The Meadows Blog

"It's enough," said the 64-year old.... "Something has changed. The world feels strange now. Even the way the clouds move isn't right." (Excerpted from an article on the 7.1-magnitude aftershock in northeastern Japan, USA Today, April 8, 2011.)

Dissociation: Personal Transition in a Chaotic World

Traumatic events set off a chain reaction of biological, emotional, psychological, interpersonal, and spiritual changes that can disrupt your entire sense of self and how you view things going forward. When your world is shaken and you no longer feel safe, you can lose your sense of identity. The resulting shifts in perspective and perception can cause a disintegration of your baseline ego.

Survivors of traumatic events say things like:
"I was so frightened, I stopped feeling. It was like I reached a point where I didn't care anymore if I lived or died."
"Once I got through this and accepted my own death, my fear went away. I was able to get through."
"It is odd; I would look at myself, look at my hand, and it was like it was no longer attached. Everything shifted from three dimensions to two; it is like colors disappeared, yet everything was intense. I can't really describe it; I just went numb. I became disconnected from my body."

Such shifts in perspective and dimensionality are a core component of dissociation, which tends to follow in the wake of absolute fear or panic. Permitting one to detach from emotion, it can be very adaptive. For instance, it can help soldiers to act as a team and follow orders. In Vietnam, many soldiers would recite a simple chant while doing horrible tasks: "Just another day, no big thing...." This helped to desensitize them, reinforce dissociation, and establish the numbness required for survival.

Dissociation also permits emergency room personnel to disengage from the horrors they see and do their jobs. ER workers who are “in touch with their emotions” may not be able to act as efficiently in a crisis as a focused, emotionally dissociated team. Optimally, rescuers need to perform first and process their emotions later.

Soldiers, healers, and survivors encounter problems if they cannot reattach to their bodies or emotions after the intensity diminishes. If they remain in a state of constant arousal, it negatively affects their sense of balance, communication, self-awareness, and connection to loved ones. Once your core is shaken, it is difficult to resume a "normal" perspective. Everything feels different. On one hand, things that upset others might not set you off. New crises are familiar, almost expected; they may even be welcomed or become "the new normal." Survivors often adapt well to overload. They feel comfortable, perhaps even comforted, within new arenas of challenge or intensity. This, in part, is why so many soldiers devastated by war would enlist again if offered the option. They get used to functioning well at the edge; it almost becomes addictive.

Paradoxically, little things can cause overreaction. A partner's complaint about a failure to clean the kitchen, for example, might result in a temper tantrum, a fit of righteous indignation, or a violent clash. The big things become little, and the little things become big. The new normal is numbness, punctuated by fits of rage or terror. In this "fifth dimension," everything is scrambled. You are numb and detached; nothing hurts. It's "just another day, same old thing...." Yet everything is different - even the clouds.

Dr. Jerry Boriskin is a Senior Fellow at The Meadows. He is an author, lecturer, and clinician with expertise in trauma, PTSD, and addictive disorders. Dr. Boriskin is a licensed psychologist and addiction specialist who recently resumed working with traumatized soldiers at the V.A. of Northern California. He is the author of "PTSD and Addiction: A Practical Guide for Clinicians and Counselors" and co-authored "At Wit's End: What Families Need to Know When A Loved One is Diagnosed with Addiction and Mental Illness."

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Note: This article was originally published in the Summer 2005 issue of The Meadows‘ alumni magazine, MeadowLark.

Dissolving Fear and Nurturing Joy: the Personal Story of a Recovering Agoraphobic with Panic Disorder

By Charles Atkinson, MA, MSW, LCSW

Hello, my name is Charles Atkinson. I am a 55- year-old recovering agoraphobic with panic disorder. The term "agoraphobia" derives from the Greek language. The interpretation of "agora" is marketplace, and a "phobos" is defined as flight. Hence, agoraphobia literally means "flight from the marketplace." Further examination of the word agora reveals it was not only a place of intense commerce where goods were sold and bartered, but also the social hub of town for the exchange of exciting new ideas and concepts. Consequently, an agoraphobic could not venture into the marketplace for fear of overstimulation in unpredictable and chaotic surroundings. Therefore, at an unconscious level, the marketplace represented to the agoraphobic a mirror image of his childhood environment.

