Tag Archives: trauma

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Make space for the difficult feelings

I am watching a four part video from the UK about illness and trauma.

The first part is about how trauma memories are stored differently from regular memories. Regular memories are stored in files, like stories in a book or a library.

Trauma memories are stored in the amygdala and often are disjointed and broken up and have all of the sensory input from the worst parts, including the emotions.

The therapist is talking about healing: that our tendency is to turn away from the trauma, smooth it over and try to ignore it.

However, the amygdala will not allow this. It will keep bringing the trauma up. And that is actually its’ job, to try to warn and protect us from danger!

The therapist counsels finding a safe time and place and safe person (if you have one) and then making space for the trauma to come back up. One approach is to write out the story, going through that most traumatic part, but not stopping there. What happened next? Writing the story and then putting it aside. Writing it again the next day and doing this for four days. As the story is rewritten and has an ending, even if it is not a happy ending, the story is eventually moved from the amygdala to the regular files. People can and do heal. They may need a lot of time and help, but they can heal.

I am not saying that four days of writing stories is enough. That is one approach, but nothing works for everyone and people need different sorts of help. There are all sorts of paths to healing.

In my Family Practice clinic I would see people in distress. With some gentle prompting and offering space, they would tell me about trauma and things happening in their personal life or work life. Things that were feeling so overwhelming that they could not tell their families or friends and they just could not seem to process the feelings about it. I would keep asking what was happening and give them the space to tell the story. Many times when they reached the present they would stop. There would be a silence. Then I would say, “It seems perfectly reasonable that you feel terrible, frightened, horrified, grieved, whatever they were feeling, with that going on.” And there was often a moment where the person looked inwards, at the arc of the story, and they too felt that their feelings were reasonable.

I would offer a referral to a counselor. “Or you can come back. Do you want to come back and talk about it if you need to?”

Sometimes they would take the referral. Sometimes they would schedule to come back. But nearly half the time they would say, “Let me wait and see. I think I am ok. I will call if I need to. Let me see what happens.”

When a person goes through trauma, many people cut them off. They don’t want to hear about it. They say let it go. They may avoid you. You will find out who your true friends are, who can stand by you when you are suffering. I have trouble when someone tries to show up in my life and wants to just pretend that nothing happened. “Let’s just start from now and go forward.” A family member said that to me recently. Um, no. You do not get to pretend nothing happened or say, “I wanted to stay out of it.” and now show back up. No. No. You are not my friend and will not be. And I am completely unwilling to trade silence about my trauma for your false friendship.

Yet rather than anger, I feel grief and pity. Because this family member can’t process his own trauma and therefore can’t be present for mine. Stunted growth.

People can heal but they need help and they need to choose to do the work of healing.

The four videos are here: https://www.panspandasuk.org/trauma.

This song is a darkly funny illustration: she may be trying to process past trauma, but the narrator doesn’t want anything to do with it. And he may not have the capacity to handle it. He may have his own issues that he has not dealt with. And maybe they both need professionals.

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Prayers for people in Turkey and Syria

I took this photograph with my phone yesterday before I heard the news.

The ambulance has been out for a week or so, along with the doll tent. Two doll babies, the doll doctor, various pieces of equipment. I took the photograph because the cats keep “helping” and it keeps looking a bit like a disaster. Sigh. I wish they were just doll disasters with giant cats wandering through, not real earthquakes.

I wrote Flooded after the tsunami in Japan, about PTSD and about feeling helpless watching. I think we all have a little post-Pandemic PTSD and are more hair trigger and more ready for fight or flight.

Send prayers and money and huge blessings on on the first responders that are heading there or are already there.

For the Ragtag Daily Prompt: strange.

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trauma bunnies

We can work it out, the song says. But no, maybe not, not always.

Trauma bunnies together. Walking. Why would you walk with me, I am so down? Oh, you are a trauma bunny too. Walking on the beach, slowing down, looking at rocks. The walks get longer and longer. You bring FOOD and tell me I have food insecurity. I laugh. But it is true.

