Self-medication and PTSD: A Path to Greater Complexity and Addiction?
Readers familiar with their own journeys or observing the struggles that loved ones endure know that PTSD symptoms sometimes demand immediate relief. Mood-altering chemicals, especially alcohol and marijuana, often provide temporary relief from anxiety, anger, depression, and other "limbic" surges. For many, alcohol and marijuana "take the edge off." They numb intense feelings, appear to quiet repetitive thinking, and afford some sleep and relief from the aftermath of trauma. In fact, in Western culture, alcohol has been a favored method of "recovering" among warriors, firefighters, and others who engage in vital but dangerous missions. Temporary relief usually comes in the form of "feeling no pain."
Actually, for a small but significant percentage of survivors, alcohol and other chemicals permit relief from the absence of feeling. In other words, getting drunk or high permits some feeling - any feeling - to break through the numbing produced by PTSD. Self-medicating is a devilishly seductive way of managing trauma. Self-medication provides temporary relief - a shortcut with the illusion of healing - but, oh, the price you pay! Alcohol, for example, will add to depression, confuse thinking, poison core relationships and, for some, set off violent behavior. For many, self-medicating will become a full-blown addictive disorder. Instead of one problem (PTSD), they now have two! Self-medication can involve food, sex, and the usual suspects: cocaine, opiates, amphetamines, cigarettes, alcohol and marijuana.
Academics and clinicians differentiate drugs from medicines: Drugs are self-administered without controls for dose, purity, etc. Medicines are taken only as prescribed (but often abused by active addicts). It's an oversimplification to say that all medicines are good, and all self-medication is evil. Many medicines cause harm; benzodiazepines and some sleep medicines can become addictive. However, in the hands of a skilled practitioner, medicines can provide much-needed symptom relief while the patient masters natural techniques that are highly effective in managing PTSD's multidimensional symptoms.
Recovery takes hard work and support. Re-stabilizing one's body and soul requires more than simple, singular solutions, sayings or insights; it is a process we know works. Self-medicating is not only risky, it is often tragic. Too many soldiers and civilians have been further injured by self-medicating. Simplistic, seductive, addictive, compulsive, and self-administered "treatments" too often result in broken marriages, broken careers and broken bodies. Life is hard enough without trauma, and trauma is hard enough outside of addiction.
The path to healing takes work, and work sometimes requires peer and professional support. John Barleycorn and Jack Daniels are not healthy supports or tools for recovery. If you are new on the journey of healing, do not be seduced by the temporary fixes offered by alcohol, drugs or other self-medicating behaviors. Recovery requires new skills. It's a process of integrating and healing, achieving and connecting - not masking, numbing or avoiding. Keep it simple and do not be intimidated, distracted or seduced by the siren song of medicating oneself.
Note: This article was originally published in the Winter 2007 edition of MeadowLark, the Meadows' alumni magazine.
Spirituality is Something You Are: Forgiving, Loving, Finding Serenity
An excerpt from Changing Course: Healing from Loss, Abandonment and Fear
by Claudia Black, PhD, MSW
When you set out on a new course in your life, the course of recovery, you are on a spiritual path. It is a path that leads to forgiving, accepting, loving, and finding serenity within yourself and with others. This spiritual path promises to lead you from aloneness and emptiness to a sense of connection and meaning in your life.
On this new journey, we are often involved in a process of spiritual growth before we recognize the spirituality of it. Looking back, the turning point came when we allowed ourselves to begin letting go of our fears and defenses to hear the truth:
There is another reality than the one I live.
I want it. This insight led us to learn more about the "other reality" and to learn more of the truth. The truth is that we are all human, both unique and ordinary, filled with dark and light. The truth is that all of our life experiences, whether admitted or denied, form the ground we stand on now. And the truth is that - in spite of our imperfections, our past and present pain, and the roles we've adapted to survive - we now know that we are free to choose how we live our own lives. Realizing this, the victim's passive plea, "Why me?," becomes a new, proactive question instead: "What can I do now?" This shift brings us to another turning point and another awareness:
I am responsible for the choices I make in my life.
When we accept our humanness and exercise our responsibility for making our own choices - for example, choosing what we do when we are angry, lonely, or sad - we are involved in a spiritual process. Our spirituality must be based on a vision that attends to our whole self and honors our whole experience, while at the same time acknowledges that we are accountable in the present for our own feelings, beliefs, and behaviors.
In The Spirituality of Imperfection, Ernest Kurtz writes that we have suffered zerrissenheit, or "torn-to-pieces-hood." Spirituality, as he describes it, is the healing process of "making whole." Spirituality helps us first to see and then to understand, and eventually to accept the imperfection that lies at the core of our human be-ing.