Today, the definition of agoraphobia has been refined to include an avoidance of a specific place or situation in which one feels trapped and may experience embarrassment. The terms "panic attack" and "anxiety attack" can be applied interchangeably. Panic attacks occur when the sympathetic nervous system goes into overdrive and generates a cognitive distortion of second-order fear, or "fear of fear." This emotion of fear is felt on both the conscious (physical) and unconscious (emotional) levels. The results are panic attacks that feel as if the sufferer is going to lose control, go crazy or die.

It is not fully understood if agoraphobia with panic disorder has its fundamental inception in biology or is a learned behavior. I believe this disorder has its roots in both theoretical paradigms. However, additional schools of thought can be applied.

Dr. Shelley Uram, a Harvard-trained psychiatrist at The Meadows, helps articulate a layperson's perspective of how the neuropsychiatry model of the mind and body adapts to stress and trauma. She explains that our amygdala is located in the limbic system of the brain. The limbic system is located in the midbrain, where our emotions originate. Constant stresses, such as childhood traumas, rattle and sensitize our amygdala, which is also referred to as the "smoke detector," a moniker indicative of its function. It does not gradually activate the sympathetic nervous system for the fight or flight response. It spontaneously stimulates the adrenal glands to flood the body with adrenaline. This results in a state of arousal for the body and mind. If the brain continually perceives the message of an external threat, whether real or imagined, it will create an internal state of perpetual hypervigilance and angst. It is analogous to revving your car's engine to the highest RPMs while in park.

Pia Mellody's longtime work in the area of trauma and addictions has resulted in a behavioral model called "Developmental Immaturity." This model addresses the problems of being relational and achieving intimacy. To gain a better understanding of Pia's model, imagine a tree.

The roots of the tree are the childhood traumas, including physical, sexual and emotional abuse. The trunk of the tree allows the core issues of immaturity to fester and impede personal growth. These core issues include problems with self-esteem, boundaries, reality, dependency and containment. The branch of the tree denotes the secondary symptoms of unmanageability. This is the stage when addictions, depression, fear and panic disorders appear. The leaves of the tree represent the final outcome of all of the dysfunctional stages and an inability to establish and maintain healthy intimate relationships.

My first panic attack occurred at age 27, six weeks after I was married. It as if I were losing control, going crazy and having an emotional breakdown. A visit to the emergency room ensued. The hospital medical staff said I was having an anxiety attack, gave me a tranquilizer and sent me home. Not only did I feel emotionally trapped and ill-equipped to engage in an intimate relationship, but the sense of overwhelming fear and impending doom was ever-present. I tentatively speculated that marriage was the problem. It was too incomprehensible to think that the problem was endogenous to me. So began my journey through life, filled with hidden shame, fear and depression spanning the next three decades.

After two years of visiting a myriad of psychotherapists and experimenting with numerous psychotropic drugs, I was still battling depression, fear and anxiety. Fortunately, at 29, I found a psychologist who diagnosed my condition as agoraphobia with panic disorder. He explained that my disorder stemmed not from my perception of marriage, but from the cognitive distortions and childhood trauma embedded in my psyche due to physical abuse. Recalling the physical abuse experience was so powerful that it felt as if my heart and soul were being suffocated. I could not address my childhood abuse issues.

However, as I developed more psychological ego strength and better coping skills, I gradually reflected back to my childhood. I was physically battered multiple times between the ages of 5 and 13. I tried unsuccessfully to stave off my father’s abuse with my feeble attempts to express anger. My retaliation was met with scorn, disdain and an escalation of violence. This violence would trigger my body to mobilize and prepare my internal milieu for the most primitive response: survival.

