It happened on an ordinary Wednesday morning. I was driving to college, my brain on autopilot, lost in thoughts of upcoming academic obligations and the daily minutiae of deciding what to cook for dinner. After stopping at a red light, I saw the passenger door open in my peripheral vision. Before my brain could even fully register what was happening, a middle aged man I’d never seen before, reeking of sweat and urine, entered my car and sat down in the passenger seat next to me, closing the door behind him.
“Take me somewhere right now! Take me now!” He yelled at me. I could actually feel the adrenaline flood my body, my face and hands felt clammy as my heart pounded. Initially frozen in indecision, I suddenly remembered a TV show that I once watched, in which a police officer stated that if anyone is ever held against their will in a vehicle, the best course of action is to either refuse to move (if the victim is the driver), or to escape the vehicle (if the perpetrator is the driver). The officer had reported that the victim’s survival rate rises exponentially when they refuse to travel by car with the perpetrator.
I immediately knew what to do. I turned to face this invading stranger, my anger rising, my heart pounding, and while my foot pressed down tightly on the brake as the light turned green, I screamed back “Get out! Get out of my car!” beating him in the shoulder with my fist. At first, he continued to yell at me to “take him somewhere!” I responded by screaming at him to get out of my car and hitting him as hard as I could. I even leaned over to open the passenger door and shove him toward the exit. Maybe it was my panicked screaming, maybe it was the cars angrily honking behind me as I remained rooted to my spot on the road, maybe he thought I had simply lost my mind, but for whatever reason, he left my car at that very moment, returning to stand on the sidewalk and watch me through the passenger window of my car as I hurriedly drove away.
While the stranger had left my car, and my life, for good, the experience, like many of the traumatic experiences my clients report, stayed with me, through subtle subsequent changes to my internal responses toward my external environment.
This part of the trauma process is often a mystery to trauma survivors, and it absolutely shouldn’t be. We must have an understanding of our physiological traumatic responses in order to fully appreciate our selves and learn how we can heal.
Take for example, a person diagnosed with Diabetes Mellitus. Now imagine if that diabetic patient had no understanding of how this disease process progressed and no knowledge of its effect on the body. How can he understand what is happening for him physiologically? He can’t! And if he can’t understand how his body is working and why, how can he properly treat his symptoms and care for himself?
You guessed it. HE CAN’T.
For trauma survivors, as with those diagnosed with a medical condition, the understanding of traumatic physiology, which eventually may lend itself to the appreciation of the self, ultimately paving the way for survivors to experience true, lasting recovery, is fundamental and integral to the healing process . And yet, those diagnosed with Diabetes meet with their primary care physicians, endocrinologists, nephrologists, podiatrists, ophthalmologists, and nutritionists who explain the inner workings of diabetic physiology. The disease process information is transmitted to the patient to further the goal of optimal self-care. But for trauma survivors? Not only aren’t there professional round table discussions between providers and patients for the purpose of education and treatment, but we often aren’t even aware that the collection of symptoms we are experiencing are the direct result of physiological traumatic response. We are left to essentially fumble around in the dark, dismissing our anxiety and depression, explaining away our memory loss, covering up our ‘embarrassing’ hypervigilance. If we do acknowledge our symptoms, we do so without an understanding of why we are experiencing them and what is actually happening to us, and often try to treat ourselves off of friends’ suggestions, late night WebMD searches, or our own blind journey of trial and error.
So what actually happens to us in incidents of trauma?
During a traumatic experience, the brain senses that the body is in danger and immediately shuts down all nonessential physiological activity. The sympathetic nervous system ‘takes over’, increasing the body’s stress hormones in order to prepare the body to respond to the perceived threat. When the threat ceases, the brain and body return to its normal, parasympathetic nervous system functioning. The brain registers that the threat is over, stress hormones are reduced to pre-threat levels and normal functioning resumes.
For those with sustained trauma symptoms and PTSD diagnoses, the brain and body do not return to pre-threat functioning after the traumatic incident. Instead, the brain continues to register perceived threats long after the threat is over, has difficulty mediating traumatic memories for the purpose of distinguishing past threats from present ones, while the body struggles to self-regulate its biological and chemical imbalances caused by sympathetic nervous system reactions to perceived threats that continue to present long after the traumatic incident.
According to Bremner (2006) and several other studies on the subject, activity in select areas of the brain and subsequent chemical and biological stress responses of those who suffer from PTSD as compared to those who do not, are structurally and functionally different, long after the traumatic event(s) took place. So while our brain may be preparing us for survival (it really means well!), it doesn’t do the best job of distinguishing real danger from the imagined. That is why trauma survivors may feel disturbed by trauma symptoms such as being easily startled, loss of memory, nightmares, flashbacks, anxiety, phobias, depression, insomnia, social withdrawal, guilt, shame, anger and more, even when there is no real danger or threat.
