An Overview

Part II of this book is about recovery—how it happens and how you can help make it happen. This chapter paints the overall picture of the healing process. I'll address the essentials from the point of view of the different people involved in the ensuing chapters. Chapter 5 is for the actual trauma survivors, and Chapter 6 is for the loved ones, Chapter 7 is for parents of traumatized children. But this chapter provides the overall game plan for recovery. You may want to refer back to this chapter at times in order to understand how the parts fit into the whole.

Aspects of Recovery

William, the survivor who went through the recovery process while living on a commune, did not make his healing journey alone, as we saw in Chapter 1. He had the help of several close friends and a community of caring, understanding people. It's very difficult to make the healing journey without such help from other people. Loved ones provide a sheltered place where the survivor can slowly come to terms with what's happened to her and turn her attention to rebuilding her sense of self. Helpful, understanding people who care are the backbone of the recovery environment.

The Recovery Environment

A trauma response consists of both the damage to the self (the traumatization) and the rebuilding of the self (the recovery). In order to recover, the traumatized person must resolve the primary and the relational traumas—that is, her unfinished emotional response to the traumatic experience, the deterioration of her relationships with others, and the damage to her sense of self. But recovery from traumatization is a unified experience. It's often arbitrary, even impossible, to separate overcoming the primary trauma from overcoming the secondary trauma.

Although we talk about an individual's recovery as if it took place in isolation, the truth is that the recovering survivor must be seen in the context of his significant relationships, which I lump under the term family. Not to do so would be like talking about a fish without acknowledging that it lives in water. So as we look at the recovery process in terms of its individual components, remember that they are all interrelated in a family system.

Overcoming the Primary Trauma

I've emphasized the importance of being able to express a full range of emotions in talking about the buried feelings that are part of the primary trauma. That process is called catharsis, and it sometimes brings a release of tensions. But the solution to the primary trauma is not simply to express all the feelings associated with it. Although a catharsis of the buried emotions can be a significant part of the solution, it is not the end‑all solution to the primary trauma. Resolving the primary trauma is more like a change of attitude than an emotional peak. It means finding a way to think and feel about the trauma that makes it bearable, finding a way to get it into perspective. If you can find a way to make sense of what happened, you'll be able to put the feelings to rest and look ahead at life instead of back at the trauma.

The idea of finding a suitable meaning for one's trauma may seem a little esoteric. What does it mean to find a meaning or create a meaning? This very personal process is unique to every person who undergoes it. A suitable meaning for many people is that "it was God's will." Yet even a common religious explanation can mean something different to different people because no two people have precisely the same worldview. Loved ones and others who wish to help a traumatized person by sharing their personal meanings must do so with an understanding of these differences. Ultimately, the trauma survivor will find his own meaning.

How? Well, he had a meaning for his life before he was traumatized. He had some way of understanding what it's all about, some way of making sense of the whole life experience. Everyone struggles with these questions, and some of us probe more deeply than others. Trauma survivors and their loved ones are forced to probe deeper than most.

Many people who've been traumatized report that the meaning of their entire existence changed as a result of their traumatization. You're probably familiar with stories of combat veterans who return to their homes and become pacifists, ministers, and other sorts of humanitarians. Or the parents of children who've died or suffered—such as those involved in drunk driving, cults, or drugs—who become crusaders against these sources of trauma. Literature is full of inspirational stories about persons who were traumatized, then devoted their lives to something. These persons' traumatization led them to probe more deeply and find new meanings for their lives.

Most trauma survivors, however, don't find new meaning for their entire existence. They simply find a suitable meaning for the traumatization, a view of it that allows them to accept and live with it and what it did to them. They find new ways of viewing themselves and the world they live in; in other words, they change their worldview. But accepting what happened doesn't mean becoming passive—it means letting go, giving up the preoccupation with the past and focusing on the present and the future. An athlete who loses the use of his legs can view himself as a former athlete who can't perform anymore, or he can view himself as a man who doesn't have the use of his legs and therefore must find other avenues of fulfillment in life. The difference is simply one of attitude, but its impact on the quality of life is profound.

A change in attitude is intellectual, but the process that leads to it can be quite emotional. You must accept the emotions that are associated with your trauma, and that means you must overcome your numbing in order to be able to experience those feelings. You must talk about the trauma and its meaning, as well as the feelings. Some people are apparently able to have this talk with themselves, and they manage to change their perspective. But most people can't change their own perspective; they need someone else's perspective to balance their inner dialogue. And you can only let yourself be influenced by someone else's perspective if you trust them. At times the discussion will be very emotional. It will take place more than once, maybe many times. But over time, you can acquire a different perspective on yourself and what you've been through.

Overcoming the Relational Trauma

Although the relational trauma' is reflected in your relationships, it is, at heart, a damaged sense of self. You feel changed from who and what you were before the trauma. The damage to your sense of self is worsened if you get a poor response from others. The more different you feel from others and from your former self—the more you'll be likely to withdraw. If others fail to address your trauma, your traumatic thoughts and feelings will become more ensconced behind your trauma membrane. You'll feel even more different and distant from others, and the relational trauma will take on a life of its own.

