyst long to pick up that my difficulties not only lay with the present but also some early life challenges in addition to inherited genetics from my mothers side of my family. Suffice it to say that over the next 10 years, despite ongoing major medical/emotional struggles my daughter and I made slow but amazing progress. My daughter was in college, and without warning, died from an Epileptic seizure one night in her college dorm during sleep (which is when her seizures occasionally would happen and she would sleep through them). This time once again with this sudden trauma my genetics reared it’s ugly head and this time I had some severe PTSD symptoms and my analyst referred me to his office colleague, a psychiatrist/psychopharmacologist, for about 2 years of meds to give me time to analytically work through the horrendous loss with reasonable sanity.

    I make all these points because I found that my responses to traumas had a lot to do with not only the specific trauma at the time but my genetics and also early childhood problematic experiences along with my own inborn personality characteristics. I can visualize to this day the words my psychopharmacologist said pointedly on my initial consultation….”you have some very bad genes!”. My analyst’s take was a bit milder….and his words were… “well most of us have some bad genes of one kind or another and we do the best we can with the genes we were dealt”……Both points are valid…genes can be very bad news, but we do the best we can with what we’ve got. Sorry this is so lengthly, but to me this blog post brings up important points….thanks Shirah.

    • Very interesting and moving, Eleanor. Your details in how trauma brought up latent issues and how the latent issues interfered with your ability to cope with the traumatic experiences brings this dynamic to life. Had you not had a daughter with spina bifida, parts of your personality might have remained unknown to you. The good news about your “lousy genes” is that they gave you a springboard to explore your inner world, with all of its’ many dark rooms. Thanks again for chiming in.

      • Eleanor said

        Shirah, if you haven’t checked the latest posting on the American Psychoanalytic Facebook page today, there is an excellent article entitled “Psychiatry’s Identity Crisis”. New York Times. Worth a read but it’s basically a lot of what you’ve been ranting about….the disappearing value of psychotherapy by psychiatrists.

  3. Shelly said

    What do you think would have happened to Clint if he had had therapy right away, at age 5? Would the perspective on his future have been different? And can you say a bit about the nurture part–how his home environment with his “ok” step-mother had an impact on his life? For with the diagram with this blog, you basically make very dire predictions about anyone who has undergone trauma at an early age. Where is the hope, which you so fervently write about, in general?

    • The timing of childhood psychotherapy is difficult to say, and impossible to be definite about. I think that if Clint had started therapy at 5, then it is possible that he would have felt the strong advocacy of his therapist and although a very far replacement from his mom, he could have built self-esteem from knowing that he had someone who was consistently and intensely on his side. By contrast, his mother’s abandonment, led him to a deep feeling of insecurity which he could never shake. Given that each child is different, there are children, like Clint, for example, who depend on having that strong passionate mother to remind him of his value and worth in the world. The “OK step-mom” did not hurt him, but nor did she provide the feeling that he was a special child who could make a significant difference in the world. The point of this post is to articulate that a mom’s passion for her child is very hard to replace, and for some kids, this absence could be very damaging psychologically. As for early childhood trauma causing life-long problems, I think this is a possible outcome, but again, my hope is writing these posts is that knowing the potential hazard of life-long scars, then we, as a society, need to support giving traumatized children a lot of high quality mental health care. The issue that we face today is that most psychotherapeutic interventions are superficial, and as such, deny the depth of despair caused by loss and sudden life changes. Thanks.

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