Comparing notes about childhood. You say yours was worse. Yours was terrifying. You ran away over and over and over, but came home. Small children need food and shelter. You get older. A neighbor says if you run away now, you will never stop running. You do not run away permanently. But you still run.

My childhood has no bruises to the skin. But the bruises to the heart are a nightmare. You finally say that I win, my childhood was worse. But I was not trying to win, I want to say. I was just telling you as you’ve told me.

We have both survived damage and coped. I have the resource of a grandmother with money who paid for medical school. I apply without telling my parents, after my mother says, “You don’t want to be a doctor. It’s too much work.” I am a poet, a writer, being a doctor so I can study people and have children and be certain there is food. Job security. And food security, true. With a husband or without.

You fight school all the way, but when you are told that you will be a failure or in jail, you decide that you will prove them wrong. You are still proving it. You won’t tell how you make your money, not to the locals, but the new car every two years tells them you have money. And it’s the wrong kind of car: a liberal car for a professed conservative. It stands out.

We start playing trauma bunnies after six months. You want me to come to dinner and I turn New Yorker and direct: is this a date? You are surprised. I set the boundaries and you think about it. And say yes.

But trauma bunnies is not as much fun as the beach. We get close and intimate and then you run. When you run, I run too: the other way. I don’t chase you. You haven’t experienced that before. You keep coming back. Why aren’t I chasing you? Because I too am a trauma bunny, remember?

Back and forth: close and far, together and apart. All holidays become times when you run, so that I will not be part of the family. I announce that I am now your mistress and you can’t be with my family either. Back and forth. Closer and then you refuse to come to my son’s wedding. Far again.

You say the summer will be very busy. You say your focus is music. You say we can go to one beach. One beach? For the whole summer? I run to europe and you are surprised. I ask, are you too busy to have me around? No, you say. But when I return, you have a friend staying with you. Intimacy disappears.

I am tired of it. My daughter is here.

At last I bring up sex: are we done with that?

No, you say. We have visitors.

Wouldn’t stop me, I say.

You say, sex is still on the table. Then you hem and haw. You say sex is not important, you can take or leave it. The friendship is more important. Well, the friendship is most important, but sex IS important to me and hello, it’s damn insulting of you to say you can take or leave it. Leave. This is all triggered by your yearly family get together. You need me at a distance so you won’t be tempted to invite me. You don’t want me there so I am distanced again.

And I am done, done, done. I dream of a small child, a wild woman, a woman doctor and someone new: a quiet woman. I think about the quiet woman and I ask the other three. Yes, they say.

The quiet woman is the adult. Not the mask of the professional, not the wild defense fighter, not the small child. The small child has healed. She is the connection to the Beloved, to the source of the poems. She blesses the others. The quiet woman takes over.

The quiet woman takes over. She says goodbye, farewell, Beloved keep you and bless you, you may contact me any time.

You are in your cave alone and do not answer.

You may end up there, alone, alone, alone. You want freedom most of all, you say. Another song: freedom is another word.

Yes it is. People can change and grow. But some want to and some don’t and sometimes we don’t grow at the same time.

Yes, says the quiet woman. Sometimes we don’t grow at the same time.

Fade to quiet.

______________________________

I took the photograph from a canoe at Lake Matinenda in Ontario, Canada.

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gently

I try to be so gentle with you
trauma drama boy

I know just what it’s like
though mine is not the same as yours

you run away, though
again and again

saying that you would never try
to hurt me ever

that is a shut down
really

since you disavow all intention of hurting
you do whatever you want

your attitude is that if I am hurt or sad
it’s my own fault

you take no responsibility for failures
as a friend

trauma drama boy, you run away
once more

and this time
I’ve had enough

This time
I let you go

Beloved bless you and keep you
for the days you have left

sending love
goodbye

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Arty’s warning

Trigger warning: non graphic mention of child abuse.