Today, my father would be labeled a "rage-aholic." His impulsivity and inability to contain his rage were equivalent to a ticking time bomb, ready to explode at any time, for no reason. Since I was the oldest male child in the family, I was the focal point of his outbursts. This dysfunctional
behavior perpetuated the male rite of passage in our family. The sins of the father were being passed to the next generation as an acceptable form of discipline.

After decades of therapy, I found that the model that helped me grasp and understand my problems most clearly was Pia Mellody's. Her approach illustrated that my father had an extreme failure in maintaining his boundaries, contributing to my feelings of being exceedingly vulnerable and without boundaries. His constant verbal and physical abuse was an edict to our family; he was the boss. If he was in the perennial position of one-up, we were always one-down. Being one-down all the time obviously had a negative impact on my self-esteem. Also, he emphatically and without question demanded obedience, putting himself in a position of omnipotence. This eventually distorted my reality, dislodging me from the spiritual path to my higher power. My father was continually on the verge of being out of control. His lack of control influenced my behavior, as I always tried to be in control and perfect.

As a survival technique, especially during the physical battering, I dissociated my emotions from my body. If I felt any feelings, I cognitively appraised them as anxious feelings. This psychological tactic of turning my anger at my father into anxiety within myself allowed me to function in a chaotic and unpredictable home.

Consequently, after decades of dissociating from my feelings, convoluting and twisting my emotions, I was unable to identify and appropriately express emotions. Therefore, every time I had a feeling, I assessed it as anxiety - and only anxiety. This increasing accumulation of stress and inappropriate processing of emotions provided a fertile environment for the onset of panic attacks. Pia Mellody would call this psychological process "carried feelings" or "carried shame." More pointedly, during my father's rage attacks, I felt shame, and he was shameless. As a vulnerable child, I symbolically swallowed all of his emotional frailties and inadequacies. The psychological process of feeling my shame, fear and anger, plus my father's feelings, was too overwhelming. A panic attack was the result of the carried fear and shame.

Healing the sins of the father is a Herculean effort. Many therapists employ traditional talk psychotherapies, which are extremely helpful. However, traditional talk therapies primarily engage the higher cortical portions of the brain. Some research indicates that childhood trauma seems to be locked in the more primitive limbic system. One of the most effective ways to access the limbic system of the brain is through modalities that stimulate the midbrain, or our seat of emotions. An example of this modality is guided imagery used to re-experience the childhood trauma as an adult. Pia Mellody uses this technique and others that bridge both portions of the brain, the frontal cortex (thinking) and the limbic system (feeling).

In closing, the abatement of the carried feelings is not the end; it is the beginning of one's spiritual path. Ironically, recovery is not only achieved with the dissolution of fear, but with the nurturing of joy.

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Wednesday, 14 January 2009 19:00

Denial is Not a River in Egypt

Note: This article was originally published in the Summer 2004 edition of Cutting Edge, the online newsletter of The Meadows.

Denial is not a River in Egypt
By Robert Fulton, MA, LISAC, Administrator, The Meadows

One of the wittiest adages we hear in 12-Step recovery is “Denial is not a river in Egypt.” It is so witty, in fact, that many recovering people repeat it without asking themselves the absolutely important question, “If denial isn’t a river in Egypt, what is it?”

The answer seems too obvious for further inspection. Denial is about denying that I had a psychological problem. Most often, I denied that I was an alcoholic or an anorexic or that I was a sex addict. But now that I have admitted to myself and to another person that I am any one of those things, I am no longer in denial. I am back in control.

Sadly, intellectual admission often leaves the deeper denial in place – intact and poisonous. The alcoholic awakens every morning swearing not to have another drink and, by 5 p.m., heads to the bar. The anorexic, who has planned three healthy meals, looks at herself in the mirror, sees a fat woman, and decides not to eat. The sex addict at the SA 12-Step program shares the agony of his addiction and, after the meeting, hits on the attractive newcomer.

