Back From the Brink: A Family Guide to Overcoming Traumatic Stress, by Don R. Catherall, Ph.D.
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3

 

STAGGERING IN SYNC

Loving a Trauma Survivor

 

Now you have an idea of how far‑reaching the effects of traumatization can be on a trauma survivor. His or her life can literally be torn apart. But the effects of traumatization do not stop with the trauma survivor. The survivor's loved ones, those who are emotionally close to her, can also pay a mental, emotional, or even physical price. The effects of traumatization are easily passed on from parent to child, from child to parent, from spouse to spouse, or even from friend to friend. An entire family can be affected by one member's traumatization.

 

Marsha and Philip were high school sweethearts. Philip was a star athlete, and Marsha was a star pupil. Soon after he finished high school, Philip went to Vietnam and served in heavy combat, including the very stressful siege of Khe Sanh. He was badly wounded, but he recovered and seemed to have put his traumatic war experiences behind him. Marsha and Philip were married shortly after he was discharged, and they launched into a relatively normal life together. They had two children and successful careers while remaining active in church and community affairs.

 

More than ten years after they married, Philip began having nightmares and flashbacks of Vietnam. As with many Vietnam veterans, the reason for the long delay in the ap­pearance of his symptoms is not clear. But his symptoms increased, and he became withdrawn and irritable with Mar­sha and the children. He spent long hours sitting in front of the television, and he no longer coached his son's Little League team or worked for the church. After a number of counseling sessions with his pastor, he withdrew from that relationship as well. He started attending group therapy ses­sions at a Vet Center, beginning many years of treatment. Meanwhile, his son and daughter entered their teenage years without a father actively involved in their lives.

 

The emergence of Philip's traumatization had a severe impact upon his life. He went from being a highly respected husband, father, and community member to being a neglect­ful husband and father who was very much at odds with his community. The neglect certainly had an effect upon his fam­ily, but the impact on the family was even broader than that. It's much easier to live with a husband and father who has never been involved than to lose one who was once heavily involved. The symptoms of Philip's traumatization affected his entire family.

 

In the early phases of the development of Philip's PTSD, everyone was supportive of him. The church came to his aid by providing emotional support and financial assistance and by helping him find jobs. Marsha was very understanding and worked extra hours when Philip became unable to hold a job. The children learned to be more patient with him, and the entire house became quieter as the family adjusted to Philip's irritable moods and disquieting flashbacks.

 

But as time passed and Philip didn't return to his old self, the support began to be strained. Philip steadily drained the resources of his church; he kept losing the jobs they helped him find and eventually soured the pastor on the use­fulness of the counseling sessions. At home, the family established new living patterns that simply didn't include Dad. Philip continued to live in the family home (usually sitting in front of the TV), but in many respects, he no longer seemed a member of the family.

 

Marsha went through a period of fighting with Philip before she basically gave up and simply tolerated him. She was working more, and she had to compensate for Philip's absence in all the activities in which the children were in­volved. Consequently, her social life declined to the point where she lost almost all contact with her friends. Her own activities with the church declined, and she found that even when she had a rare opportunity to do some of the work she used to love to perform for the church, she really couldn't enjoy herself. She became depressed and very lonely.

 

Their oldest child, Gary, was eight when his father's PTSD first appeared. At first, Gary stuck up for his father whenever anyone was critical of him. Gary and Philip had been very close, particularly sharing athletic interests. Gary tried to help out more around the home, and he would de­fend his father when his parents argued. Then he went through a period of becoming obsessed with war. He bought toy weapons, read war comic books, and played war all the time. When he entered his teenage years, he became highly involved in dirt biking. He continued to play baseball, but he fell from the varsity to a second‑string player and his interest in it declined. His father never came to his games anymore.

 

Gary spent his free time riding dirt bikes and was sel­dom at home. He continued to help his mother quite a bit, and he maintained good grades in school. But he stopped taking his father's side. Instead, he became critical of him, and Marsha began to defend Philip to Gary. Gary was very scornful whenever he spoke to his father, but Philip never confronted him about it, which only contributed to Gary's loss of respect for his father. Gary never seemed to have a good time anymore; he was angry at his father and always serious. He tried to take over many adult responsibilities around the home, such as discussing the family finances with his mother. She resisted letting Gary become too responsible for adult concerns, but she admitted that she was tempted because she felt so alone in dealing with it all.

 

Gary's younger sister, Suzanne, who was six when it be­gan, reacted to the situation very differently. She'd always been fairly quiet, and now she became even quieter. She never took sides during arguments and seemed unaffected by the problems in her family, maintaining her few close friend­ships and continuing to do all the same things she'd always done. In fact, she acted as if she were completely oblivious to the situation. But over the years, her mother perceived that Suzanne was suffering silently. Suzanne never complained, but when pressed to discuss the situation at home, she would quietly cry, never able to say much about why.