_____________________________

I don’t notice that things are frozen at first, because the cats aren’t frozen. I do notice the light. Also I notice the change in sounds. The car outside in the street is not moving nor making sound. Uh-oh.

I go to the front door. Might as well if everything is frozen. I just finished putting on make up, which always means a dangerous mood.

She lands first, on a white flying horse. Who smiles at me, showing fangs. Smoke is coming out of the Pegavamp’s nostrils. Eeeee.

Arty herself is in silver and black today. Silver cloth with black embroidery that seems to be writing a little.

“Good morning, Goddess.” I say, bowing. The other horses and dragons and flying motorcycles and pterodactyls are landing as well. Sol Duc is in the window. Elwha has gone to hide, quite sensibly, I think.

Arty stomps her staff on the ground. “I am really pissed.” she says.

“They named a rocket after you.”

“That penis toy? That is supposed to please me while they are killing virgins who refuse to tent their heads?”

“Sorry.” I hang my head.

“And do you know how much the smoke is going to shorten the lives of my birds and stags?”

“A lot, I think.”

“Do you all want to starve in the dark?’

I look up at her then. “No. I want grandchildren and a healthy earth.”

“Work harder.” she snarls. The rest of the dangerous crowd is muttering and snarling and the local cats have come out. They are sitting very respectfully at a distance. Rooftops. The ridge above my house three blocks up. The tree tops are frozen too.

“Do you need prescriptions again?” I ask. “I see that there have been a lot more rapists jailed. Thank you, Goddess.”

She looks tired for a moment. “We are hunting them everywhere: cities, countryside, hovels, palaces, movie sets, where ever.”

“You don’t turn them into stags any more?”

“Yes, sometimes. My hounds love to tear them apart. But sometimes prison is slower and crueler and a better punishment.”

I kneel. “What service can I do, Goddess?”

She touches me with the staff. I feel a hard bright shock, pain that roars through me and is gone.

“Write this. Write my warning. If this continues, it is death in the cold dark of nuclear winter and we will begin again.”

“Is that the only choice?”

“Oh, no, we are all being very creative. One suggestion has been the sperm banks. There is nothing that says they can’t be used to make one gender only. The one that rapes less and doesn’t kill young girls for what they wear.”

“Thank you for your warning.”

“Stand up.” she says. “You and every abused child, male or female, are under my protection. Yet the cycle must be broken and the abused must not become abusers. Write this.”

The Pegavamp drops one knee and she steps up easily. The other riders start to roar and shout and howl. Her winged creature jumps in the air and the whole group follows. There is a snap and they are gone.

The car in the street is moving and the treetops as well. The cats stand and move away.

I keep writing.

___________________

October 22, 2022

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Embodying a dream

I wrote about the two dreams I had one night, with seven people. Two babies, a boy and a girl. Two professionals, a woman physician and a male policeman. Two rebels, a woman and a man, the man lying or at least misleading the rebel woman. The rebel woman trying to do something that she suddenly realizes is not important and is, in fact, foolish and dangerous. And a quiet woman.

I have been thinking about the quiet woman ever since. My Meyers-Briggs type in medical school came out INTJ, but we are not one thing or another. We have preferences, but we all have to use all the skills. I can be extroverted. I had to work on feeling, that was the really difficult one for me after a frightening childhood. I can pay attention to facts though I sweep them into the intuition very quickly. Medical school is facts and facts and facts, except then there are parts that turn out to change as science changes.

The eighth person is a quiet man. He is not present in the dream. I am thinking about him. I wonder if I will have another dream when I am ready.