Accepting our human limitation brings us inner peace. What a relief it is to put an end to the fight within ourselves. Also, as we find the permission to be the imperfect beings that we are, we become able to let others be who they are.
The experience of inner peace is foreign to those of us from shame-based families because there was so little peace and harmony in our lives. We didn't have the models that projected unconditional love, acceptance, or gratitude. As a result, we came to believe that if we were anything less than perfect we were inferior and of little value. So, we sought perfection, believing it was our only avenue to acceptance and love.
We were so hurt by the absence of the nurturing we needed to thrive that we have spent a great portion of our lives trying to make that unconditional love happen in the present, hoping somehow to make up for the past. Paradoxically, when we are willing to believe that we cannot change the past, then we become willing to let go of our pain.
Think about the family being a house with many rooms. Our growing up years were lived in our parents' room, which was connected to their parents' room, and their siblings' room, and so on. The present day is the room where we have lived our adult lives. A mixture of experiences has taken place in all of these rooms. Some experiences were good, some caused a lot of pain. We need to realize that all families are imperfect, as all of us are imperfect people. Those of us who don't understand or want to accept that truth remain actively in denial. As Thomas Moore writes in Care of the Soul, "The sentimental image of family that we present publicly is a defense for the pain of proclaiming the family for what it is - a sometimes comforting, sometimes devastating house of life and memory."
To deny or disown any part of our experience leaves us dangerously incomplete and especially vulnerable to our shame. The lifeblood of shame is secrecy, fed by the dark fear of being found out. To grow toward wholeness in the context of our family home, we have to open all the doors and windows to let in air and light. Then for us at last, healing will begin.
"You and I are children of mud, earthy and moist," Jane Smiley writes in A Thousand Acres. "We're not all fire and light - no matter how much we wish otherwise." Facing this truth, we reach another turning point:
It is in the acceptance of all that was and is that our spirits become whole.
Bill Moyers described acceptance as wholeness and health in an interview about his book, Healing and the Mind:
"Health is... a state of mind that recognizes the history of life, which includes moments of great delight and moments of deep sorrow. When we see all these parts of our being as connected, we come to terms with where we come from, who we are and where we're going. Health is a whole."
In the process of becoming whole, we may say we "have spirituality." But spirituality isn't an event or a possession. It's a way of living and being. Spirituality doesn't mean we never get hurt again, or that we are always smiling, always happy, never angry, and never scared. In part, spirituality means that when we are hurt or afraid we can respond without making matters worse. Also, as we change course and take steps on this spiritual road, we are able to enjoy the good feelings of being solidly balanced, open and unguarded, peaceful about the past and generally positive about how we are living in the present.
Note: This article originally appeared in the Winter 2007 edition of MeadowLark, the magazine for alumni of The Meadows.
A Miracle is Just a Shift in Perception
By Colleen DeRango
In working with clients to help them heal their trauma, many of us in the Somatic Experiencing® community have come to recognize that one component preceding a shift in perception may not be a thought at all: It may be the body's "felt sense" of moving from a state of calm to anxiety and then to calm again, or what is called "pendulation."
Peter Levine's influence at Mellody House has generated a subtle shift in the way we work with clients; our focus is on supporting clients in establishing a sense of "internal resourcing," as opposed to concentrating on difficulties or problem areas. Somatic Experiencing reinforces this focus and gives us the necessary tools and language.
Consider an example: A cat attentively and expectantly watches a mole dig a tunnel under the lawn. The cat waits with positive expectancy for the mole to move. This visual image represents the idea of seizing or grabbing hold of the positive. As counselors, we do this by supporting the client in reconnecting with the felt sense of "I can."Sometimes this "I can" sensation is expressed in a bodily movement. Other times, the client experiences a bodily change, wherein he feels "less tight, less anxious, less painful, less stuck." Gently encouraging the client to experience his "felt sense" of this less painful state is often the beginning of the miracle of moving from "I can't" to "I can." Clients are adept at sensing their own states of non-calm; so we focus on beginning from a place of "safety, calm, centeredness - or when they last felt most like themselves." We reflect on how they experienced these states and, from this place of resource, we support them in "touching into" the edges of the more difficult sensations of "tightness, strain or constriction."
Therapists support clients in listening to what their bodies are sensing, and we challenge them to trust it. For example, in a guided meditation or group session, if a client begins to feel "closed-in" or "anxious," he's encouraged to do what he wants to do - and to experience it from a "felt sense." Oftentimes this includes leaving the room while sensing what it is like to be able to get up and leave. When we introduced this strategy, we thought perhaps clients wouldn't return. Yet they have always returned and quite often shared with the group their sensations of empowerment.
