We all know that ending a secreted abuse and getting public support is an important element of healing. Indeed, it is nice when society comes to the rescue as they did to victims when the world trade towers fell. When victims sense they are supported there is more opportunity for resilience, heroism, and healing.
But alas, many of the people I work with on an Outpatient Psychiatric Unit do not enjoy such support. Many lead lives of poverty and neglect due to what is presumed to be medical illness of the mind. Many have done stints standing on the corner with a cardboard sign and are used to be seeing in a negative light. Imagine the constant digs or exclusionary put-downs they may receive from their community of origin. Many choose to withdraw from the world. It is as if society has managed their crisis by tying them down to their beds like African-American, male Katrina-victims. Progress toward healing is slow.
As a worker in the system, I have come to feel that many of our clients get dehumanized when we focus on behavioral control rather than freedom from abuse. Focusing on behavior can point out what is wrong with the person and make it unsafe to talk about the ways they have been hurt. I feel weeding through hurts helps a person gain acceptance and healing.
Perhaps this focus on behavior happens because of the way our institutions define human suffering as being part of a medical mental illness. Thinking you have an illness may feel good at first but often make problems worse down the line. Some who suffer may feel, they have been born with a diseased mind all along. They may feel this way, for example, with a label of schizophrenia because many people with a disease model mentality may treat them that way.
I believe that when trauma is hard to detect or complex, the mental health system assigns blame inside the scientific sanctity of the individual. This can result in things like multiple diagnostic labels, use of forced medication as a punishment, restraints, solitary confinement, psychiatric incarceration, and, eventually, permanent warehousing.
As a psychotherapist I have found that understanding these problems as signs of micro abuse that accelerate with stigma and exclusion to be vital to being able to connect with participants in our program.
Understanding the Role of Sexual Trauma in my own Life:
Like many psychotherapists my first client has been myself. I admittedly have lived experience with a long list of psychiatric labels including recurrent depression, anorexia, bulimia, ADD, dyslexia, schizophrenia, and now that I have recovered, schizoaffective disorder.
I have spent decades in therapy and received care that emphasized the illness narrative. I have taken pharmacies of detrimental pills even though I have come to a place where I believe I get some help from small doses. I have even been referred to permanent warehousing in a state hospital in Montana.
I am writing to demystify the role that complex trauma has beneath the surface for so many of our most defamed, dehumanized, and marginalized people.
How Controlling Behavior May Lead to Re-traumatization Instead of Help:
It is true I have had an ongoing suspicion that I was sexually abused. Particularly when locked up for extended periods of time for an eating disorder, and most recently for schizophrenia, my suspicion that my suffering had sexual abuse behind it escalated. I went through a phase of clothing myself while bathing post-latency that was always hard to understand. My sense of shame associated with my body was suggestive to me.
Yet, I once had a female therapist confront me about secreted accusations I had made against my mother on an inpatient unit. At the time I was confronted, I could not remember the real incidents of sexual abuse that I experienced. I just stopped confiding in the therapist in any meaningful way. This really added to my sense of shame. It’s true I recovered, but I lead a limited life of work and torment.
Without knowing that I once was abused, it becomes that much harder to discern triggered re-traumatization, from abuse. People who don’t realize that their suffering is due to trauma are often unable to do this. They may repeatedly feel abused a gazillion times and it becomes hard to see how the community might come to the rescue. Instead, we get cast as not taking responsibility for our own problems that are generated by our defective genes.
The Importance of Vigilantly Assessing for Disassociation:
I have always been aware that I disassociate. I think it is a good idea for therapists and mental health workers to assess for disassociation. It is a simple question but may need to be teased out a bit to accurately assess for it.
Though I had been in therapy my whole life, I only had one therapist take note and get suspicious about the disassociation I described. What I have come to realize by listening to others is that if a person has experiences of disassociation, there is the possibility of incidents of distressing events that they may have forgotten.
An example of a disassociation I experienced was when I was alone scouting a trail. I stepped within six inches of a rattlesnake, a childhood obsession of mine. The rattle made me run even though I knew better. Then I became aware that I lost track of time. Finally, one of my peers on the Outward-Bound course came and found me staring off into space and I grounded myself.
Another time, my best high school friend made a pass at me after communicating in metaphoric manners that were suggestive that he might have been tripping on acid. I came to at several points to find myself hiding in the house. At one point I heard him talking to my mother when she returned to the house. He was talking about gay marriage and, somehow, I had gotten down into the basement again.
And, finally, after being teargassed at the WTO Protest in 1999, and pepper sprayed directly in the eye, I took a walk and lost track of where I was and what I was doing. Suddenly, I realized I walked past my destination and had been out.
I am now at the point of arguing that these seemingly inconsequential incidents are faint traces that there is a need to explore more. I emphasize that I advocate doing this to help understand oneself instead of vilifying others. For example, my best friend does not deserve to be vilified, and yet the disassociation was real. Though disassociation experience may not seem significant to the daily suffering that gets experienced, I think it is an important indicator of trauma that may accelerate over time if it goes unaddressed.