I am attending some workshops on line for treating trauma. It is quite fascinating. They talk about working with clients who have aspects like my dream: a small child with trauma. A “fake adult”, aka “adaptive child”, with the tools that the child develops to survive in their childhood. Helping the “fake adult” recognize that some of coping tools may not be helpful or necessary any longer. First, they thank the “fake adult”, for protecting the traumatized child and for surviving at all and for not giving up. I think this is so important, to acknowledge that we have to thank that part of ourselves that did what it had to, that did what it could, to survive. And this can include things that we are ashamed of or fear that others would hate us for if found out. We had a temporary doctor at the hospital who described being a boat person escaping Vietnam at age 8. They were picked up by pirates. “We were glad to see the pirates, because we had run out of water. If the pirates had not picked us up, we would have died.” So there is perspective: death by dehydration or pirates? And she went from a refugee camp and then through medical school and became a physician. Survival and success and I hope that she is thriving.

I like it when a dream has such recognizable symbols. My now retired Unitarian Universalist minister says that we can sit with dreams for a time. What do the symbols mean to me? What is the dream telling me? My dream is in part telling me that I do not need to have the rebel woman lead: she can rest and let the quiet woman take over. And that I am very tired of rebel men who mislead me or run away. I woke up and thought, oh, yes, I see! I am tired of that and ready for change.

Change and transformation can happen throughout our lives, at any age. I welcome it.

Blessings and peace you.

___________________

The photograph is Sol Duc and Elwha enjoying doll bunkbeds. And acting like siblings do sometimes. And then they curl up together.

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only when I’m hungry (1)

sometimes
I still miss you
then I have to check
if I am hungry

I’m doing well, you see
I only miss you when I’m hungry

I’m moving on
but sometimes I still get hungry

hunger is tied up with fear
in childhood
and grief and abandonment

When you fed me
that was huge

You don’t feed me any more

Sometimes I still miss you
but only when I’m hungry

I think you’ve joined the dead
the angry dead
who didn’t feed me
and didn’t love me

or loved me during anger
and wouldn’t feed me

Sometimes I still miss you
but only when I’m hungry

________________

Photo taken by my friend JB.

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Parasympathy

In 2013, Catherine Hodes, director of the Safe Homes Project (a domestic-violence program), started a workshop called “Is it Conflict or Abuse?” An abusive dynamic, she argues, requires one person to have power over the other, whereas conflict involves two people struggling for power. The distinction can be confusing, and in some cases “both people feel like they’re being abused, because they’re not getting their needs met or they’re not getting their way.”

From the Atlantic Monthly article: That’s it, you’re dead to me. September 2022 p. 14.

I think this is a fascinating idea, in the article that questions the internet wisdom of getting rid of “toxic people” in one’s life. When we cut off someone we consider “toxic”, we aren’t peaceing them, are we? Peace me, peace you, how do we actively peace people instead of being afraid, on guard, at war. I think everyone is more afraid after the two years of Covid 19 pandemic and all of the deaths and the Long Haul Covid and war. Everyone has a shorter fuse, everyone is stressed.

Remember that stress activates the sympathetic nervous system, the fight or flight system. The body makes less thyroid and less sex hormones and makes more adrenaline and cortisol. Cortisol is a steroid and great for short term, but bad for long term. If we are continually stressed, cortisol messes up the immune system and we get auto-immune disorders, the body attacking its’ own cells. The adrenaline raises our heart rate and blood pressure, neither of which are good for the heart long term. When the thyroid hormone is on the low side, we feel tired. The adrenaline makes us feel wired and we have trouble sleeping. The cortisol makes us more likely to get sick and raises blood sugar too. The low sex hormones, well, women can stop menses and men start asking for viagra.

So we as a world, need to learn to downregulate the sympathetic nervous system and go back to parasympathetic. The relaxed one. The one where we have less adrenaline and less high cortisol and more thyroid and our gut works and sex works again. How do we get there?

Breathing is one way. Slow breathing: 5 seconds in and 5 seconds out. Work up to 20 minutes. One of my veterans said he was not used to feeling relaxed, it felt weird. Ok, it may feel weird, but maybe we need to practice it. He did. There is circular breathing too, 5 seconds in, 5 hold, 5 out, 5 hold. Zen meditation, facing a wall for 40 minutes, works too. We try not to follow the thoughts. The thoughts pop up anyhow, but not following them down the rabbit hole is interesting and challenging. Mindful mediation and Jon Kabat Zinn’s books and tapes work as well. It takes practice. Practice peace, practice relaxing. Doesn’t that sound like a lovely practice?

