When presenting lectures on trauma to patients I often state, “there is no zip code that is immune from tragic experiences.” I work
with patients who have suffered trauma and present with resulting symptoms of addictions, mood disorders, post traumatic stress disorder and more. I define trauma as an overwhelming emotional experience wherein one has a real or perceived threat to their life and safety and/or the life and safety of another. I further will explain how threat of life and safety is experienced differently across the developmental years; as what may seem life threatening to a 7-year-old may not to an adult. This however does not negate the 7-year-old child’s experience of being traumatized.
In my professional life, I have listened to stories of traumatic experiences for decades and yet I never cease to marvel at the tenacity, courage, and resolve of so many who have suffered so much. In my personal life whether friends, family, colleagues or others- I have seen the scars of trauma. I too have experienced traumatic events over the course of my lifetime. The most disorienting and excruciating experience in my life though was losing a child. I lost my 16-year-old daughter in a car accident one July morning 11 years ago. It was sudden, it was instant, it was violent, and receiving the news from a sheriff while at work that morning was all of those and more. I remember just days before her death telling her “if something ever happened to you I would die.” Something did happen, and I didn’t die. There are some days I am still stunned that I am here.
I was well into my career as an addiction and trauma specialist yet very little of my knowledge helped me in those early years of indescribable loss. Over the years, before and after this tragedy, I have researched complex trauma, betrayal trauma, traumatic grief, resilience, perseverance amidst adversity, PTSD, and other markers explaining why one individual develops PTSD symptoms and another does not. I have pondered the meaning of suffering in the context of religion, spirituality, existentialism, and questioned if human suffering is the only true catalyst for understanding our life’s’ purpose. I do not have all the answers by any stretch but continue to seek and share what I learn with others.
The word “suffering” is derived from the Latin word “sufferentia” which is translated to mean endurance. The dictionary definition is “the bearing or undergoing of pain, distress, or injury.” Humanity experiences “pain, distress, and injury.” Suffering is part of the human condition. In our culture, suffering has a negative connotation, as in general, we seldom focus on the potential that spiritual and psychic growth suffering can provide us, but rather are compelled to find ways to avoid the experience and circumvent as much psychological and physical pain as possible. We know how this desire to numb can lead to addiction and other unhealthy compensatory behaviors to avoid the walk in the pain. Resistance to distress is a normal response to frightening and abnormal experiences. An initial seeking of relief is a normal response to traumatic exposure and although many will develop PTSD, there are many who experience unspeakable adversity who do not develop long term PTSD.
The DSM V differentiates criteria for PTSD for children 6 years old and younger. In short, the manual defines PTSD based on exposure to a traumatic event, having one or more intrusive symptoms such as nightmares, flashbacks, hyper vigilance, and intrusive memories, avoidance of external reminders of the trauma, decreased ability to regulate mood and negative cognitions for at least one month in duration. We have known for decades that those who do not develop PTSD after experiencing trauma(s) have some ability to make sense out of what happened to them and did not feel complete and utter helplessness at the time of the event. These individuals generally live void of any negative self-cognitions relevant to the experience (s). Self-cognitions are beliefs we hold about ourselves as human beings. Individuals who tend to struggle more to move forward in health will often report negative self-cognitions such as “I am stupid, I am weak, I am a failure, I am unlovable, I am a bad person, I am unworthy, I am incapable, I am untrustworthy” and so on. Many trauma survivors I have seen in treatment and private practice report these destructive beliefs, and despite years of distancing them from the event, there seems to be no erosion of the cognitions.
For a parent who has lost a child, no matter the circumstances, most hold themselves responsible and carry guilt and/or shame. This
can be further exacerbated by interpersonal factors if the parent is stigmatized or shunned, or has the belief this will happen. If the child’s death involved suicide, drugs and/or alcohol, or a car accident, many parents fear reaction from others who might judge our parenting. The traumatic shame that can develop after such a loss adds another layer of pernicious symptomology that does not simply go away over time. Time is a measure of moments passing. It is not a healer.
An emerging area of research is the study of metacognition
Metacognition refers to one’s own personal interpretation of one’s own thoughts. It is also defined as our self-awareness of our thoughts. An example of metacognition is while on a conference call as one speaker engages in monologue; another participant suddenly becomes aware of not having heard the last 5 minutes of the communication. The awareness can then assist this participant in trying to maintain concentration. In this instance, metacognition is helpful. What about our metacognition though after experiencing a traumatic event? Just as our self-cognitions can be damaging, so can our metacognitions. Metacognition differs from a self-cognition as the latter is a belief about one’s self as a human being, whereas metacognition is a resulting belief about what action is needed to feel better, be better, and ultimately to stay safe in the world. So, what kind of metacognitions can result following a traumatic event that might be maladaptive? Some examples include after losing a loved one isolating due to a belief that if I don’t get close to people, I won’t have to suffer like this again, or, after a physical accident or assault, believing I need to be hyper alert and worry more about my safety to keep this from ever happening again. This latter belief can result in a sustained over active amygdala if the trauma repair is to consciously attach to a PTSD symptom. To clarify, taking on the belief that constant worry and state of alert would result in keeping the brain and body in a state of perceived threat. This would exacerbate any PTSD symptoms. Using the PTSD symptom of hypervigilance in this case only serves to keep an individual in a constant state of stress.