In recovery, behavior cannot be the driving force. Intellect and affect are the driving forces that determine my behavior. As an addict, I behaviorally shut off my affect and distort my intellect, so that I maintain the behavior that protects me from the awful confrontation with my childhood shame.

Denial of affect involves disassociating from those feelings that our primary caregivers taught us to regard as shameful. Our caregivers taught us to dishonor our feelings, because to honor them and to communicate was to be punished and to be shamed. We learned to separate self from the emotions generated by the truth of what we witnessed. In order to avoid the worth destroying poison of carried shame, we were forced to deny the feelings we had when we witnessed an emotional event in the family.

In order to medicate the pain of having abandoned our authentic self, we find ways to medicate the dissonance – we deny the truth of what we think; we submerge and camouflage the truth of what we feel. The self that emerges from the pain of denial becomes, in most adults, the only kind of “maturity” to which they have access.

We deny on an intellectual level, and we deny on an affective level. We deny intellectually by telling ourselves that two plus two is five. We were empowered to do that, or conditioned to do that, when we were growing up – and two plus two never added up to four in Mommy and Daddy’s household. Our father was a falling-down alcoholic. We said to Mommy, “Daddy’s drunk out on the lawn. He’s passed out. He looks like he’s dead. I’m scared.” And she said to us, “Don’t worry about it; he’s fine.”

The kid knows that the fear of his father’s drunken abandonment is real, but to have that truth, that reality, denied by his mother is to have his reality denied. The child then wonders what’s wrong with himself. Mind you, he doesn’t ask what’s wrong with his father or his mother. They are the ones acting shamefully, yet it is he who feels ashamed – he is carrying their shame. Because the kid’s real fear of the father’s death is being made illegitimate by the lies of the mother, the child himself is now experiencing a death of self – of his own emotional reality and his access to it. He is not allowed to feel the fear of losing his father.

This is the most damaging kind of shame-based denial, because it attacks the child’s very authenticity. He has learned that to have the terrifying emotions attendant upon Daddy’s drunkenness is not all right. Disassociation from self becomes habitual. Denial of self is honored in the dysfunctional family system.

When the child is older and he witnesses a shameful act, the kind of disassociation he experiences will be covered up with a more sophisticated form of social camouflage than when he was 5. For example, he may think that his father’s shameful drunkenness will disgrace the family in the eyes of the neighbors. The primary lie that Daddy is not drunk is justified by the need to remain socially acceptable. The young adult now needs a defense system that not only deflects his father’s shame, but protects his own social self as well. Such denial is often called loyalty and is praised as being politic. He is often told that his cover-up makes him a good citizen.

The child who has viewed his father’s shameful drunkenness may fear that his father will stop loving him should the father became aware that his son sees him as a failed father. In Michelangelo’s Sistine Chapel fresco The Drunkenness of Noah, Noah’s two sons come into the tent and see him drunk, and they experience intense shame. They identify with their father’s unexpressed shame at having abandoned his children and given up power in regard to his sons. The intended Biblical lesson is that to see someone in his nakedness is to obtain power over them. Rarely has the Bible been so psychologically deluded. It is not the children who have power over the parent; it is the shameless parent who holds power over the children through the mechanism of carried shame, setting off a career of adapted wounded-child codependence.

So denial, better than alcohol, is the best dysfunctional medication for shame. However, denial cannot salve one against that sense of hopelessness and despair that is engendered when one loses connection to self. It is then that we feel the need to buddy up to an addictive process that will give a false sense of power, that will eliminate the fear in a moment, that yields that one-up posturing of denial and grandiosity.

When dealing with these disconnects, one is driven back not only to the newborn-to-age 5 feelings of shame but to the adapted state of ages 5 to 17 as well. The early shame sets the stage for the acting out, through which each individual learns to dramatize brilliantly his dysfunctional avoidance of emotional truth. It is an artistic way of keeping from connecting to oneself and avoiding the agony of re-experiencing the death of our truth.