Stupid cat videos work for me too. Laughter works. What makes you laugh? I like the silly animal videos, the moose playing with the wind chimes, three baby bears rescued (with care) from a dumpster, with the truck driving off to avoid momma bear. Rocking, knitting, sewing, fishing, walking the beach, cuddling a baby, dancing, listening to music, playing music. Which works for you? Silly movies. I don’t like horror movies, and I love cartoons and animation. Engage the child at heart for the parasympathetic nervous system.

In high school my daughter said that most fights were stupid. “One person says something without thinking. The other person goes off and gets upset. She stops talking to person one, who has no idea what is going on, and they often talk to their friends. So there is this big fight over some dumb comment.”

I don’t think it ends with high school, sadly enough. And before we label someone “toxic”, maybe we need to wander off and breathe, or watch a silly cat video. Whatever works for you that doesn’t hurt others.

We need more parasympathy in the world. Yep, I just made that word up. Relax and if you can’t or won’t, consider practicing.

Peace you and please peace me.

https://my.clevelandclinic.org/health/body/23266-parasympathetic-nervous-system-psns

https://healthnews.com/family-health/healthy-living/how-to-activate-the-parasympathetic-nervous-system/

August 19, 2022

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Adverse Childhood Experiences 13: on gratitude

I saw a meme today about gratitude. It is saying that some people look at a garden and see thorns and weeds, but others see the roses. That we need to have gratitude. I think this is simplistic and papers over the trauma and grief that some people have. If they have endured a highly traumatic childhood, who am I to say they should focus on the roses? They may have a very good reason to see if there is something like a thorn that can hurt them before enjoying the roses.

I work with many patients with high Adverse Childhood Experience scores and mine is high too. I don’t tell my patients that they should have gratitude. I tell them “You survived your childhood. You have crisis wiring. Good for you. Some of your learned crisis survival wiring may not serve you as well now as it did when you were a child.” Then we discuss whether they want to work on any aspects and the many many different approaches. One example: a man who sleeps very lightly. He said that it was lifelong. When asked about his childhood he says, “We would have to leave in the night when there was shooting in my neighborhood. It was a very dangerous area.” I said, “I am not surprised you sleep lightly. You HAD to in childhood to survive. Is this something you want to try and change?” He thought about it and decided, no. Once it was framed as learned in childhood to survive, he stopped worrying about “normal”. He was satisfied that the way he slept was “normal” for him and he wanted to wake up if he heard shooting.

I think we have to ask why a person sees thorns and weeds in a garden before we judge them. My first thought with a new and angry or hostile patient is always, oh, they have been badly hurt in the past. What happened? I don’t worry that the anger is at me. I know it’s not at me, it’s at the system or a past physician or a past event. Under the anger there are other emotions, usually fear or humiliation or grief. I have brought up Adverse Childhood Experience scores on the first visit sometimes. One person replies, “I am a 10 out of 10.” The score only goes up to 8 but I agree. He was a 10. He stated once, “The military loved me because I could go from zero to 60 in one minute.” Very very defensive and very quick to respond. The response may seem extreme and inappropriate to other people: but it may feel like the only safe way to be to my patient.

I grew up hiding any grief or fear in my family, under anger, because grief or fear would be made into a story told for laughs. In college, a boyfriend told me I was an ogre when I was angry. I started working on it then and it was difficult to tame that. The person who took the longest was my sister: she could make me explode until I was in my residency. Medical training was excellent for learning emotional control, at least, on the surface. After my mother died, I had to do the next piece of emotional work: open the Pandora’s Box of stuffed emotions, mostly fear and grief, and let them out. It was such hard work that my day where I saw the counselor for an hour was harder than my ten hour clinic day. I did the work, for two long years. Blessings on the counselors who stood by me while I worked through it.