To further explain, an adult who is assaulted while walking in a dangerous neighborhood, despite having been harmed, may be able to make some sense of the experience due to the location and do so without self-blame. If this individual also was able to run away and fight the level of helplessness experienced at the time of the attack, it may not be significant. Someone else walking in the same neighborhood that lives there and knows the perpetrators and was unable to flee or fight will struggle to make sense of the assault and the degree of helplessness will be more profound. The second individual will more likely experience PTSD symptoms than the first. The second individual may develop the self-cognition of “I am stupid”or “I am weak.” A metacognition for this individual might be “I should never relax” or “I need to always be prepared for the worst.” From here a tendency towards catastrophizing the future could present.
There are many recent studies on resilience. Resilience is defined as “the ability to rise above difficult situations”. Several studies conducted in Australia concluded that resilience comes from having been exposed to risk and adversity and successfully negotiating these events, thus, building self-reliance and confidence. Other studies demonstrated that having resilience modeled for us by a parent or other attachment figure strengthens our ability to access this survival trait. Studies have focused on psychological factors influencing resilience and most recently on physiological health. All provide valuable information about the connection between resilience and secure attachment. Those who experienced safety and consistent support in childhood are more prone to strong cognitive ability and problem solving strength, develop good social support systems, personality traits such as a sense of humor, healthy selfconcepts/cognitions, and ability to regulate emotional responses.
The research on physiological health and resilience is pertinent today as longevity has increased and healthcare is becoming integrated. “Evidence of chronic health issues affecting mood, and the relationship between post-traumatic stress disorder, anxiety, and negative health outcomes, strengthen the hypothesis of a link between positive health and resilience.
Current research is also examining the relationship between BDNF (brain-derived neurotropic factor) and resilience. BDNF is a protein in the brain’s nerve cells that support brain function by building brain cells and helping them to grow, as well as encouraging the growth of new neurons. BDNF improves neuron function and protects them against cell death. Studies are beginning to link low levels of BDNF with less propensity for emotional and mental resilience. This protein also promotes effective learning. It falls to reason therefore, if our levels are low, we may not quickly develop optimal coping abilities post trauma despite having resilience modeled for us. Scientists have determined that exercise can induce BDNF expression but the full physiological impact of this remains unclear and more detailed studies are required.
We already know that exercise produces benefits that enhance learning and memory as well as reducing depressive symptoms.
Research in 2013 demonstrated that individuals deemed resilient were better able to cope with serious health issues. It was also discovered that the individuals deemed resilient engaged in regular exercise, were nutritionally conscious, and reported sleeping well for a solid seven to nine hours a night.
So how do we harness resilience, positive self-cognitions, and healthy metacognitions to provide our children and grandchildren with optimal knowledge and experiences to support them moving through adverse, stressful situations? Knowing that no one has immunity from traumatic events, I propose further challenging the stigma of mental health issues; which includes addiction, by incorporating our significant discoveries from neuroscience into school curriculums’, parenting classes, medical practices, hospitals and as responsible clinicians we go into our communities and teach and share what we know.
When I lost my daughter, I had worked with a few bereaved parents that were patients in treatment, but I did not know anyone well who had experienced this with the exception of my mother, who lost my brother, and my grandmother who lost her son. Both of these women were deceased however when my child died. Despite their absence, I returned to memories of these two profoundly influential women in my life and also thought deeply of my deceased father and how he managed after my brother was killed in an accident.
Within a year after my loss I came to know many bereaved parents and today I continue my journey providing support for newly bereaved mothers. I am not fixed or healed. I have not had an epiphany that provided a sudden insight into how losing my child made sense. My innate response from the beginning was to focus on why not me as
opposed to why me, why her, why our family? What I did find was that I had the power to choose what I thought about me as a parent and as another hurting human on the earth. I had the power to choose my thoughts and develop beliefs that I consciously chose to not exacerbate my painful state. I knew we all have access to a buffet of thoughts we can choose from at any given moment. It only made sense to me therefore to select the least painful thought from the buffet to be able to keep on. This knowledge gave me a tiny bit of movement from feeling completely helpless. The tiniest bit of relief from indescribable emotional hurt and pain can actually be enormous as it breeds hope.
I have hope today and that hope is that in at least some small way I have modeled some resilience for my son and future generations. I have hope for the amazing people that touch my life everyday with their strength and courage as they call upon me for help on their journeys of living despite indescribable pain. I am blessed and I am grateful.
My hope for those of us working with addiction and trauma and other mental health issues is that we continue to unite in positivity and increase the sharing of our wealth of knowledge with our communities and each other for the better of not only our lives but those of future generations. As we continue to learn more about the way memory works and how our thoughts and beliefs and experiences influence our ability to rise above the trauma, my hope is that we begin to see a reduction in addiction and other mental health issues. Rising above does not mean we forget what happened or that we get over it. Expecting someone to “just forget about it” or “get over it” is irrational and unkind. Rising above means we engage our innate tools to help us maintain and thrive despite adversity. It means that we access the courage to feel the pain and allow it to be experienced fully in our bodies and then move forward in life as best we can as the way out of our pain is through.
Nancy Jarrell O’Donnell specializes in addiction and trauma treatment. She has spent most of her 25-year career working in residential and in-patient facilities. Her experience ranges from Psychotherapist to Clinical Director to President of Clinical Services/Operations. She is a licensed therapist in Arizona currently in private practice. She developed The Sabino Model: Neuroscience Based Addiction and Trauma Treatment™