There is a Catch-22 in this artistic denial, no matter what relief it seems to give us. Even when we manage to get in touch with our honest feelings, if we do not have the tools to survive the encounter, we cycle right back into the wound of abandonment or of shame.

Feelings then seem to us a trigger to an unhealable vulnerability. They become something that we need to stay away from, which is why one of the first things a good clinician does (once a patient is reasonably stable) is to urge the patient to drop into his honest feelings, and to let him know that it is okay, that he is okay. He needs the security to feel that accessing his affect will not kill him.

This is actually what happens in the Survivors Workshop. People begin to express their affective authenticity, and they are not shamed – they are honored. And they begin to honor themselves. I often remember what I always said in group: that we have to learn to honor our feelings, which is to hold them – and ourselves – in high regard. Our feelings are our windows of insight into the depth of who we are. But all of that is for naught under the guise of affective denial when, in a defended posture, we compulsively seek to offset the initial wound of being defective, of being unworthy.

In reactivity to the carried shame of abusive childhoods, there are those who acquiesced and expressed their shame, pain, fear and anger in neurotic, seditious ways. Then there are those who rebelliously fought for some kind of voice, but who lacked the tools for connection. In either case, the trauma disconnects one from oneself.

The aim of treatment is to allow me to reconnect to me for the first time as the beneficent parent, the loving parent who needs to be nurtured for who and what I am. At the same time, I learn to present my authenticity and accept the vulnerability that my truth may meet within the world, even if the world shuns me. You may be sad, but you will have the joy and power and value of not disconnecting from the self. You do not rise above and go one-up; acceptance of one’s imperfect perfection is a soaring disengagement from that which is destructive.

People taking the first steps to deal with the trauma of carried shame will choose submission rather than surrender. This submission is often an intellectual admission that there is a problem. But unless the submission is also a surrender to the will, this apparent surrender of dignity will leave a bad taste; it will feel dissonant. It will be sensed as a false admission, one made to keep the depth of the real problem at a distance. The feeling of true surrender is internal peace. Only I will know. But I know I have surrendered when I feel that peace.

The concept of denial and surrender being in that same crucible is vitally important, because denial is a form of false security through control. If, by admitting we are addicted, we seek clarity for the sake of control, it is only to give ourselves the illusion of safety. We remain terrified of letting go of control, because if we let go of this charade, we are going to be left in the abysmal pit of carried shame. So our whole life has been to orchestrate this nonsense. We know it to be nonsense, but we don’t know anything other, so we medicate the nonsense.

In recovery, however, I am now invited to go to a place of powerlessness, and that is a miraculous paradox, because it is only there that I can be empowered. The first thing that has to happen is for you to acknowledge that change is impossible without help. When I surrender, I learn to trust another to give me that help, to help me get on the path to recovery. The recovering individual, once the path becomes a reality, takes the path and continues to go forward.

When somebody gets into recovery, and they begin to date again, it is like being back at 14 or 15, even though she is 40 or 50, because it is a whole new experience. There is the similar excitement and fear and passion – it is a whole new way of relating. It is not a state of authenticity and acceptance of self within memory. Because it is new, it is innocent. In recovery, we experience “innocence.”

And so the healthy lineage allows for the delight, the life, the joy, the possibility and the joy-pain – ever new, ever going forward. Healthy, functional shame, not the sickness of carried shame, is what fuels the joy and the richness, because it reminds me of my authentic self; it puts me back on the path, back on line. As you move in a new venture, it is all new and, therefore, a delight.

And you may find that you have overstepped and then feel ashamed of a behavior because it was all new, but it is now functional shame that allows you to become more intimate, to feel more deeply. I am imperfect, and I make mistakes. My mistakes may cause me pain, and they will. But they don’t make me bad. They only make me human. And that, I don’t have to deny.

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