 

This family was struggling with an unusually severe case of traumatization. Their reactions may be more extreme than most, but in many respects they're fairly typical. This family exemplifies many of the common dynamics we see among families of trauma survivors: There were major shifts in their relationships, with the son taking on some of the father's role and the father giving up most of his authority, the general level of family closeness declining and family members end­ing up feeling isolated from one another; the intimacy in the marriage was lost. Marsha felt guilty about getting fed up with her husband's symptoms and losing patience with him. Gary became preoccupied with his father's trauma and tried to relive it. And Suzanne became withdrawn and was emo­tionally numb much of the time, just like her father.

 

In effect, the family members began to show symptoms of traumatic stress—the reliving and preoccupation with the trauma—as well as the guilt, anger, depression, isolation, and emotional numbing. A close, supportive family became a fragmented group in which it was very difficult for members to share their feelings with one another.

 

In this chapter, we'll look more closely at the impact that a family member's traumatization has on the family, as well as at the effect that loved ones can have on the trauma survivor.

 

 

The Impact on the Loved Ones

 

One of the central messages of this book is that trauma affects entire families, even if only one individual was ini­tially traumatized. If more than one family member was ini­tially traumatized, it's easy to see how the entire family is affected. Families who are traumatized together, such as sur­vivors of natural disasters, tend to deal with their trauma­tization together. It's no surprise that the members should all develop similar symptoms. But it often comes as a surprise that the same thing can occur in families where only one member has been traumatized. This section and the next show how other family members are affected and how the family relationships change as a result of one member's trau­matization.

 

Reactions to a Family Member's Traumatization

 

You hear about trauma every day—the news is full of trauma—but you tend to be unaffected by it until it hits close to home. When you personally relate to something traumatic happening to someone, you react very differently. If the trauma you hear about is one that you've experienced your­self, you're more likely to relate to it intensely.

 

You can also personally relate to someone else's trauma if you feel related or connected to the person to whom it happened. We tend to feel more involved with someone whose house burns down in our neighborhood—even if we have never met them—than with someone whose house burns down across the nation. If you witness a trauma occur­ring to someone else, it's likely that you'll feel related and thus be affected. To some degree, you're likely to feel as though the trauma has happened to you. At the park, when I saw the dog being hit by a car and the owner suddenly struck with grief, I felt an empathic pang of loss, as though I'd lost my own dog. I related because I was a nearby witness and because I'm a dog owner and could imagine my dog getting hurt.

 

Certainly, you'll feel most personally related to a trauma victim when you are, in fact, related. If you love the person who was traumatized—as a friend or as a romantic partner—you'll feel, to some degree, that you've been traumatized yourself. Simply witnessing a trauma can traumatize the witness, even if you don't know the victim. So consider the implications if the trauma occurs to someone you love, and if you actually witness the event. It would be as if it had happened to you. And if you feel either personally responsible for the victim, as a parent feels, or excessively dependent upon the victim, as a child feels, then your own traumatization may even be worse than the victim's.

 

So you see that, to a greater or lesser extent, you can be traumatized yourself by what's happened to your loved one. You experience many of the same feelings as she does because you can't help but put yourself into her shoes. You may even feel the added burden of responsibility for what happened to her. Then the aftermath of the trauma comes. And you relate not only to what happened to her, but to what continues to happen‑because it's happening to you as well.

 

Enduring the Survivor's Symptoms

 

Living with someone who has the symptoms of PTSD isn't easy. You are affected on a variety of levels. Concretely, if your intimate partner has a sleep disorder, your own sleep is affected. And on a feeling level, if your partner is withdrawn, irritable, and frequently reexperiencing a trauma, you're likely to feel rejected, abused, and frustrated at your inability to help.

 

People who are depressed invariably report that their depression has negative effects on others and that others come to avoid them and relate to them in only superficial terms. If you're trying to maintain a close relationship with someone who's depressed, your efforts to cheer him up generally fail. Over a period of time, you may stop asking how he is because the answer is always the same. You feel worse because you can't change how he's feeling, and he may begin to feel that you don't care since you've stopped asking. You can't win either way.

 

If your loved one has severe symptoms of emotional numbing, this also has a disconcerting effect upon you. You often can't tell whether he's numbed out or if he's become too jaded and cynical to really care anymore. Many people who rely on emotional numbing seem to be feeling things quite normally until the intensity increases or they have an experience that makes them feel particularly vulnerable. Then suddenly the feeling turns off. The effect on you can be devastating. You're feeling close and comfortable with your loved one, then all of a sudden you're a million miles apart. You may feel that you've suddenly become the enemy. Appar­ently, your loved one's empathy for you disappears. This is very hard to endure, especially when your loved one switches unpredictably from Dr. Jekyll to Mr. Hyde. You find yourself always preparing for this to happen, so you end up holding back yourself. Your loved one senses this, of course, and that adds to the tension between you.

 

Often, this unpredictable switching‑off of empathy is ac­companied by rage attacks. Your loved one can abruptly change from treating you as a support to behaving as though you're the source of all his problems. This has a devastating effect on your ability to remain close and supportive. You can easily respond in ways that confirm his fears: that he really doesn't matter to you, that you feel he's only a burden, that you don't understand, that you think he could control his symptoms if he'd only try, or that you think he's just feeling sorry for himself. We all tend to become defensive when we're attacked, and we often counterattack when we can. Some people believe that anger makes the truth come out. I disagree. I think we find things to say that will hurt, whether they're truthful or not.