Additionally, we give clients choices; for example, in meditation sessions, they are welcome to follow the guided meditation or to make a choice about how they want to meditate and then do so. Choice, when given to trauma survivors, is powerful; clients often share that they experienced the act of choosing as a felt sense of power, as opposed to the powerlessness many experienced during past traumatic events.
Knowing that trauma is about disconnection and that healing is about reconnection, the client experiences the sensation of being able to move, versus the trauma of being forced to stay. We wondered if clients would use their ability to choose as an excuse to leave group. Interestingly, the clients who left once rarely left again; they shared that they experienced a "sensation of empowerment" as a "life force" versus "life depletion." In SE language, we would identify this as the "miracle" of self-regulation, i.e., activation and deactivation. In SE we also learn that the body has the ability to self-regulate and that "trauma disconnect" interrupts this capability.
Somatic Experiencing® meshes well with The Meadows' model, which is trauma-based. In the powerful Survivors' Workshop, an experiential exercise encourages the client to "identify with his functional adult caring for his inner child." He then shares his reality with the people in his life who have been "abusive, neglectful or abandoning." This involves resourcing prior to touching into the anxiety or pain. The workshop is completed within a community of five or six other clients. As in SE, healing work is meant to be processed with someone, versus by oneself.
At Mellody House, we reinforce the value of community in working toward trauma healing and recovering from addictions and self defeating, addictive behavior patterns. In essence, we encourage clients to support themselves and one another from a place of compassion. Following the SE approach of giving counselors permission to make mistakes while training, we encourage our clients to "experiment and make mistakes," encouraging the "try" without the limitation of the expectation of perfection. The successful part of the try is "pounced on positively," not only by counselors, but by other clients as well. As the client experiences the "felt sense" of "I can do this," energy becomes available to "touch into" more pain, anxiety, frustration or "stuckness." The "I can" part of self-regulation is restored, and the result is a client who senses new empowerment. "I cannot drink" becomes a "felt sense" experience of "I CAN not drink."
Clients who have achieved "self-empowerment" have an energy about them, a "coherence" that other clients seem to move toward. And somewhere along the way, the shift toward healing gains momentum, stronger than perhaps the "triggers to use." As a client discovers that "more of me is available to use my strategic thought" to manage the triggers, he develops resiliency.
I realized early on that I could talk at length with clients about their problems and still not know how to restore their resiliency. But if we can "pounce on the positive" and support clients in identifying their "felt senses" within, their human systems move into healing. The "I can" capacity of the human system is amazing.
In considering the recent Somatic Experiencing Conference, where many of us gathered to learn and to share our experiences, I think about the simple enjoyment of connecting with others in this community. My sensation of restored resiliency was reinforced by a wonderful "ventral vagal" connection with so many SE practitioners. What a strong reminder to balance work with fun, connection and growth.
In closing, instead of saying, "A miracle is just a shift in perception," one might say, "A miracle is the ability to shift and change perception." Either way, I believe in miracles.
Note: This article was originally published in the Fall 2005 issue of MeadowLark, the magazine for alumni of The Meadows.
Remembering Who We Are: Tools to Gain Clarity
Kathleen O'Brien, LCSW
"I want to change, but I don't know how."
How many times have you heard yourself utter these very words? Most people come to counseling knowing that their lives need to change, but they often don't feel confident enough in their abilities to make that happen.
Confusion about what is most important can lead, at the very least, to poor choices and mildly co-dependent behavior and, in the extreme, to serious addiction problems.
It doesn't work for us to behave in ways that go against our own values. We can suffer depression and/or anxiety when we ignore what we believe to be most important. We then "treat" our unhappiness with self-destructive behaviors, such as dysfunctional relationships, substance abuse, irresponsible spending and so forth. One poor choice leads to another, and soon we find ourselves at the bottom of a very deep hole.
That downward spiral is daunting, to say the least. My experience both personally and professionally has shown me that, in order to make a significant life change, we need to remember who we are, i.e. to have clarity about what we value most.
The truth is that most people know intuitively what is most important to them. When a client finds herself in a predicament, I ask what she would tell a son or daughter to do in the same situation. Almost without fail, she has an instant answer for the problem at hand. It is as though she can access her wisdom for someone else's benefit (especially her child's), but not for her own. It's not that she doesn't know the answer; she just doesn't feel entitled to act on her own behalf. As a result, she usually doesn't develop the skills necessary to get her needs met in a healthy way.
Take a few moments to ponder the following:
The point here is to focus on remembering who you are. Pia Mellody calls this "remembering that you are precious."
Over the years, I've tried many techniques to help clients clarify how they feel and what they value. I call this "accessing one's own wisdom." Here are some techniques I've found helpful:
In conclusion, remember that the way to heal yourself is to know who you are and to live according to what is true for you. When a person acts in truth, it resonates down to the cellular level. You are your own best healer!