Now to circle back to my trauma narrative:
I had never considered it a possibility that a stranger would enter my car uninvited. Because of that, I had always driven with my windows rolled all the way down, my doors unlocked. I allowed myself to get lost in my thoughts, my level of vigilance toward my environment was low. I felt safe.
Enter my traumatic incident, after which my entire driving experience changed due to organic traumatic response.
For several months following the incident, I felt scared and unsafe when entering or leaving my car (traumatic fear). I locked the doors immediately after sitting in the driver’s seat, and checked all 3 mirrors religiously (hypervigilance). I used the A/C more and rolled the windows down less. I chose a longer, circuitous route so as not to travel the same road as I had before (avoidance). I felt physically and emotionally uncomfortable while driving and found myself to be surprised when each driving trip ended without incident. All of these symptoms were caused by lingering traumatic physiological responses.
Understanding my traumatic physiology and appreciating how my brain and body were working to keep me safe were an integral part of my own traumatic recovery, as it is for many trauma survivors that seek healing.
Essentially, many behaviors that present as manifestations of physiological traumatic responses resolve as a result of trauma focused psychotherapeutic treatment, which essentially trains the mind and body to respond to external stimuli as though the survivor is currently safe.
With the passage of time and the application of trauma focused therapeutic exercises, my symptoms lessened and my physiological, cognitive and emotional responses began to reflect what they had been pre-traumatic episode. I felt more confident in my car. I lowered my window a bit more. I waited a moment before locking the car after climbing inside. I still checked the mirrors, but was no longer surprised at not finding anything suspicious or alarming. I never forgot my terrifying incident, but with the assimilation of cognitive therapeutic skills and relaxation techniques, I was once again able to navigate my world comfortably.
Differently, but comfortably.
And that’s good, because striking a balance between healthy self-protection and awareness and a sense of emotional regulation and calm is an excellent goal for those who have experienced trauma. We are working WITH our biochemical makeup to maintain our safety, while reducing traumatic responses which interrupt our healthy day to day functioning.
So are trauma responses good for us, or are they something we need to fix?
I’d answer that with the old adage, “If it ain’t broke, don’t fix it!”
People are incredibly strong and adaptive, and we learn quickly to integrate traumatic experiences to help us formulate new blueprints illustrating how to protect ourselves from environmental dangers. Our sensitivity and responsiveness to the environment reflects our evolutionary ability to survive despite countless physical and psychological threats to our well-being. There may be a lot of things we can think of fixing, but our protective responses in the face of trauma shouldn’t’ be on the list.
So what does it mean when psychotherapists discuss ‘treating’ traumatic injury?
It means that we want to encourage clients to examine their physical, mental and emotional processes to understand and appreciate human adaptability and strength, and to guide and manage the traumatic responses that make them feel uncomfortable and cause dysfunction in various arenas of day to day life, such as in relationships and workplaces.
At Daniel’s Place Center for Healing, physiological understanding of traumatic stress provides the foundational education upon which appreciation of the self is built. Ultimately, from the lens of learned self-love, I help guide clients along the healing process through the transmission of individualized skills and techniques that aid recovery. Some of these practices include utilizing relaxation techniques in order to facilitate emotional and physiological self-regulation, a challenge for trauma survivors whose biochemical processes continue to reflect a crisis of imminent threat. Cognitive techniques involving reframing, examining and challenging self-talk, assist clients with shifting their automatic thoughts over time from alarmist and exaggerated cognition to adaptive, reality-oriented reasoning.
There is no one size fits all answer in trauma treatment, as no two traumatic histories are the same, which is why each healing approach is unique and customized to meet the needs of each individual trauma survivor.
When it comes to trauma, we can’t, and one may argue, shouldn’t, seek to ‘fix’ our natural responses. Instead, understanding why we feel and react the way we do increases our self-love and acceptance, ultimately setting a healthy stage for learning how to achieve equilibrium by balancing our natural responses with our learned skills.
And in the spirit of appreciating our stunning survival abilities, check out the Destiny's Child song posted below for a shining example of the human ability to survive. Just as Beyoncé, Kelly, and Michelle can survive performing their dance and musical number while trapped on a tropical island, perhaps we too can survive life's adversity (although maybe not while sporting 6-pack abs)!
Elana Friedman, LCSW, CCTP