That’s a cheery title! Hope I haven’t frightened off too many people.
I just read a book entitled “Surviving Survival” by Laurence Gonzales. It is an interesting read on what happens after people have endured traumatic events or extended traumatic conditions. He also touches on conditions as diverse as phantom limb syndrome and it’s opposite, “body integrity identity disorder” BIID, Tourette’s syndrome, and knitting. Gonzales is the top author on the psychology of trauma and extreme survival and a lay expert in neurology. His interest in the topic stems from his father’s experiences in World War II.
I’ve read his magnum opus “Deep Survival“. It is the best book ever written about the psychological traits that make one more likely to survive an emergency. Next on my list is “Everyday Survival” by the same author. I’m not even sure what it is about.
The people he speaks about have experienced some of the most horrific events a human can and still live. Anne lost her beloved 5-year-old daughter, almost overnight, to an aggressive infection and was consumed by madness. Micki was almost eaten by a shark and multiple miracles had to happen just for her to survive. Chris was blown up in an IED attack that took one leg and nearly an arm and destroyed his short term memory. Debbie was lost for weeks at sea and watched her closest friends lose their minds, deteriorate physically, and die. Lysette was shot several times by an abusive husband in front of her children. Jess worked in a mortuary collection unit in Iraq where the job was to collect and reassemble bits and pieces of soldiers who had been blown to pieces. Soon the entire unit had slipped into psychological trauma from the horror. Michele endured savage beatings from her husband for years. Aron Rolston famously had to cut off his own arm to escape a fallen rock.
And there were others. What they all had in common was horrific trauma that took time to recover from.
One thing I noticed very quickly is that I think he may have cherry-picked his traumas. There were men who worked in that mortuary unit who were scarred just as badly by the experience. Did they have a different recovery experience? Debbie survived being lost at sea with a man named Ben. His story was barely touched upon. Surely there are as many men as women who are shredded by a shark or ripped apart by a crocodile or lose their beloved child. Many many more men than women came back from the war with PTSD. I have a cousin who did.
It would have been more informative to see if there was a difference in how the genders dealt with the same trauma. And comparing the experiences of those who “bounced back” quickly with those who did not.
Another issue I have is the overwrought prose with which he sometimes describes a person’s experience. He gets downright maudlin at points. Other times he becomes almost mystical. He also makes some connections that don’t click with me. One example is where he connects the loss of one’s immune system in chemotherapy to the loss of self-identity because both involve knowledge of who the “self” is. I can see that as an analogy but I don’t see a literal connection.
Yet another issue is that a majority of the survivors he discusses are both heroic by nature and have a support system that was superior to any I ever had. I understand using the best examples as role models. But what happens to the rest of us?
Ah well! YMMV.
When a traumatic event hits you or when an accumulation of many small traumas builds up to the same effect, your brain records every detail that happened into long term memory without any regard for whether the information is relevant. If it was a clear crisp autumn day when the WTC was destroyed, those same kinds of days may be associated with the terror and horror of the event. So will low flying aircraft or possibly any aircraft at all. We tend to remember where we were when something terrible happens. If that terrible thing happened to us, the association may be overwhelming.
Primitive emotions are derived from our amygdala. That’s the “reptile” part of our brain. It is all a lizard or turtle has and we still have it, along with a primitive mammal’s brain called the “limbic brain.” It is in charge of the fight or flight reflex, often called the “rage pathway” in the book. It doesn’t have a sense of time so something from 50 years ago could still be front and center.
This is where we learn things important to survival, stuff we don’t think about but reflexively do. Like avoiding predators and fighting. When signals come in on parallel lines, they become permanently associated. If a crocodile attacks you, everything else that happened in the immediate vicinity of that attack can bring out the same fight or flight response if we experience them later, even without a crocodile in sight. Call it a flashback or possibly a panic attack.
If that event was the sudden and unexpected death of the center of our life or the attempt to murder us by our spouse, we will be surrounded by reminders. The “rage pathway” pumps massive levels of cortisol and epinephrine into our systems incessantly. The end result can be mental and physical illness from constant overstimulation. Eventually, that pathway burns out and what is left is depression, a paralyzing numbness rather than a healing grief. You slip into despair and the pathway slowly recovers. Then the next reminder sets it off again.
But other things come from our amygdala as well. It is responsible for what the book called “seeking behavior.” It also controls complicated activities that don’t involve thought. Muscle memory and proprioception, directionality. Searching activity, stalking activity. Repetitive motion activities.