You can tell that you are overcoming the relational trauma when your social sphere starts to expand. That doesn't mean that you become highly social or necessarily have more friends; it means that you begin to experience a greater feeling of belonging. Along with the positive changes in your feelings about others, your feelings about yourself improve. You become more accepting of yourself, and you're calmer and more stable, less easily swayed by emotional tides.

A damaged sense of self is repaired primarily by involvement with people who are accepting, understanding, sympathetic, and willing to deal with your unsavory feelings. In order for a relationship to work, you have to trust the other person. If you trust someone, you let that person matter to you. You care about what she thinks and feels. You give her the power to influence you, to lead you to change at the very core of your personality, to think and feel differently about yourself. When you allow a relationship to become that important, it can help mend your wounded sense of self. But misused, a trust relationship can also cause severe damage.

In the course of repairing your damaged sense of self, you renew your values and restore your faith in yourself and in others. You may redefine your relationship with your social world. Your self‑esteem returns, and you can see your basic worth as a human being. Your standards for self-acceptance and acceptance of others usually become more flexible and humane. Your sense of having some control over your environment also returns, and your moods stabilize. All these things can happen if you invest yourself in a healthy trust relationship.

A healthy trust relationship is one in which difficult feelings are discussed instead of avoided or acted out. This includes your feelings about yourself and about your listener, such as whether you feel you're being understood. You and your listener must be able to tolerate discussing your feelings about each other. Family members often delude themselves into believing that they freely discuss all their feelings about one another, but they often operate according to the unwritten rules discussed in Chapter 3. It's these old, restrictive rules that have to give way, since it's hard to reveal one's true feelings in a judgmental atmosphere.

Grieving the Losses

A significant part of the recovery process is grieving for the many losses associated with the traumatization. These include physical losses, a lost sense of security, lost dreams and innocence, lost relationships, lost years, and the loss of whoever you were before and whoever you hoped to be. For each trauma survivor, there are surely more losses as well. Grieving these many losses is an important part of letting go of the past and turning to the future because once the past is grieved, it can be relinquished.

Different people grieve differently. Some people grieve very visibly, others quietly. Some people put considerable time into it; others think about the loss only occasionally. One way or another, you must allow yourself to experience the emotions and think deeply about your loss and what it means to you. This generally means talking about what you've lost. Although some people seem to be able to have that conversation with themselves, most of us need another human ear.

Creating a New Niche

A niche is a situation or activity that's especially suited to your abilities or character. The longer you are affected by a trauma before resolving it, the more you'll gravitate toward a niche that fits your traumatization. You'll be caught up in a life‑style that serves to help you deal with your symptoms and avoid your painful feelings. Some of these life‑styles are more destructive than others. You've lost your old niche, and even if you have created another new one, it's likely to have elements that support your avoidance of your trauma. Recovering requires you to build yet another new niche. This can mean anything from changing your habits to changing your job to changing your friends.

The most important part of your niche is the group of people with whom you're intimate—your family, lovers, and close friends. These are the people who must provide the support; their opinions and tolerance affect your relational trauma and its resolution. If they care about you and have healthy trust relationships with you, the necessary conditions for your recovery environment are there. But you must make efforts to actively change your life‑style and to carve out a new, healthier niche. The interpersonal changes—whether finding new friends or new ways of relating to old friends and loved ones—are usually the most difficult changes involved in creating a new niche.

Dealing with the Rage

One aspect of traumatization that many people try to avoid is rage. Rage is an emotion that other people sense and avoid; you're generally at a loss as to how to handle it. You may even hide your rage from yourself as well as others so that you may see it only indirectly, through your attitudes or the way you drive. Or it may be easier to hold the distorted view that others are the enraged ones and you're only a victim. But at some level, most victims are enraged at what has happened to them.

Learning to deal with your rage means learning to express it, examine it, and experience it without acting it out. The goal is not to simply "get the rage out"—that only tends to lead to more rage. Rather, the goal is to understand it, to accept the rage and see if anything can be done about the circumstances that provoked it. This is not easy to do—our society always has difficulty dealing with anger.

Your rage about your traumatization is primarily a reaction to your feelings of helplessness. A combination of intense anger and frustration may produce a fleeting feeling of power that combats the feeling of helplessness. Yet the rage frightens everyone, including you (though you might deny it because you're emotionally numb). Some people are so frightened of their own rage that they can allow themselves to experience it only when they're intoxicated and therefore unable to control it. In Chapter 9, we'll talk more about overcoming rage.

Dealing with Earlier Traumas

Unfortunately, traumatization often uncovers earlier problems that have to be dealt with before recovery is complete. An earlier trauma is often brought back to life by a second traumatization, especially if there are common elements. This means the earlier trauma must also be resolved in the course of recovery. Commonly, the kinds of childhood issues that people generally work on in psychotherapy are apt to be a part of the recovery process.