 

The rage attacks are related to your traumatized loved one's state of hyperarousal. She hasn't relaxed; she's anticipating a recurrence around the next corner. She doesn't sleep well; she's irritable, jittery, distrustful, and startles at the least sound. The woman who was raped views every dark corner as a potential point of attack. The child who awoke in a fire dares not go to sleep. The man who survived an auto accident starts driving as if every other driver were about to lose control.

 

Being around such people is exhausting. It's an assault on your own illusions of security‑maybe you're not really as safe as you thought. And it's wearing—the fact that she never relaxes makes it hard for you to relax. You become frustrated trying to reassure her that everything is okay. And as you become frustrated and exhausted, you become less effective in reassuring her. Trying to calm an anxious child is doomed to failure if you're not calm yourself. The child senses your anxiety and impatience and responds to that rather than to anything you say. The result is that you may actually stimu­late further anxiety in the loved one because she is frightened that something else is disturbing you.

 

Problem Drinking

 

For many loved ones of trauma survivors, the symptom that most dominates their lives is the loved one's drinking. Much has been written about alcoholism and its effects upon family life. I doubt I'd be saying anything you didn't know if I enumerated the negative effects of alcoholism. Instead, I'd like to remind you of the diverse ways people manifest drink­ing problems, and how traumatization can be involved.

 

Many people view drinking problems in rigid stereo­types. They have images of the skid row bum or the person who starts drinking early in the morning. Such stereotypes make it easier for people with drinking problems—or family members—to deny them. The truth is that there are many different forms of problem drinking. Some problem drinkers do drink all day, while others drink only in the evenings, on weekends, or even less often. Some problem drinkers stay sober for weeks or months, then go on binges, while others get drunk every weekend. Many never get drunk but regu­larly consume large amounts of alcohol. A drinking problem isn't defined by the amount of alcohol consumed‑it's de­fined by the problems the drinking creates in a person's life. If your loved one's drinking has led to poor work perfor­mance, health problems, dangerous behavior (like driving drunk), fighting with you, or other problems, then he has a drinking problem.

 

Many people turn to alcohol as a solution to some other problem, such as nervousness in social situations or difficulty falling asleep at night. People who've been traumatized may initially find that alcohol helps with their symptoms: it can help them get to sleep, temporarily reverse their depression, and contribute to their ability to numb their emotions. Other drugs can do these things, too, but alcohol seems to be the most popular. In either case, what at first seems to help soon becomes the biggest problem of all.

 

Some people are genetically more vulnerable than oth­ers to developing alcoholism. But people who've been trau­matized are also more vulnerable to developing alcoholism because they're using it to deal with their symptoms, though they may not realize that that is what they're doing.

 

It's often you, the loved one, who finally brings the drinker's problem with alcohol to his attention. Many loved ones have been labeled enablers because they protect the drinker from the consequences of his drinking and thus en­able him to continue his destructive pattern. Out of their de­sire to help, they keep picking him up when he falls rather than allowing him to suffer the consequences and thereby become motivated to do something about why he's falling in the first place. This means that you can be an important part of the problem, or an important part of the solution.

 

For some reason, we tend to look for someone to blame when there are alcohol problems. Perhaps because the act of drinking is a voluntary behavior, it's common to point the finger of blame at the drinker. Since no one likes to feel blamed for having problems, drinkers often resort to blaming someone else, saying things like, "She drove me to it." The spouses of problem drinkers frequently feel that it's indeed their fault; their spouse wouldn't be drinking if they were better husbands and wives. But this guilty attitude only hampers you. Blaming is destructive and interferes with being able to objectively address and solve the problem. Blaming is the first thing that must go.

 

If your loved one has a drinking or drugging problem, you should seek help for both (or all) of you. High levels of addiction need to be treated in intense treatment programs, often requiring hospitalization. Less extreme forms of alcoholism are usually kept out of the hospital. But find a support network, whether you go to a treatment program or use community support groups. Alcoholics Anonymous has helped millions of men and women overcome alcoholism. Al‑Anon has helped millions of family members of alcoholics. Many such organizations offer support to people with chemical dependency problems and to those of you who live with such people. (See the appendix for more organizations and addresses.)

 

Transmission of Symptoms

 

One of the really curious aspects of traumatization is that its symptoms are communicable. If you're intimately involved with someone who's been traumatized, you can literally pick up her symptoms. This may seem ludicrous, but consider the effect of living in Marsha and Philip's family, where Philip was emotionally numb practically all the time. After a while, the entire family adapted to his withdrawal and unemotional presence. Indeed, they often sat in the same room and watched television with him, though he barely participated in any discussion. Marsha and the kids tolerated this bizarre situation by relying upon the same mechanism as Philip—emotional numbing. Though they attempted to carry on normal conversation and activity around Philip, they found that their normal conversation evolved into a flatter tone‑there were fewer highs and lows. They became less reactive to emotional events and more accustomed to an at­mosphere that lacked liveliness.

