Post-Traumatic Stress Disorder

– by Lee Smith, Ph.D.

Take a deep breath…

The profoundly dirty secret came out recently that upwards of 1000 U.S. Veterans attempt suicide every month. Post-Traumatic Stress Disorder (PTSD) and inadequate help are frequently a part of their misery. This tidy label, PTSD, references the horrendous human burden and infinite complication caused by witnessing and suffering the worst depravities on the surface of our planet – not only in war but at home, school, work.

The forms of trauma are as varied as life itself, including natural disasters through to interpersonal assaults. Physical, sexual, emotional and verbal abuse, accidents and injury, sudden loss, bullying, harassment, betrayal, rape, genocide, terrorism, war – it’s quite a list. Age, severity, frequency, history and variety of traumatic exposure, and interpersonal complexities all matter. Falling down the stairs is far more traumatic if you were pushed. Some victims marinade in abuse.

And much more happens psychologically in the injury from trauma than some recording of the event itself. The fact is, trauma may lead to a whole range of adjustment problems affecting our behaviour, emotions, thinking, relationships, physical health and life-course. Because everything is always unique about trauma, in that each unique person with their own unique history experiences some unique trauma in their own unique way, the impacts are personal and highly variable. Nonetheless, there do exist general similarities across sufferers.

The tidy list of PTSD symptoms includes (a) unwanted memories of the trauma popping up anytime, (b) our bodies leaping into stress reactions and living lodged in emergency mode, and (c) avoiding anything that might cause (a) or (b) to happen, including our own memories. And life is clouded with uneasiness, all the time. Even when the mind is asleep traumatic memories commandeer our dreaming and physiology. Trauma can relocate your mind and body to a world of felt threat, emergency and despair.

Our recall of our life is most typically an uncomplicated thing. Watch as you answer this: What did you have for breakfast this morning? You’ll probably notice that you had a feeling of recalling, and that what you recalled included images and details about which you could talk for some time. These kinds of autobiographical memories are also tagged by the mind-brain with a sense of person, place and time. No one could convince you that that breakfast actually happened yesterday or at some other location.

In contrast, emotional or traumatic memories are felt and relived more than recalled.

Let’s imagine taking a veteran of, say, the Vietnam war with us for a summer hike in Algonquin Park. What might our friend experience and do? He might just freak out in response to the dense foliage, the lack of sight lines, the felt sense of mortal vulnerability from possible traps on the trail and threats in the greenery. The experienced threat doesn’t match the ‘real’ risks in the park, but instead reflect the emotional memories that flood in from another time and place, inappropriately.

Unhealed trauma means that the mental tags for place and time are unborn. The neurobiological underpinnings of healing ultimately place trauma in our past, to great relief.

Healing trauma is complicated in part because of the immediate bind between undesirable alternatives. It is our tendency to avoid unpleasant things, which include terrifying memories. I like the metaphor of dealing with slivers. Avoidance, just leaving the slivers (horrible memories) in your arm alone and wrapping them up in dressings (avoiding any reminders), perhaps with some nice local anaesthetic like xylocaine (beer, doobies), gives immediate relief. After a while of one-armed living, punctuated by explosions of pain should the slivers get bumped (reminded), life lectures us that the only wise course is to have the slivers out (to face the memories).

Our incredibly associative mind-brain is a medium for the subtlest of triggers for traumatic memories, jumpy-startle and threat-based anger. Every moment can be seen through a lens of dread, with the threat feeling as real as real can get. And it’s so subtle and so unconscious.

Trauma victims may be touched by literally hundreds of thoughts and things each day that prick a memory, sending the mind spinning, the body bolting and life to the crapper.

I was recently talking with a Veteran of many tours, including Bosnia, and his wife about PTSD and these qualities of emotional memory. His wife then connected how he was unduly upset by his present-day neighbour’s unkempt lawn with the once mentioned threat of hidden landmines on tour. Bingo! When our mind connects these dots, relief follows because the connections are now seen, their origins located in time and subject to management.

