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Posts tagged ‘Trauma Recovery’

Aug 6

Behind the Mask

Facing the Truth Behind the Mask

“Recovery is about living more in truth than in lies… it’s about facing reality and growing up.”

 –  Pia Mellody

 Over 2,500 years ago, in Athens Greece, playwrights like Sophocles introduced a form of theatrical art known as the tragedy.  Greek tragedies typically dealt with weighty themes such as betrayal, loss, pride, jealousy, rage, love, courage, honor, life and death.  Often these dance-dramas also explored man’s relationship with God and the existential challenges that are part the human condition.  Actors wore elaborate masks with exaggerated facial expressions so that their character’s role, emotional state, and intentions might be accessible to the audience.  Commonly, one actor played several characters during the course of the theatrical performance, changing masks for each character and sometimes for each scene.

Fast-forward to our lives today and the Greek tragedy might be used as a metaphor for some of the key aspects of recovery from trauma and addiction.  Like an actor in a play, often we are reacting to life’s existential challenges according to a script.  This script can influence how we move about on the stage of life; it can spell out our roles in relation to others, how we think and feel, and how we act in various situations.  From the first moments of conception and throughout development, by way of ongoing interactions between ourselves, others, and the environment, this narrative is written into our psychobiology – it becomes an implicit script in the mind-body system.

Moreover, similar to actors in Greek tragedies, our implicit scripts encourage the use of certain masks or personas.  In many ways, this is completely natural and necessary for a life in which we play many different roles.  For most of us, the scenes on life’s stage are constantly changing; we may transition from a family mask to a work mask, then to a friend mask, and back to a family mask, all within the course of one day.  However, unlike the actors in a Greek tragedy, for us these personas are not distinct, separate people – they are aspects of a single being, linked together by the person behind the masks.

For some of us, our own life resembles a Greek tragedy, with painful experiences of betrayal, loss, abandonment, and trauma.  These experiences are written into the mind-body script that tacitly flavors our thoughts, feelings, and behavior.  Some of these life events can be so traumatic that we don’t even want to look at the script – we would rather not face the reality of our situation, it’s just too painful.  Yet, our bodies and minds still play the part, even when we don’t pay attention to the script; something happens on the stage of life and we just react according to our past experiences, maybe without even being aware of the script. Read more

Apr 17

The Twists and Turns of Recovery Treatment – A Case History

In my third year of medical school, I was mentored by a brilliant surgeon who routinely pontificated about the virtues of his profession, with clear intent to dissuade me from entering psychiatry.  On one such occasion, he disrupted my tense and halting approach at a long abdominal incision with the question: “Do you know what makes a surgeon great?”  I looked up from the patient’s pale, still body – scalpel still poised.  “It’s not the suturing; you can teach any monkey how to sew.”  (That didn’t boost my fledgling surgical confidence.)  He went on to say, “When you open someone up, it rarely looks like the textbook.  It’s messy, unpredictable.  Great surgeons effectively respond to each new situation as it arises… they adapt.”

Although this gifted surgeon didn’t dissuade me from the practice of psychiatry, I was persuaded to believe that effective treatment of the body and the mind requires an ability to adapt to each new situation as it arises.  Most people enter The Meadows with some idea of their underlying problems and what they want to accomplish in treatment.  However, as people give themselves to the recovery process, often the mental and emotional landscape changes in unpredictable ways, presenting new challenges and new opportunities for healing and growth.  The following case history highlights the dynamic unfolding of one patient’s experience at The Meadows and some of the treatment modalities that were adaptively employed on the patient’s behalf. Read more

Feb 10

Allowing the Unbreakable to Bloom from Broken Trauma Defenses

Long before I was a psychiatrist, I worked at a golf course rummaging through thorny shrubbery and dense pockets of oak trees to find golf balls that had strayed from their masters.  As an eight-year-old boy, this hardly seemed like work – it was more like a treasure hunting adventure, complete with the threat of poison ivy and villainous snakes.  After a couple of cycles in the ball-cleaner, a relatively unscathed Titleist could fetch a dime, and a bucket of similar balls could finance an extravagant trip to the candy store.

Occasionally I would come across a ball that looked as though it had been mauled by a wild animal (or, more likely, a large lawnmower); the ball’s hard shell filleted open, allowing the mangled elastics to protrude through the untidy gash.  Such a ball had no monetary value at the time – but these many years later, the image of the ruptured golf ball has become a meaningful metaphor in my work with individuals who have experienced trauma.

For humans, trauma can take a myriad of forms, yet the immediate response is surprisingly predictable.  Like most animals, trauma in humans evokes an automatic and primitive instinct to survive.  The traumatic stress response has little need for logic or reason, but instead relies on the unconscious reflexes of fight, flight and freeze.  Therefore, out of necessity, the tender and vulnerable aspects of trauma are often swallowed up and pushed away.  Survival is the goal. Read more