 

It's no wonder that Marsha became depressed and that the children redirected their emotional lives outside their home, Suzanne through her friends and Gary with his dirt biking. Gary's adaptation to his emotionally dead home is typical of many trauma survivors. They find a job or a hobby that involves danger and excitement, seeking to overcome the emotional deadness inside through adrenaline highs.

 

Emotional numbing does not always mean a drab, de­pressing atmosphere. It also includes doing exciting things to overcome the emotional deadness. Some trauma survivors combat their emotional numbing by always being "on," the life of the party, if their personalities already lean in that direction. At first sight, you certainly wouldn't think that such people are emotionally numb, since emotionally numb people are usually fairly low key. But always being "on" can cover an impoverished ability to feel. The person who's al­ways ready to "party" may be trying to compensate for what he doesn't feel inside by creating an image of how he'd like to feel on the outside.

 

So family members can pick up emotional numbing as a way of coping with the same disturbing symptom in their loved one. And once you're emotionally numb yourself, you're subject to feeling depressed just like your loved one and to resort to similar mechanisms to combat emotional numbing. These may include sensation‑seeking life‑styles or an addictive and excessive pursuit of eating, drinking, drugs, gambling, or sex.

 

Relating to the Traumatic Emotions

 

Your loved one's symptoms may also be transmitted to you through your experiencing the emotions associated with her primary trauma and your ability to relate to her trauma. Simply knowing that your loved one was raped, or burned, or lost all her possessions can be traumatizing to you. This phenomenon can deepen as you talk to her about her trauma. As she describes it and begins to relive it, you may vicariously live through it with her. If you're effectively empathizing with her as she talks about the trauma, you'll personally feel something of what she went through. You won't just have thoughts about it, you'll have an emotional reaction to it! You may not have the same feelings as she, but you'll have feelings of your own. You may not have a reaction strong enough to produce your own traumatization, but many people do develop secondary traumatization as a result of intimate exposure to a trauma survivor.

 

A vivid example of traumatization‑by‑association is seen among female psychotherapists who've had intrusive memories and combat dreams after working with combat veteran patients. (I mention the gender of the therapists only to emphasize that they had never been near or shown much interest in combat.) Similar phenomena have been observed among male therapists working with female rape victims. Becoming intimately involved with another person's trauma can make it so real that it can become your own trauma as well. Thus, the full array of primary trauma symptoms can develop in intimate listeners. These include the reexperiencing, the heightened arousal symptoms, the emotional numbing, and all the mechanisms people employ to deal with these symptoms.

 

Shrinking Social World

 

Just as you can recreate the primary trauma, you can recreate the secondary trauma as well. This can occur in two ways. In the first, your preoccupation with your loved one's primary trauma and the traumatic emotions leads you to feel distant from others. In effect, you come to feel like a trauma survivor yourself‑different, misunderstood, and not connected to the society around you.

 

The other way that you can acquire the secondary trauma is more troubling. Your other social relationships be gin to break down because of your loyalty to the trauma sur­vivor. When she withdraws, you're put in the position of choosing between keeping up your own outside relationships or staying home with her. If you go on with your own life, it widens the gap between you and her and contributes to the loss of her feeling of belonging to the intimate pairing formed by the two of you. This distance makes her feel re­sentful and more alienated, and it makes you feel guilty. But if you stay home with her, your own relationships are bound to suffer. In that case, she feels guilty and you feel resentful. Either way, there's conflict.

 

The Impact on the Family as a System

 

As we have seen, trauma has a very real effect on indi­vidual family members. But in addition to its effect on indi­vidual members, it affects the family on another level as well ‑the systemic level. That is, the trauma affects the family as a whole, or system. From the systemic point of view, we can discover underlying rules and patterns that govern the ac­tions of every family member. This can give us more insight into why people behave as they do and what specifically needs to change in order to make things better.

 

Rules That Govern Family Relationships

 

All families have rules about the expression of emotion. Some families express powerful emotions like anger and grief loudly, with lots of gesturing and facial expression. They yell and scream and jump up and down. Other families express those same powerful emotions quietly, with very lit­tle gesturing or expression. Each of these family systems abides by underlying, unspoken (but well‑understood) rules.

 

Family rules can govern how emotion is to be expressed, when it's to be expressed, whether it's to be expressed, and who can express it. Some family rules govern whether men can cry, whether children can express anger at their elders, or just how sad, angry, joyous, or affectionate family mem­bers are allowed to be. The rules may be different for sub­groups (men may not be permitted to cry or be depressed, but women can) and for different individuals. Often, one member or subgroup of a family expresses emotions that other members experience but don't express (such as the mother who expresses everybody's sadness).

 

So in one family where there has been a traumatic loss, the mother may cry and express the sadness, the father may get angry, the daughter may get frightened, and the son may get depressed. Individually, their reactions are very different, but systemically they may represent the range of feelings that everyone is experiencing, and each member is expressing in his or her way according to the family's rules. These rules, however, can sometimes interfere with the process of recov­ery.