How I Broke through the Wall:
I took it upon myself to write about starting to disassociate in front of my nephew when he was a bathing cherub in a tub in front of me. I did not fully disassociate and I considered the experience a flashback. I was going outside my body but didn’t leave all the way. This had been happening to me on a few occasions when I was working seven days a week trying to get back on my feet financially after my post-state-hospital period of homelessness.
As I was editing the scene suddenly I got a vague flash of being molested in a bathtub. The girl, my best friend’s sister, was only one year older. I would later remember that she ordered me to take my clothes of and get in the tub with her while our parents were out walking on the railroad grade.
I still don’t remember my response. There is a story that I ate a moth ball thinking it was a marshmallow necessitating poison control to be contacted. I was a little old to make such a silly mistake. It’s true I could be wrong, but I connect that action to my response to the tub incident. I do believe that that was the summer I started bathing in my trunks.
When I took this story to my mother, I got an additional answer. “No, you are thinking of the time we caught the babysitter touching you,” she said.
While I continue to have no memory of this incident I remember several occasions when I was around this babysitter later in life. Before I hadn’t been able to understand my piercing feelings, behavior and memory of those occasions.
“Thank you for telling me,” I stated to my Mom.
“I probably shouldn’t have told you,” she said, “Now you are going to think you have been abused a gazillion times!”
When Hypervigilance and Numbing Seem Like They Are Normal:
Just like the bath with my step-sister might not have been distressing to many untraumatized young boys, there is the possibility that memories of intense hypervigilance may not always be indications of sex abuse. Not all intense memories I have led to recovered memories.
Before I broke through the wall disassociation I could never understand why I got such strong intuition and suspicions. I didn’t realize that I was doing this for a good reason. I often presumed there was something wrong with me. I had to learn to numb out to prevent embarrassing myself worse socially.
I also have a hard time defending myself when I get attacked. When I do defend hypervigilance, I come off too strong and the results never go well. Then, when I am called on to defend myself during a test, I often fail to act because I think it may be hypervigilance.
People who prey on others can see these signs and chose people they can hurt without getting in trouble. This can open a body up to bullying that can become institutional when labels get attached. Powerful mental health administrators have done this to me and I remain marginalized in the county in which I work.
More Meaningful Memories:
When I found out that her brother had sexually abused a childhood friend, I suddenly had a flash and an image. I saw him rape her, became paralyzed with fear and fled. Had I really behaved like that? It seemed like more of an intuitive dream, that a solid reality.
Typical, I thought, for a schizophrenic to hear about sex abuse and think it is all about him. Perhaps some of the readers may think so as well.
However, I do remember visiting the two of them alone in a vacation cabin along the Chatooga River in the Adirondacks. They were skinny-dipping, she with just a shirt on, he in the nude, and me, very attached to my bathing suit. My last memory of the evening involves him standing behind her wrestling her around.
The distinctive flash of a rape and an overwhelming feeling of cowardice and helplessness that overtook me when I should have protected the victim is unconnected to any other part of the evening.
The brother has only admitted to inappropriate touching. So, I acknowledge that even saying the word rape may be inappropriate and unfair. If I considered these flashes reality, there are several other incidents in my life to talk about with other adult men.
Years later I had rescue fantasies and psyched myself up to respond to rape scenes. This happened at a time when I took a job in a lawless section eight housing project; and used community activists and the press to fight the management company, the police and the black market dealers against all odds. This is action that caused the police and my parents to attempt to institutionalize me in a state hospital.
Is it possible that my objectionable behavior of using the press to out real murder and mayhem was simply an unconscious expression of ongoing existential guilt from unrealized events? Is it possible that some of my schizophrenia was exacerbated by real government monitoring? For a year the only job I could maintain was an arranged job at an Italian Deli through which I thought I was being persecuted by the Italian Mafia. When I stopped acting persecuted and started being thankful for a nine-dollar an hour job, I was able to return to professional job opportunities.
“The first question that gets asked shouldn’t be what is wrong with you, it should be what happened to you?”—Jackie Dillion
I think therapists have a responsibility to assess for incidents of abuse. This is not about potentially wrongly vilifying people like the brother above, it is about healing and changing behavior. For healing even heinous acts need to be emotionally accepted, yet never forgot. It involves constant intuitive listening and questioning and remembrance of patterns on the part of a psychotherapist. What is far more common in psychiatry these days is the focus only on symptoms and behaviors associated with mental illnesses. It becomes easy to become part of the problem for many when blame is assigned within the genetic codes and neurotransmitter cocktails of the individuals.
Overemphasizing these concepts without acknowledging the role of trauma promotes stigmas and generalizations. This not only orients us towards not considering traumatic occurrences, it makes it highly likely that we will re-traumatize sufferers and further marginalize them.
I believe that when therapy is governed with an illness narrative mentality, money gets made, and many of the recipients lose support and wind up deprived, impoverished and defeated. The mental health system becomes much more a system of control and ongoing abuse when things are as such.
I would advise someone who is suffering and receiving psychiatric care not to underestimate the role that trauma may have in their suffering. Learning about this and honoring it yourself can help you make meaning of your suffering. Unfortunately, if our communities don’t understand or teach us about trauma, we need to do this for ourselves. I believe this is when psychotherapy can be helpful. However, when psychotherapists maintain the psychiatric illness mentality, therapy can go on for years without understanding underlying complex trauma.