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.
Susan, as I will call her, was a 32 year-old, single, female from Denver, Colorado who was referred to The Meadows by her outpatient therapist. She initially reported symptoms of anxiety and depression that had contributed to significant problems in her close relationships and work performance as a financial consultant. She identified pervasive feelings of uneasiness and tension, with debilitating spikes of episodic panic and fear. Also, she noticed that her self-confidence was very low and that she was uncharacteristically tearful, emotional, and sad. After discussing her condition at length with her psychiatrist at The Meadows, they both agreed to explore the symptoms further before deciding if a medication was necessary.
Forming relationships of trust with peers and providers allowed Susan to acknowledge that her symptoms of depression and anxiety were partially related to worsening addictive behaviors with alcohol, food, and sex. She admitted to a life-long struggle with binge eating, excessive dieting, and shame about her body. She also shared that, after ending a ten-year, co-dependent romantic relationship in the months prior to admission, she immediately turned to compulsive sexual encounters via phone, internet, and night clubs. With the help of her outpatient therapist, she was able to reduce her sexual acting-out, but she then turned to excessive and reckless use of alcohol. Her life had become unmanageable.
In response to this additional information, Susan was reevaluated by the medical doctor to monitor and treat any symptoms of alcohol withdrawal. She spoke with the dietician so that the treatment team could better understand the nature of her disordered eating patterns and could help her establish an eating and wellness plan. In collaboration with her primary therapist, Susan set clear limits on her use of communication devices and her interactions with fellow peers, so that she could effectively address her compulsive tendency to rely on unhealthy relationships. Susan was also encouraged to attend 12-step meetings and to make use of important mind-body activities, such as yoga, tai chi, and meditation.
Although Susan had acknowledged a history of sexual trauma during the intake process, she was unsure of its significance in her life. Starting in the second week of treatment, she participated in a unique five-day experiential form of therapy that specifically addresses childhood trauma and early family relations. For the first time in her life, she began to see how her mother's tragic death at six-years-old led to years of depression and social-withdrawal on the part of her father. She was able to see herself as a scared and lonely child who tried not to worry her already distraught father, even when she was molested by the babysitter at nine-years-old. She discovered that during those lonely years, food was a trusted ally, but by the time she reached her teen-age years, food had become the enemy and she was at war with her own body.
As Susan's second week of treatment came to an end, years of shame, anger, and self-hatred gave way to profound sadness and grief. Long-held defenses began to relax, and as a result, she touched into another source of pain and sorrow connected to a date-rape in her early twenties that resulted in miscarriage. With guidance from peers and providers, she realized that this additional trauma and loss had contributed to soaring alcohol use and plummeting self-worth. In response to Susan's evolving treatment needs, she was offered several visits with an individual therapist trained in Somatic Experiencing to specifically address her adult trauma-related symptoms. Also, her focused work in 12-step recovery during the third week became more meaningful as she explored further the links between her past trauma and her addictive behaviors.
As a result of many lectures and hands-on practice regarding interpersonal communication and boundaries, Susan felt prepared to engage in family therapy with her father and two sisters during the fourth week of treatment. Relying on the inner-child work from her second week, she was able to talk openly with her family about the bewilderment and loneliness she felt after her mother's death. For the first time in her life, she shared the deep emotional pain associated with her experiences of sexual trauma, her ten-year, unhealthy relationship, and her addictive behaviors. Susan's family members responded with concern, but also with an outpouring of love and acceptance. Together, she and her family received information and practical tools to move forward in a way that could support Susan's recovery and a healthier family system.
As Susan entered her fifth week of treatment, she was invited to participate in a special grief workshop to specifically address lingering feelings of loss and pain regarding her mother's death and her miscarriage. Also, after weekly meetings with her psychiatrist about her particular condition and possible treatment options, she decided to start a medication for symptoms of depression. Several discussions with her providers, discharge coordinators, family, and outpatient therapist resulted in an aftercare plan that fit her therapeutic needs. Susan finished her treatment with a new lease on life - ready to face old challenges and embrace new opportunities.