 

Stop and think about your own family. What rules gov­ern the expression of emotion? How do those rules bear on you and your loved ones in dealing with trauma? Do they interfere with the effective expression of powerful emotions? If your family members are dealing with trauma, are they hampered by rules constraining them from being able to ef­fectively deal with powerful emotional experiences?

 

·        What recurring messages did you grow up with and do you still see being followed and passed on to younger generations?

 

·        Do you have significant gaps in the emotions that are expressed in your family? Is it acceptable to be angry, sad, grief‑stricken, or terribly fearful?

 

·        Can people have conflicts and work them out? Are they eventually able to talk about their differences without getting overly defensive?

 

·        Are family members able to be vulnerable and re­veal their weaknesses, fears, and insecurities?

 

·        Are people able to be affectionate with and sup­portive of each other?

 

·        Is there a flexibility in the roles family members play? Can father and mother each be both a nur­turing figure and a disciplinarian? In family con­flicts, do people take different sides at different times, or does everyone always line up in the same coalitions?

 

·        Does everyone in the family have a right to speak up with their feelings?

 

If so, identify the dysfunctional rules, talk about them with your loved ones, and change the rules to fit your family's needs. The more you can identify and talk about the rules that hold your family back, the less power those rules hold over you and the easier it'll be to change them.

 

Of course, some people can get past a loss without much grieving and can keep a trauma buried without it erupting into consciousness through intrusive memories. But in gen­eral, it's better to be able to express the powerful feelings associated with trauma and loss. The closer a family is, the better they usually are at expressing these feelings with one another.

 

The "Dry Drunk" Family

 

Considered as family systems, traumatized families have a lot in common with alcoholic families. They share a coping style‑dealing with feelings through some mechanism other than open discussion. But the similarities between the trau­matized family and the alcoholic family are clearest when alcohol is removed from the picture. Many alcoholics who give up alcohol continue to live according to the same old pattern; family members frequently say that the recovering alcoholic might just as well still be drinking, for all the differ­ence it makes in their lives.

 

The pattern that continues is one in which the recover­ing alcoholic remains distant from those who matter to him and is unable to express important feelings. For example, the husband and father who was never around when he was drinking gives up alcohol but is still never around because of work or other commitments or new interests that absorb him. Stopping drinking makes profound changes in the life of an alcoholic, but it can have little effect in the most impor­tant relationships, where change requires more than the ab­sence of alcohol.

 

Some people speak of alcoholics who've not given up the dysfunctional patterns that accompanied drinking as "dry drunks." The "dry drunk" family resembles many trauma­tized families in their difficulty experiencing and expressing powerful emotions. People in "dry drunk" families often "act out" powerful feelings rather than express them verbally. They usually have a lot of difficulty maintaining closeness, and spouses keep a constant distance by either fighting regu­larly or losing interest in each other. At some level, every member of such a family feels isolated. One of the primary benefits of close relationships‑the feeling of not facing life alone‑is often missing in these "dry drunk" families.

 

In both the "dry drunk" family and the traumatized fam­ily, the rules must change if the relationships are to improve. Here are some of the kinds of dysfunctional rules that we see in such families.

 

·        Sadness is not to be expressed openly and di­rectly, either by the whole family or by certain individuals or subgroups (males, females, chil­dren, parents).

 

·        Fear and anger and affection are not to be acknowledged openly and directly.

 

·        Conflict must be avoided at all costs.

 

·        Vulnerability must be avoided at all costs (so ev­erything can only be expressed through conflict).

 

·        Forgiveness is a sign of weakness.

 

·        No one is safe.

 

·        No one is entirely trustworthy (even family members).

 

·        People outside the family can't be trusted.

 

·        Never give an inch.

 

·        There is nothing worth getting upset over.

 

It's true that most children aren't told that excessive expression of sadness is not permitted, but many have been told to "stop that crying, or I'll give you something to cry about." Expressions like "If I ever spoke to my mother the way you're speaking to me" pass on family rules about the expression of emotion from generation to generation. Similarly, children acquire family attitudes about the ways other people express emotions. "No child of mine ever spoke like that" and "No daughter of mine would dress that way" are reactions to people outside the family that also define the acceptable range of emotional expression within the family.

 

Disowned Feelings

 

Many people who are in perpetual conflict are really struggling with what are called disowned feelings. Your loved one may have some bad feelings from her traumatization that she hasn't adequately sorted out. She feels bad, usually about herself, but she focuses on you as the source of these bad feelings. In effect, she disowns her bad feelings"they're not mine, you put them there"—and blames you.

 

 

Not only do traumatized people sometimes blame their loved ones for their bad feelings, they may even provoke a loved one to play the appropriate role in the drama of "creating" the feelings. Both trauma survivors and family members know each other well enough to push each other's emotional "buttons" and stimulate feelings without even realizing that they are doing it. For example, if you have doubts about your­self, you can provoke your loved one to treat you as if he doesn't trust you. You might do this by keeping him in the dark about what you do with your time, even if you use your time innocently. When he gets emotional and harangues you about what he thinks you're doing, you can blame your doubts about yourself on him since you know you're inno­cent of any wrongdoing. Thus, you don't have to face the fact that the feelings started within yourself.