It can generally do only one thing at a time. All that cortisol and epinephrine are locked into a negative feedback loop. Positive emotions from the amygdala like lust and excitement also depend on cortisol and epi. So do feelings of hope and love, which emanate from the limbic brain. But the negative association with the trauma prevents them from being turned on.
As an aside, cortisol and epi are not themselves either good or bad. It is the experience that causes them to be produced that colors them. Experimenters had people walk across a rickety bridge that appeared dangerous. Some simply walked across the bridge and nothing else. They recorded the experience as being scary. Others walked across the bridge with someone on the other end who was generally deemed attractive waiting to greet them. These people tended to record the experience as pleasurable and somewhat arousing. Same pounding heart, same shaky bridge, different experience.
But the body is a system in tension. For every push, there is a pull. For the sympathetic nervous system that moves us, there is the parasympathetic nervous system that holds us back. One system pumps action hormones into the bloodstream, another neutralizes them. When fight or flight has come to dominate the body, we need to activate another system that does the opposite.
When Anne was cycling thru fight or flight reactions every time something reminded her of her daughter, she literally had no control over herself. She would end up places and have no memory of getting there. This is because the amygdala doesn’t talk to the higher brain much. It is quite capable of running your body on its own without thought or awareness. It is perfectly capable of sleepwalking, sleep-driving, and even sleep sex.
It’s also where “muscle memory” resides. Neural signals get to your amygdala long before the higher brain allowing for much faster reflexes. That’s how a basketball player can dribble the ball without looking at it then twist and shoot a basket without a thought.
The author describes people who are blind because their visual cortex is damaged, but the optic nerve is still working. You can put them in a dark room with a single light and they can point at the light with great accuracy. Hidden within that reptile brain is a second visual cortex that does not communicate with the conscious mind. It can make out light and dark, shape and motion and direction and combines this with the sense of proprioception. It explains why there have been highly skilled blind martial artists. It is called blindsight.
However, it can’t do that and be in “fight or flight” mode. The athletic greats all look like they’re fighting desperately to score. In reality, the greats are all in a very “zen” state. Cortisol and epi are great for massive short term feats of raw strength but they also cause muscles to shake, vision to narrow, and strategic thinking to fail. There is little room for fear or anger as distractions on the playing field. Let the amygdala concentrate on motion while the frontal cortex works on outsmarting the other guy. It is called “keeping your head in the game”.
Enter knitting. Mastering the basic motions of knitting is a matter of training the amygdala. If you can get it busy doing that, it shuts out the “rage pathway”. Once you have mastered the basic knitting motion, the amygdala happily sets into the repetitive motion. The higher brain is set free to focus on the pattern. The act of knitting becomes a kind of mantra and it leads to an almost hypnotic state. Every stitch is a tiny little shot of endorphin, keeping you “in the zone”. The “zone” is a relaxing place and one can emerge hours later wondering where the time went. Time spent in the zone weakens the rage pathway.
Anne was well into mental illness and on the brink of insanity when her friends introduced her to knitting to get her mind off her memories. It worked and offered her amygdala something else to do besides rage. It also broke her self imposed isolation. Humans are social animals. Being preoccupied with “rage” isolated her from the herd. With knitting to focus on, she had something to share with a group of supportive people who shared the interest. You don’t support a sufferer of PTSD by reiterating your apology for the cause, you support them by allowing them to move on.
It doesn’t have to be knitting. It could be crochet. Or it could be writing. It could be video games as long as the games are safe relative to the trauma. It could be running or hiking. Any kind of art will do. Any kind of sport. The requirements are some kind of repetitive physical activity to keep the amygdala happy, some kind of progress markers so tiny shots of endorphins get delivered each time something is accomplished and some kind of higher-level mental work to keep the cerebral cortex busy. Needs to be something where you can simply zone out and lose track of time. Needs to be something you can start up instantly if you feel a panic attack coming on.
Of course, this isn’t the total story. There are many other recovery strategies to be taken advantage of. One is travel. Get away from the associations that trip your flashback. The farther you can get from the origin, the better. One thing the hippocampus, another reptile part of the brain, does is mapping your world. Landing in a totally strange environment forces it to go into mapping mode. Unless your trauma involved getting hopelessly lost, this forces you out of “rage” mode and into “Where the hell am I?” mode. The strange environment sends the brain into learning mode for language and culture.