Of course, there are additional elements of The Meadows' treatment program that are not discussed here and not everyone's experience is like Susan's... but that is the whole point; the human psyche rarely conforms to overly-simplistic, textbook universals and treatment often unfolds in unpredictable and complex ways. As my mentor suggested, this requires that treatment professionals recognize and adaptively respond to situations as they arise. This means that providers must have the appropriate training and therapeutic techniques to effectively respond to the dynamically changing landscape of each person's recovery process. The Meadows has a proven track-record of providing this kind of treatment.
Free Lecture Series - Dallas, Texas - June 21, 2011
Daniel Gowan, M.Div, LCDC, LPC-S, will be speaking at the Dallas Free Lecture on Tuesday, June 21, 2011, at the Unity church of Dallas, Sanctuary, 6525 Forest Lane, Dallas, TX 75230 from 7:00-8:30 pm.
The title of the presentation is "Boundaries: THE Building Block of Relationships".
You will understand how to engage your boundaries to equip you to begin to enjoy healthier relationships and learn tools to help you grow. When all else fails, use natural consequence to reinforce the boundary! In this presentation you will learn two types of boundaries, to understand how typical communication confuses these boundaries and how to improve the process. You will also learn the characteristics of natural consequences used to maintain healthy boundaries.
If you have questions, please contact Texas Community Relations Representative, Betty Ewing Dicken, at
800-892-7799 or email@example.com.
Note: This article was originally published in the Summer 2004 edition of Cutting Edge, the online newsletter of The Meadows.
We Are All Neighbors
By Peter A. Levine, PhD.
What has happened to our world? Why this large-scale killing, maiming and torture as human populations increase in number and complexity - and as their access to Ethernet information grows each year, seemingly in inverse proportion to their compassion? Even when competing for their most basic resources - food and territory - animals typically do not kill members of their own species. Why do we?
While there are many theories of war, post-traumatic stress is one root cause not widely acknowledged, even though it is the single most important instigator of the perverse cruelty of modern warfare. Mankind's history of war, xenophobia and genocide has generated a legacy of trauma-induced dysfunction fundamentally no different from that experienced by individuals, except in its scale. There remains, however, an enormously important question: Can recovery from trauma be replicated on a larger, societal scale, with similar healing effects? At The Meadows, this has become our living promise.
Let us review what happens when a person is traumatized. First, his internal system remains aroused; he is always on edge, unable to relax or tune down. He is constantly aware of a pervading sense of danger, suspicious of everything and everyone. Not knowing why he feels threatened, this fear and reactivity escalate. This, in turn, amplifies the need to identify the source of the threat. Propelled by a tremendous terror and rage lurking just beneath the surface, he is unconsciously driven into re-enactments to help regulate the ongoing escalation of arousal.
Imagine now an entire population of people with a similar post-traumatic history. In fact, imagine two such populations located in the same geographical region, perhaps with different languages, religions and traditions. What will happen? Croatian civilians are sawed in half by Serbian soldiers. Atrocities are committed, in turn, by Croatian troops. Dozens of truces are called, and each time the result is the same: The urge to kill and destroy takes over, and insanity once again prevails. The Serbs and Croats have been repeating their violent patterns as virtual instant replays of World Wars I and II. Middle Eastern nations can readily trace their wars to Biblical times. Even when wars do not repeat with the kind of ferocity and brutality seen regularly around the globe, suffering in the form of societal dislocation, child abuse and other forms of hatred will. There is no avoiding the traumatic aftermath of war; it reaches into every segment of society.
Transforming Cultural Trauma
Trauma is an inherent part of the primitive biology that brought us here, biology which cannot be changed without completely redesigning us, down to our very cells. To release ourselves from reenacting our traumatic legacy, both individually and as a society, we must transform it. We can do so only by addressing the problem at its roots: in our physiology.
Several years ago, Dr. James Prescott, then at the National Institute of Mental Health, engaged in some important anthropological research on the effects of infant and child rearing practices on the prevalence (and absence) of violence in aboriginal societies. He found that the societies in which child rearing was characterized by close physical bonding and stimulation through rhythmical movement had low incidences of violence. Conversely, the societies with diminished or punitive physical contact with their children showed clear tendencies toward violence in the forms of war, rape and torture.