 

Trauma survivors disown their feelings for several rea­sons: They are dealing with powerful feelings, they are un­aware of the exact nature of their feelings, and they are operating according to rules they learned in childhood and that are still in force in the current family system. Violating the rules usually feels like an act of disloyalty, and many of the rules define the way a person is supposed to feel about him or herself. Thus, breaking them tends to be a blow to one's self‑esteem. If a man is brought up to believe that it is unmanly to cry, he will likely disown feelings that might lead to tears and indeed feel he is being unmanly should he cry.

 

So as you can see, preexisting rules that interfere with the appropriate expression of powerful feelings can lead to excessive disowning of feelings and failure to be able to deal with severe emotional experiences like trauma. You take these rules with you through life; they become part of your personality—and they're hard to change. You may never no­tice that you are carrying many dysfunctional rules until you encounter a severe emotional event. But the rules are there, and they don't tend to change unless you make an effort to change them. You will recreate these internal rules in each "family" you become a part of throughout your life.

 

The Impact of Loved Ones on the

Trauma Survivor

 

In the family situation we discussed at the beginning of this chapter, Philip's family reacted to the emergence of his traumatization initially by being supportive. Everyone un­derstood that he was hurting inside and that it had to do with the terrible things he had experienced in the war. This is how most families respond to the traumatization of a family mem­ber. They care, and they want to help their wounded member recover from the trauma. But they don't always know how. Often their support fails to help, and they become frustrated and allow the loved one to withdraw into a shell. After a while, they may come to feel that the only thing they can do is to leave her alone and allow her to deal with it in her own way. But allowing any family member to become walled off from the rest produces an unhealthy atmosphere for every­one.

 

Avoidance

 

You may find yourself struggling with what to say and how to respond to a traumatized loved one. You have feelings about her, and you have your own emotional reactions to the trauma itself that you're not certain how to handle. But whether you realize it or not, you will be communicating these feelings unconsciously. Trauma survivors are particu­larly sensitive to communication that occurs through many channels, including tone of voice, eye contact, body lan­guage, choice of conversation topic, attitudes expressed about seemingly unrelated issues, and how much members make themselves available.

 

Although you say you want to hear all about the trauma, you may actually be conveying a totally different message in other ways. For instance, you may smile inappropriately when your loved one brings up the trauma, look away more than you normally do, or deny that the traumatization is up­setting—while your voice goes up an octave every time you speak about it. You may sit more stiffly or fidget with some­thing or choose to sit in a chair that's too far away for inti­mate communication. You may leave the television on, hold the newspaper in your lap, or attempt to draw someone else into the conversation whenever the topic comes up.

 

Perhaps most significantly, you may selectively respond to what your loved one expresses‑responding to the less dis­turbing aspects and ignoring the most upsetting parts. You likely are not doing this on purpose, and it doesn't neces­sarily mean that you don't want to listen and help. But your loved one may get the feeling that you're uncomfortable and don't really want to talk about it. She may fear that you find the emotions she's trying to control to be as overwhelming as she does, and that you don't want to encounter them either.

 

One family came for a counseling session after their col­lege‑age daughter Debbie was in a serious auto accident and started having nightmares. The family told her that they wanted to hear all about it, and so Debbie told the story of how she handled herself at the time of the wreck. She wasn't hurt and she performed admirably, helping the people in the other car and remaining very level‑headed throughout. But the next day she had a case of the shakes and began to relive the accident in her mind. Then she became plagued with thoughts of the accident and couldn't sleep without dream­ing about it.

 

Debbie's family seemed to listen attentively and commu­nicated their concern and relief that she hadn't been injured. But they focused their comments on how well she'd handled the situation, and they kept reminding her that she'd come through it without injuries and now it was over with. Some­how Debbie felt dissatisfied with what they said, so she told them how scared she'd been. As they focused on the fearful­ness of the event, she felt more understood and supported. She saw that they too had been scared, even after they'd learned she hadn't been hurt. She was then able to accept their helpful perspective that she had in fact survived. Her nightmares quickly dwindled away.

 

This family experienced a focused trauma that was briefly upsetting. It was all over in a couple of weeks because Debbie's family was very responsive to her and willing to do whatever was necessary to help. They had felt it would be more helpful to remind her of her strength because they thought she was too focused on her fearful feelings and they were trying to help her regain a balanced perspective. They thought that if they were to focus on how frightening the accident had been, they might confirm her fears and she might become permanently damaged. But to her, their fail­ure to focus on her fearful feelings meant that they didn't really want to hear about them‑despite what they claimed­and that they didn't trust that she could handle talking about them.