Another strategy is extinction. After she recovered enough, Micki’s husband put a photo he’d taken of the shark which had attacked her on her computer as wallpaper. This may sound despicable but it was actually therapeutic. She knew the photo was there, so no sudden shock upon seeing it. She could muster her resolve and face the demon and tell it to go to hell – then go on to doing something she enjoyed. Soon, seeing pictures of sharks, even unexpected ones, no longer triggered her.
Still another is suppression. Suppression isn’t a popular thing to advocate, but it is how we overcame trauma in the past. My father was in the WWII generation, so were the parents of most of my classmates. Most of the people who saw really violent action never talked about it. They kept it packed away. Runs counter to today’s theory that everything has to be talked out. Perhaps it can be better at times to lock it away.
Along the same line, the military have found combat-oriented video games to be useful in fighting combat-related PTSD. Counterintuitive? Maybe not. Starting with the simplest and least violent of games, the soldier works his way up to more and more realistic games. Environmental associations with death and destruction get rewired into a rewarding pastime. Plus it shares all the good points of knitting in taming the amygdala.
Once you have started to recover, helping someone who is worse off than you is extremely therapeutic. Once out of the depths of despair, Anne met a woman in therapy who had lost her two-year-old son much more recently. Helping the other woman up from the depths assisted her own recovery.
He goes on to discuss the experience of concentration camp survivors and finishes with a list of things he believes will help a survivor reintegrate into a new and frightening world.
FEMA got 150+ million dollars set aside for therapy after 9-11. It was believed that a quarter-million people would need counseling. Less than 300 people took them up on the offer. Once the immediate aftermath of the attack was over, many of the first responders were coerced to go into therapy and talk about the things they experienced. Talking about what happened, soon after it happened, had the effect of making the people relive what had happened. This just reinforced the fight or flight associations.
Better outcomes were reported by people who went into therapy much later or even not at all. It takes time for the mind to process what happened, to form useful concepts that could be spoken of. People have been facing trauma for as long as the species has existed, as have all the hominid species we evolved from. When it is time to talk, humans will talk. It may not be a therapist. It could be a spouse or a parent or a sibling. Maybe a priest or other figure of faith. It could be with drinking buddies or working buddies or people who shared the same trauma.
Or it may be some idiot like me, blogging TMI for all the world to see and cringe.
Not everyone needs therapy. I know in my own case that it helped very little. I had to work things out for myself and the therapist might as well have been an AI program. My biggest step forward was in the opposite direction from what my first psychotherapist had expected. Other people benefit greatly from a skilled therapist but, inevitably, not all are skilled.
At the conclusion of WWII, millions of soldiers came home from a hell that was every bit
as bad as any more recent war. There were many cases of battle fatigue (as PTSD was called at the time) but we didn’t see the high rates of unemployment, depression, dysfunction and even suicide we’ve seen more recently. Jews rescued from the camps drove the British out of Israel and built a thriving and powerful state, not the actions of people who were irrecoverably damaged.
A lot of it has been ascribed to a much slower process of extraction from the battle zone and return home. There were months to talk things out with fellow soldiers. When you got home, there was a hero’s welcome and the workplaces and play places and watering holes were full of men who had gone thru exactly what you had and understood. There were benefits to help you start your new life. You were expected and encouraged to simply pick up and move on. The culture was different then.
Perhaps the freed Jews were benefited by a similar process.
We delude ourselves to think there is anything magical about a therapist. All a therapist is is someone who has been paid to listen and to make suggestions. They may have seen and been taught many things but it isn’t knowledge most people need. Damaged people need a bit of love, acceptance, empathy and friendship, even solidarity with others in the same boat. No therapist can hand out empathy and friendship to every patient who needs it. It would soon exhaust and destroy them.
The word “recovery” has been used a number of times in this write-up. It is probably not the right word. You can never return to who and what you once were. Not even from one day to the next, let alone after a terrible trauma. You change and you are a slightly different person. In ordinary life, we evolve and the change can be seen as a series of small steps along an arc.
In the case of severe trauma, our life is truncated. We lose who we are. There are bits and pieces of us scattered about. Some can be reused and some cannot. We have to reinvent ourselves. Many trauma survivors report being reborn and having a completely different take on life. We’ve had a massive piece of ourselves torn off and something has to fill that gap. The person who comes out of severe trauma may not be recognizable. It will be a new you, updated, reborn, and reinvented. Consider it a second chance in life.