Unfortunately, we don’t have any anaesthetics for emotional pain. Skillful courage and skillful support and skillful help to face and open up to past trauma are the right ingredients to heal trauma’s injuries. Talk about easier said than done! But suicide and the many other forms of avoidance are not the way.

Cycle of Badness

– by Lee Smith, Ph.D.

How do we become psychologically troubled? Oh, let me count the ways…

For some of us the seeds of our most harmful and simultaneously puzzling behaviours were sewn so long ago that it makes sense that we may not now clearly see how we got here.

As a general example, let’s suppose that as a little one, doing the things that a little one does, we’re scolded by an overly stressed parent, perhaps even a young parent who is still rather unresolved about his or her own life. What if we hear, “What the hell’s wrong with you!”, or “You just make me sick”, or “You stupid brat”. And we hear some number of those judgments with some frequency, because an unresolved parent may be unresolved for years. Being overwhelmed and bursting out with angry verbal smacks is a regrettable and unintended pattern that a stressed parent may have.

As little people we internalize the things we hear. If these big people tell me I’m bad, then, ouch, I must be bad. As the negativity continues the message of badness is strengthened, conditioning deeper feelings. A growing mind also explores this badness, a self-protective curiosity that helps with learning about the conditions and contingencies of badness.

In time a young one may do bad little things to see what happens, testing their standing in their relationships. It might unfold that ‘bad behaviour’ is met with some greater frequency of more or different scolding, with neglect or with surprising understanding, making the mystery more complex and more important to explore.

Our ‘badness’ becomes something that we begin to participate in, born of our essential emotional curiosity, and a dynamic cycle spills forward. With more negativity, withdrawal or resentment and anger become the roommates of the question about our badness and whether we’re loveable. Being ‘bad’ may look rebellious, but it’s often a litmus test, with the ‘proof’ of how loveable we are residing with the one(s) who does the judging. Kids and teens may so test and do scary things secretly. Some number of those secret things may be discovered and the judgment cycle creaks forward again.

If the pain and question about our badness remains unresolved and is carried forward into our teens and young adulthood, we may find that we’re still doing bad things like drinking, taking drugs, skipping responsibilities, having random sex, vandalizing. Seeking acceptance by peers gains even greater importance, as if they have the power to give us value. Independence and dependence, acceptance and rejection, good and bad, self-determination and helplessness, now and then – borrowing from Cormac McCarthy, if this isn’t a mess it’ll do until a mess gets here.

Lots of research shows that when we have been mistreated as kids we are much more vulnerable to developing substance, psychological, physical and social problems later. Also, because most ‘bad things’ can provide ‘good feelings’ from their direct effects or from temporarily decreasing stress, ‘bad things’ can become a life-feature, a habit.

We hopefully reach the point in our development where we are able to look at our life and ‘discover’ our own responsibility for what happens to us next. When we see that we have been carrying the question and exploration of our badness and of being judged forward, we realize at last that we have different options. “Ah, I’m hurting myself here! If I do something that’s bad for me, of course dad/mom/teacher/boss will disapprove. It’s really about me doing something bad to myself.”

That one’s life is up to oneself is a pivotal developmental epiphany.

Help From Einstein

– by Lee Smith, Ph.D.

Einstein was not simply a physicist. He offered wisdom for all seasons of life and existence. At one time the whole world looked to him for guidance, like an oracle. He said that his genius was to look in to things deeply and to see with an uncommon clarity untethered to what we think we know. Let’s have an annotated look at some of his wise equations to get some ideas about searching our own life’s dark matter.

“A man should look for what is, and not for what he thinks should be.” Women too! The difference between looking and thinking is the wisdom here. We can get quite caught up in thinking that things are a certain way because our own thinking seductively feels true. Thinking is undoubtedly a powerful and transformative ability, but we can get hijacked by it. A partial inventory of problematic types of thinking includes thinking that is self-critical, catastrophic, magical and superstitious, irrational, anxious, prejudiced, delusional, counterfactual, dysfunctional, ruminative and dogmatic. Instead, if we can remember to just stop and look and accept things as they are, we’re then better set up to work with what’s true. Lotteries would disappear.