 

This example demonstrates how easily people can selec­tively respond to or steer away from the disturbing emotions associated with their loved one's trauma. You may feel it's better not to focus on the negative feelings, but you may also find them too disturbing yourself. Bear in mind that the rea­son the primary trauma keeps recurring is that the original emotions were so overwhelming that your loved one had to shut down her capacity to experience them. But now she needs to express her feelings to recover her ability to feel such things. In order to listen empathically, you must be will­ing to experience something that was overwhelming for her. Just listening can be traumatizing, so you may want to shut down the same way she did. But you must overcome this urge within yourself just as she must try to overcome it within herself. The process of talking about the traumatic emotions is a personal challenge for both you and your loved one.

 

Denial

 

In your efforts to help your loved one put the trauma behind him, you may unwittingly contribute to his failure to recover—by minimizing the extent of his traumatization. Like Debbie's family, you might focus on his successful sur­vival and pay too little attention to the symptoms he manifests. Denial is a psychological mechanism that people sometimes employ in dealing with upsetting situations. Basi­cally, they tell themselves and others that an upsetting situa­tion is simply not that upsetting. Thus, they deny the impact of the situation and, in a sense, try to think of it as a minor thing in order to make it a minor thing. We see denial all the time. It's the child who screams, "I'm not angry." It's the depressed adult who claims that the loss of his job doesn't really bother him. It's John Wayne claiming that it's nothing but a minor flesh wound just before he faints. And it's the rape victim who says she isn't uptight about men, she's just too busy to date anymore.

 

Denial, in itself, isn't necessarily bad. It's one of the many ways we cope with life's traumas. But denial can be­come an impediment to your coming to terms with some­thing, such as a loss, that's too big to go away. It's generally no big deal if you deny the impact of the little losses. But the bigger the loss, the more you'll need to acknowledge its im­pact in order to make adjustments and carry on. If you deny the impact of a major loss, you're unable to recognize your need to either replace what was lost or learn to live without it. Part of coping effectively is being able to change. And if you're too immersed in denial, you're blinded to your need to change.

 

I'm not advocating that you confront any and all of your loved one's denial. It's a normal coping process, and most people who've been traumatized do deny the extent of their traumatization at times. But if it becomes your loved one's sole means of dealing with the trauma, then she's at risk. Moreover, denial has a sort of communicable quality. If your loved one is dealing with her trauma by denying that it had any great impact, there's pressure on you to join in that de­nial and not disrupt her way of dealing with her trauma. So you don't talk about it, or at least you don't talk about it in any way that will cause her to get upset.

 

Prospects for recovery are made much worse when the entire family joins with the traumatized member in denying the impact of the trauma. In effect, they perpetuate the idea that the trauma left no lasting psychological scars. Some families don't allow themselves to recognize psychological damage. For them, life is a simple pursuit, and people who have problems are viewed with suspicion, as lazy or weak.

 

I suspect that most families who live in a permanent world of denial have some kind of unresolved trauma in their past. Frequently, members of such families make comments like, "I saw my father die a violent death when I was a kid, and it didn't `traumatize' me." Alcoholism is also very com­mon in families that deny the psychological impact of trauma. The alcoholism serves as a form of chemical denial; if they can't talk themselves into feeling that the trauma didn't bother them, they can anesthetize the feelings and at least believe it didn't bother them.

 

If the entire family participates in denying the impact of a traumatic event, the trauma survivor is up against much more than his own reluctance to experience the overwhelm­ing feelings. If his symptoms force him to recognize that he's still carrying the effects of traumatization, he'll find it nearly impossible to do much about it as long as his loved ones continue to deny. He may try to argue with them, but he won't win unless other family members support him. He may withdraw from the family and become more symptomatic, or resort to alcohol or drugs. Or he may leave and seek an envi­ronment where others will not deny his problems.

 

The survivor has the best chance for recovery when loved ones don't deny the impact that his traumatization has wrought upon him. One of the most important characteris­tics of in‑patient hospital programs to treat stress disorders is that the staff refuse to join with the patient in denying the seriousness of the traumatization.

 

Although denial can be used to avoid any emotion or experience, it is most frequently used in regard to loss. Trau­matization always involves some kind of loss—at the very least, a loss of beliefs (such as an illusion of security), atti­tudes (such as trust), meaning, and feelings of control. More often, there's a loss of dreams, of innocence, and of the basic sense of self. And sometimes, there are losses of actual peo­ple and physical abilities. The main problem with failing to acknowledge loss is that it interferes with the process of adapting, changing, and creating new avenues of fulfillment to replace the ones that are lost. 

 

Wanda, thirty‑four, sought therapy because of a lack of fulfillment in her life; she was depressed and had the "blahs." Nothing really excited her, but nothing really got her down either. Wanda's mother had committed suicide when Wanda was seventeen years old. It was a violent suicide, and Wanda had discovered the body. But from all indications, no one in Wanda's family had acknowledged the impact of this terrible event on her. Very little sadness was ever expressed‑Wanda herself hadn't cried since the funeral ‑and the family avoided discussing what had happened. They simply "took it in stride" and continued their lives as they'd been before.