Dealing with Moods and Physical Symptoms

Recovery is difficult, even if you have energy and can apply yourself diligently to the work of recovering. But it's much harder if you're depressed, are not getting adequate sleep, or are preoccupied with other physical symptoms and anxieties. Emotional improvement generally leads to physical improvements, but physical factors—such as depression and physical aches and pains—can prevent emotional work from moving forward. So the emotional work of recovery—which largely occurs in relationships—should be accompanied by work on the physical symptoms associated with depression, anxiety, and hyperarousal. This second kind of work, which we will focus on in Chapter 8, can include diet and exercise, changes in sleeping patterns, and other efforts to get control of one's physical existence.

Tasks and Rituals

There are a number of things that trauma survivors and their loved ones can do to facilitate the recovery process. I've emphasized talking openly and honestly about painful issues, the meaning of the trauma, and the feelings that exist between the survivor and the listener. This should become a regular habit, not just a scheduled event. If you discuss your feelings openly, you'll learn to process your life as you experience it. This allows you to deal with upsetting details as they emerge rather than storing the reactions until they build into more powerful fears.

With tasks and rituals (which I'll describe in detail in Chapter 10) this experiencing process can occur in a manner that is directly related to your traumatization. It's hard to feel completely alone with a loss if you go through a ritual such as a funeral with a large group of people who share the feeling and process it together in some kind of ritualized form.

Stages of Recovery

It's popular to discuss recovery in terms of stages, whether it's recovery from trauma, illness, or any other setback. For years, theories about loss—marked by stages like denial, anger, and bargaining—dominated our way of looking at the grieving process. But stage theories of recovery can be misleading. People read that they're supposed to go through such and such stages in such and such an order, and they can come to feel that something's wrong with them if that's not the way it happens for them. There was always a group of people who didn't fit the stages, and this can contribute to a point of view that regards these people as not grieving. Instead, it appears that they are grieving in different ways. At best, stages describe the more common experiences. Like statistics, they're useful for describing large groups, but they're limited when applied to an individual.

So as I describe the natural order of the recovery events I've discussed in this chapter, bear in mind that some of you will not follow the order I suggest, and others won't experience all the events. More often than not, you'll be dealing with several of these "stages" at once.

The Primary Trauma Stage

The two primary trauma symptoms, reexperiencing and emotional numbing, are usually cyclic in nature. Their cycle can be interrupted if you stop the emotional numbing and stay with the feelings more. This doesn't mean the numbing suddenly stops—at times of stress, you may resort to it again. But numbing can become less pervasive, and as it diminishes, the reexperiencing symptom takes on a different form. You choose to examine and thus reexperience; as a choice, it feels more under control. Your examination of your suppressed thoughts and feelings becomes more intense, and you avoid your intrusive memories less—they're expressed, examined, and accepted. This examination process leads to changes in your attitude and your feelings about the primary trauma.

The Relational Trauma Stage

The relational trauma usually takes the form of a steady withdrawal from wider circles of social belonging. You bury yourself in the innermost concentric rings of your social sphere. Recovery reverses this and generally proceeds from your inner, most intimate groups to your outer, more distant ones. The most important step tends to be the first one allowing some individual or group to become important to you once again. When you find an intimate and highly supportive situation where you can be honest and vulnerable, you can express and examine the thoughts and feelings related to your primary trauma. The relational trauma "stage" can't be entirely separated from the primary trauma stage. These close encounters with others eventually lead to changes in the way you think and feel about yourself and your world.

Initial Blocks

Often, you cannot really start your recovery until you overcome your inability to express your grief. Some trauma survivors won't be able to form a significant trust relationship until they have developed some control over their rage. Debilitating moods and physical symptoms must be improved before many survivors can devote energy to the other work of recovery. You'll continue working on grief, rage, moods, and physical symptoms throughout the recovery process, but initially they can form a block that must be acknowledged and addressed before other issues can receive attention.

Changing Niches

For most trauma survivors, the changing of the niche occurs during the middle and later phases of recovery. The old niche tends to be one where you no longer feel safe enough to reveal your more tender feelings; the new niche is one where hopefully you do.

Pursuing Tasks and Rituals

Just to be clear, tasks and rituals don't constitute a recovery stage per se. Rather, they accompany the other aspects of recovery, and you can use them to try to bring certain elements of recovery to a head. Rituals often mark transition points, so they may be particularly visible at certain points in the recovery process. Tasks and rituals occur all the way through the recovery process, though their nature may change as recovering proceeds.

Resolving Earlier Traumas

Earlier traumas tend to be uncovered during the middle and later phases of recovery. The resolution of earlier trauma can be one of the last things that occurs in the recovery process. If you're in psychotherapy, you may be interested in continuing in therapy beyond the resolution of the current trauma so that you can work further on these issues.

Recovery begins with reexperiencing and reexamining the primary trauma. It's completed when you've recovered your sense of self and feel a sense of belonging to the wider segments of society. The journey between these two points can be a lengthy one; I hope you can start feeling better as soon as you recognize that your journey toward recovery has actually begun.