“We cannot solve our problems with the same thinking we used when we created them.” Most disputes with a loved one are not resolved by more disputing. Usually what breaks a dispute is one person shifting and softening in some compassionate way, suddenly seeing the other person instead of clinging to their own rigid view. Thinking can keep us from foraging elsewhere. Recall that anxiety (future thinking) and depression (negative thinking) are epidemic.

“Insanity is doing the same thing over and over again and expecting different results.” Thanks for the diagnosis, Albert! Sometimes we think and think and think, going to absurd lengths to try to divine what someone is going to do or why they said a certain thing. And we keep on thinking, unsettled that we don’t know. Maybe if we realize that it’s true that we can’t know now, we can stress a little less.

“It has become appallingly obvious that our technology has exceeded our humanity.” If that was true in his time, what about today? Technology is now substantially managing our occupational, financial, social and emotional life. The tail might be wagging the dog.

“Everything that can be counted does not necessarily count; everything that counts cannot necessarily be counted.” This one feels like a big bag of groceries, a candy store. It recalls the sorry bumper sticker, “He who dies with the most toys wins.” What matters may not be what we expect, and what we expect may not be what matters. Opening up to look at your life as it actually is, with curiosity and interest, lets you tap in to intuition, feeling and a personal knowing that offers better guidance than any rational accounting of your life.

“Everything should be as simple as it is, but not simpler.” We should be careful with fast fixes, pat answers (sorry to all Pats out there) and prescriptive advice. Oprah knows that weight loss is more complicated than any advice that her show can package.

“One may say the eternal mystery of the world is its comprehensibility.” This is perhaps one of the most optimistic insights of all time. Somehow this universe gave rise to us and to our capacity to know this universe and ourselves. When your life seems incomprehensible, please know that it only seems that way. It might be that, by stopping and looking and accepting things just as they are, it gets a little clearer. When we “Ah ha!” we’re suddenly seeing something that’s true, and a little of the dark matter becomes instead something that we comfortably know.

Working on Mental Health

– by Lee Smith, Ph.D.

Okay, it’s time to do another survey.

“Hands up – who has a mind?” Hmmm, I thought so – everyone believes that they have a mind. “Okay, and now who among you has ever received any guidance or orientation or training in what it means to have a mind and how to work with it?”

When I ask a group this question there’s often a unanimous sense that we have never ever been taught or shown what having a mind is all about or how to work with our mind. These questions bring up a realization that there’s been this little bitty oversight by our culture – school offers sex-ed but no mind-ed. Actually, there seems to be a cultural taboo against knowing our feelings and against working on our mental health.

So, do you think it would make a difference? Do we need to? Do we want to?

On the latter question, it would seem that we’re awash in self-help books, shows and health gurus. These might be cultural indicators that there exists some prevalent condition and that people are hungry for guidance.

We also seem to be flush with psychopharmaceuticals that promise to do the job of adjusting our minds for us. Indeed, pharmaco-genetics is an emerging area of research attempting to develop antidepressants that are tailor-made to suit individual genetic variations.

But what if you prefer to DIY? Wouldn’t it be great to drop in to Mind Depot where they say, “You can do it, we can help?”

Given that mind and mental health embrace the working and content of our emotions, thoughts, perceptions, memory, behaviour and physical reactions, it’s a broad area that doesn’t lend itself to quick, fast-food remedy: “Ya, I’ll have a Big Insight, hold the Irony, a side of Wisdom and some Contentment, please.”

Our society doesn’t have a lot of difficulty with the idea, if not the practice, that getting into better physical condition takes work and dedication and time. Four weeks of effort is just a beginning. We accept the truism that a neglected body is more likely to be an unhealthier body, vulnerable to break down. The development of skills also entails repetitive work. To become adept at guitar or you name it, we have to arrange to practice, working patiently as little gains are earned.