 

The key point here is that the family members tried to continue their lives as they'd been before. Wanda had been about to get her driver's license and was enrolled to start college. But she never got the license, and she didn't finish the first semester of college. Her brother and sisters also seemed to get stuck at that point in their lives. The family members spent a lot of time together, but they had very little sense of what was going on with one another. At age thirtyfour, Wanda began to change this through therapy, making a start by getting her father to give her driving lessons. Then other family members began to liven up a little, and Wanda decided to take more responsibility for bringing the family together, planning some holiday activities that they hadn't pursued since before her mother's death.

 

One thing Wanda's family hadn't done since the mother's death was to make Christmas cookies, so Wanda announced that she was going to make some. But her attempt turned out to be a disaster—her cookies were nothing like the wonderful ones that her mother used to make. Her mother seemed to be the only person who could bake Christmas cookies, and Wanda cried for the first time since the funeral seventeen years before.

 

Everyone in Wanda's family had denied the impact of her mother's death and consequently had never really dealt with the loss. Their failure to mourn and share their feelings of loss with one another had caused them to become emotionally numb and distant. And as the episode with the cook­ies so painfully illustrates, their denial of their loss prevented them from being able to adapt to it and replace the functions mother had served for the family. Only when Wanda finally attempted to replace one of mother's functions did her denial shatter, and she experienced the tremendous loss. As you can see, failure to acknowledge loss leads to failure to adapt to it and replace what was lost.

 

Protecting the Traumatized Member

 

You may fail to focus on your loved one's traumatization because of your own denial and/or because of your reluc­tance to feel the traumatic emotions, but most likely your actions are intended to spare your loved one from reliving his or her intense feelings. You don't want to upset him, and you may think he'll forget the trauma in time and that it's best just to leave it be. In some cases, your loved one will adjust without delving into the trauma. But in most in­stances, he won't adjust; he'll continue to reexperience the trauma and will remain emotionally numb and withdrawn. And as we've seen, many people seem to adjust and have no symptoms until suddenly, after many years, they appear.

 

If your family tends to deal with your traumatized loved one through denial and distancing from the traumatic emo­tions, your family is likely to be trying to protect the trauma­tized member. You may form a sort of protective shield between him and the rest of the world, like an offensive line surrounding a quarterback. You don't let him encounter things that are going to be too upsetting, particularly those that will stir up the traumatic emotions. Jacob Lindy, a psy­choanalyst who specializes in the treatment of trauma disor­ders, refers to this shield as the trauma membrane. He says a traumatized person, in a sense, forms a membrane around the memories and emotions associated with the trauma. The family and loved ones become part of that shield.

 

A trauma membrane is not a bad thing—it’s a healthy and caring response to someone who's hurt. When you place a bandage on a wound, you're protecting the hurt from further injury. But there comes a time when it's important to remove the bandage or artificial membrane so that the wound can continue to heal. A cast protects a broken leg to allow it to heal, but if it isn't removed, it interferes with further healing and causes the leg muscles to atrophy and become weaker. If your family relies upon denial and avoids traumatic emotions beyond the time it's healthy, they are likely to maintain the trauma membrane beyond the point where it's helpful.

 

The trauma membrane is maintained in obvious, visible ways and in subtle, invisible ways. On the obvious level, you may insist that your loved one is "not ready" to do this or that. But you may, in fact, be treating her as if she were a child. This creates resentment in your loved one and can have the same effect as the cast left on the leg too long; her ability to deal with "life"—particularly reminders of the trauma—atrophies, and she comes to doubt herself. On a more subtle level, you avoid certain topics—again, reminders of the trauma—and fail to acknowledge her visible symptoms. In effect, you've altered your expectations of her and, whether in an obvious or a subtle manner, her expectations of herself will begin to change and she'll start to doubt her abilities.

 

Marsha, Gary, and Suzanne's response to Philip's traumatization is a good example of the creation of a trauma membrane. After their initial, futile efforts to get him to talk about what was bothering him, they learned to back off. The situation reached the point that Philip became noncommunicative and sat in front of the TV for hours, and no one would comment on it or question what was going on. It was as if there were an elephant in the living room, and everyone was acting as if it weren't there at all. Nothing was demanded or expected of Philip—he was free to turn into a hermit in his own house.

 

This family is an extreme example, but they exemplify processes that occur in many traumatized families. Their reaction to Philip's withdrawn state resembles the fable of the emperor's new clothes. Everyone denies what they're seeing until a small child speaks the truth. This is an excellent story about denial and how it can collapse if people are willing to accept reality. Sometimes we need an innocent child‑per­haps that's a service you can perform for your family.

 

Consider what it would be like to be Gary or Suzanne, living in a situation where there is an elephant in the living room and no one acknowledges that they see it. How does this affect the child, or the adult, who resides in that same living room?

 

You should now have a solid grasp of what happens when a person is traumatized, both to the individual and to those who are close to him or her. It may have been dis­turbing to read about all the things that can go wrong. But have hope—the traumatization is only part of the trauma re­sponse. There's also a natural process of recovery. Part II will provide you with many specific things you can do to improve and make the most of that healing process.