As we know from the studies of Dr. Prescott and others, the time around birth and infancy is a critical period. It is then that the infant associates the states of its parents with basic security and ability to regulate arousal. When parents are traumatized, they have difficulty imprinting their young with this sense of basic trust and resource. And without this sense of trust, children are more vulnerable to later trauma. One solution to breaking the cycle of cultural trauma is to involve infants and their mothers in an experience that generates trust and bonding before the child has completely assimilated the parents' anxious state.
In Scandinavia, I am involved in some exciting work inspired by my Norwegian colleagues. This project uses what we know about this critical period around infancy to allow not just one individual, but an entire group of people, to begin transforming the trauma of their past encounters. This method of bringing people together requires a room, a few simple musical instruments and some blankets strong enough to hold a baby's weight.
The process works as follows: A group of mothers and infants from opposing factions are brought together at a home or community center. The encounter begins with this heterogeneous group of mothers and infants taking turns teaching one another simple folk songs of their respective cultures. Holding their babies, the mothers dance while they sing the songs to their children. A facilitator uses simple instruments to enhance the rhythm in the songs. The movement, rhythm and use of voice in song strengthen the neurological patterns that produce peaceful alertness and receptivity. As a result, the stuckness and fixation produced by generations of strife begin to soften.
At first, the children are perplexed by the events, but they soon become interested and involved. They are enthusiastic about the rattles, drums and tambourines the facilitator passes to them. When not provided with rhythmic stimulation, children of this age do little more than try to fit such objects into their mouths. In this situation, however, the children join in generating the rhythm, with great delight, squealing and cooing.
Because these infants are not blank slates, but highly developed organisms even at birth, they send signals that activate their mothers' deepest senses of serenity, responsiveness and biological competence.
In this healthy exchange, the mothers and their young engage in an exchange of mutually gratifying physiological responses that, in turn, generate feelings of security and pleasure. It is here that the cycle of traumatic damage begins to unravel.
The transformation continues as the mothers place their babies on the floor and allow them to explore. Like luminous magnets, the babies gleefully move toward each other, overcoming barriers of shyness as the mothers quietly support their exploration from a circle around them. The joy and mutual connection generated by their small adventure is difficult to describe or imagine - it must be witnessed.
The group then continues, with smaller groups of a mother and infant from each culture working together. Two mothers swing their infants gently in a blanket. These babies aren't just happy; they are completely blissful. They generate a roomful of love so contagious that soon the mothers are smiling and bonding with members of a community they earlier feared and distrusted. The mothers leave with renewed hearts and spirits they are eager to share with others. The process is almost self-replicating.
Once a group of people has participated in the experience, the group can easily be trained to replicate it. The impact of this experience is so powerful that participants want to spread it throughout their communities, and many of them do so. The beauty of this approach to community healing lies in its simplicity and effectiveness. An outside facilitator begins the process by leading the first group.
The experience offers a gentle alternative to the destructive cycle of trauma, suffering and violence by allowing the biological imperative for natural bonding and love to assert itself. Resistance to stress and trauma, the development of basic trust, and the capacity for enduring personal and peaceful relationships are forged during a critical period of life.
Developing physiological and neurological patterns give us the instinct of the animal and the intelligence of the human being. Lacking either, we are doomed to act out our hostilities. With the two working together, we can advance on our evolutionary path, utilize all our human capacities and bring our children into a world that is safe.
Non-traumatized humans prefer to live in harmony. Yet traumatic residue creates beliefs that we are unable to surmount our hostility and that misunderstandings will always keep us apart. It is imperative that we make every effort to discover and teach treatment modalities like the Scandinavian model I described previously. We must be passionate in our search for effective avenues of resolution. Not just peace, but survival, depends on it.
Nature cannot be fooled. Evolution happens as a result of forces that threaten to destroy the species. Trauma is one such force.
Cutting Edge Editorial Board comments in response to this article:
The theory of childhood development and immaturity developed by Pia Mellody and its application to the patients at The Meadows is a most encouraging demonstration of how post-traumatic stress can be treated and individual destinies turned to the path of self-knowledge and relational peace. And while The Meadows applies its processes of analysis and recovery to individuals, at its center lies a template that we must apply on a broader societal scale.