There’s good reason to suggest that mental health is essentially similar. Neuroscience is effectively showing us that repeating some healthy (or unhealthy) activity over and over changes the brain tissue that mediates that activity. Want to like yourself better? Want to manage your anger or your depressive thinking?

Research shows that our abilities to hold and regulate emotion, heal trauma, and to pay attention are complexly rooted in a neurobiology that can be strengthened like a bicep. It might be that wisdom, intuition and compassion are skills that can be strengthened.

What might it be like to exercise the capacities of mind to see your mind and, really, to see your life, just as it is? What might it be like to learn to respect and listen to your emotion, rather than to avoid it?

Improving mental and physical health takes intention, practice and dedication. And mental health training takes courage, the emotional equivalent of resistance training, pushing against our massive tendency to avoid discomfort. Mental health won’t magically improve. Our relationships take work, our parenting takes work, loving ourselves takes work. If ‘being a good person’ is living in a way that reflects your deepest values, your potentials, your compassion, your heart, then that’s the work.

What Causes Depression and Anxiety?

– by Lee Smith, Ph.D.

What causes depression and anxiety? Many notions have seeped into our collective understanding about how we come to be depressed or anxious. The most common and deceptively simple idea is that these problems result from a chemical imbalance in the brain. Big Pharma promotes this idea so that we might flock to their products to gain relief from our misery, which we often do.

More sensibly for me, the current and promising state of our understanding of the development of depression and anxiety identifies the chronic experience of powerlessness, defeat and entrapment as a prime culprit.

Lots of evidence shows that animals respond physiologically and behaviourally in ways that look a lot like stress, depression and anxiety particularly when social standing is lost. This response is understood to be an adaptive way of dealing with being an underling. A subordinate monkey or wolf is in real danger of death if it signals any challenge to its dominant counterpart. Evolved ways of unplugging from being a threat to a bigger baboon are life-saving. The evidence is that social mammals have evolved wired-in defeat systems.

But when powerlessness becomes a constant in life, these defeat systems get jammed on (hello stress system!), actually causing emotional and physical illness.

How we human animals may come to feel powerless follows from many familiar and persisting external and internal conditions.

Intractable problems at your job, chronic pain and health problems, relationship and financial burdens, bullying and harassment, and so many other conditions can collapse hope.

Also, our consumer culture breathes life into defeat through all of the many unrelenting messages that imply that we aren’t rich enough, successful enough or good-enough looking – we can’t get no satisfaction! These chronic reminders are all around us, fuelling our wanting brain, and poke deeper insecurities about how we “should” be.

Internally, we may be very caught up in grim habitual ways of seeing and thinking about ourselves. Punishing messages and abuse during childhood and later traumatic events can unconsciously script our internal self-narrative in adulthood. Unresolved early abusive relationships make it more likely that we’ll feel and behave with similar powerlessness in our dealings in the adult world. It’s a subtle quality of mind, but a very powerful one.

Feeling and thinking chronically that we’re unworthy or inadequate are internal conditions that feel uncontrollable, unremitting and inescapable. Perpetually feeling trapped and defeated is a fundamental way in which depression and anxiety arise. And bad coping just keeps us stuck in additional ways and compounds our hopelessness.

It then follows that seeing your life as it actually and presently is can be incredibly liberating, and dissolves the conditions that support emotional problems. Wanting and cherishing what you already have and distinguishing between needs and truly empty wants turns media buy-in to something sadly funny instead of controlling. Seeing our actual situation at work and at home, instead of seeing the view we get stuck in, can reveal empowering options and alternatives.

Coming to terms with past abuse and loss reveals those old self-views to be unfortunate relics that are without present validity.

Strengthening our ability to be mindful enables a clear look at our life just as it is, a look that includes those parts of our life and mind that create the illusion of entrapment and defeat. It’s no wonder that mindfulness is being found to be a powerful approach to relieve anxiety and depression.

Mental health is a tough undertaking. We feel a huge inhibition to talk openly about these aspects of life. The shame we hold leads to a hushed privacy, a deep reluctance to face our life and mind and to explore them with the interest and tenacity and delight that they deserve and require.