I do not think we are ever done with that sort of work. I think, what do I need to learn next? What is this friend teaching me? Why is this behavior frustrating me and I have to look in my inner mirror. Why, why, why?

Blessing on your healing path and may you not be judged.

Link about ACE scores: https://www.cdc.gov/violenceprevention/aces/about.html

Sometimes I do feel like a fossil, now that I am middle aged. For the Ragtag Daily Prompt: fossil.

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Patient Satisfaction Score

The latest issue of Family Practice Medicine has an article on patient satisfaction scores.

I remember my first patient satisfaction score VIVIDLY.

I am in my first family medicine job in Alamosa, Colorado. I receive a 21 page handout with multiple graphs about my patient satisfaction scores. I am horrified because I score 30% overall. I am more horrified by the score than the information that I will not receive the bonus.

I go to my PA (physician’s assistant). He too has scored 30%. We are clearly complete failures as medical providers.

Then I go to my partner who has been there for over 20 years.

She snorts. “Look at the number of patients.”

“What?” I say. I look.

My score is based on interviews with three patients. Yes, you read that correctly. THREE PEOPLE.

And I have 21 pages of graphs in color based on three people.

I am annoyed and creative. I talk to the Physicians Assistant and we plan. I call the CFO.

“My PA and I think we should resign.”

“What? Why?”

“We scored 30% on the patient satisfaction. We have never scored that low on anything in our lives before. We are failures as medical people. We are going to go work for the post office.”

“NO! It’s not that important! It is only three patients! You are not failures!”

“Three patients?” I ask.

“Yes, just three.”

“And you based a bonus on three patients? And sent me 21 pages of colored graphs based on three patients?”

“Um…”

“I think we should discuss the bonus further….”

I did not get the bonus. It was a total set up and I am not sure that ANYONE got that bonus. Much of the maximum “earning potential” advertised was impossible for any one person to get. You would have to work around the clock. They got out of paying us by having multiple bonuses that each required a lot of extra work…. They were experts in cheating the employed physicians. That became pretty clear and I was 5th senior physician out of 15 in two years, because ten physicians got right out of there. I lasted three years, barely. I knew I would not last when an excellent partner refused her second year of $50,000 in federal rural underserved loan repayment to quit AND stayed in the Valley working in the emergency room. I called the CEO: “Doesn’t this get your attention?”

“She just didn’t fit in.”

“Yes, well, I don’t think anyone will.” I asked my senior partner how she stayed. “You pick your turf and you guard it!” said my partner. I thought, you know, I hope that medicine is not that grim everywhere.

Unfortunately I think that it IS that grim and getting grimmer. Remember that in the end, it is we the people who vote who control the US medical system. If we vote to privatize Medicare, we will destroy it. Right now 1 in 5 doctors and 1 in 4 nurses want to leave medicine. Covid-19 has accelerated the destruction of the US medical non-system, as my fellow Mad as Hell Doctor calls it. We need Medicare for all, a shut down of US health insurance companies, and to have money going to healthcare rather than to paying employees $100,000 or more per year to try to get prior authorizations from over 500 different insurance companies all with different rules, multiple insurance plans and different computer websites. Right now I have specialists in four different local systems. The only person who has read everyone’s clinic notes is ME because it is nearly impossible to get them to communicate with each other. Two of them use the EPIC electronic medical record but consider the patient information “proprietary” and I have to call to get them to release the notes to each other. Is this something that we think helps people’s health? I don’t think so. I have trouble with the system in spite of being a physician and I HATE going to my local healthcare organization. Vote the system down and tell your congresspeople that you too want Medicare For All and single payer.

Physicians for a National Healthcare Program: https://pnhp.org/

Healthcare Now: https://www.healthcare-now.org/

I have had people say, but think of all the people out of work when we shut down insurance companies. Yes AND think of the freedom to start small businesses if we no longer have to fear the huge cost of insurance: Medicare for all!