What You Can Do When Trauma Reminders Intrude


Victims are easy to identify — or so we think. We see them on TV each day. We are inundated with injury. Too many terrified people, mistreated people, and survivors of war zones and privation carrying their children and belongings. The images arrive from displaced persons camps, airports, and highways.

Look in the shadows, however, and you will find even more. Those are the second-hand souls, the past sufferers, the ones reinjured at a distance.

The men and women to whom I refer are recovering from Post Traumatic Stress Disorder. Some of them are rebroken by watching or reading about the latest victims and the menacing public statements of elected officials. They shudder at the unpredictability in the air. According to the conservative columnist David Brooks, we are witnessing  “a rising tide of enmity” in the USA. Indeed, swastikas have appeared in the public library men’s room of my own suburban Chicago community.

Yesterday’s unfortunates are reminded of their imperfect healing by the incivility and xenophobia around them. Their bodies respond by saying “fight or flee.” A sense of being flooded, overwhelmed — even to the point of collapse — sometimes is not escaped for minutes or days.

Retraumatization of this kind can leave the individual disoriented and dissociated. He may undergo flashbacks of his past: a psychic reexperiencing of the event. At the extreme, there is the loss of awareness of where you are, in what circumstances you are, what age you are. You time-travel to a place you escaped, reinstalled into a mental chamber of prior misfortune. Perspiration, nausea, tearfulness, and intense fear are only a few of the possible sensations and emotions.

You are alone, even if others are nearby. The triggered individual is often unable to describe his internal world. He is awash in a fetid river of word-preventing feelings. The proper vocalizations do not come.

What is one to do?

Here is an example of a young man who dealt with a mild version of the problem, but still enough to put him in treatment. He was in his early teens. A bike accident — he was struck by a car — left him with a painful recovery. Even after the physical injuries healed, the newspaper account of the collision — one which blamed him — still felt like an attack. Moreover, the intersection where he had been hurt remained dangerous. He felt both unfairly targeted and helpless to do anything either to vindicate himself or prevent harm to others. He continued to avoid the location, but traffic reports of pedestrian injuries (regardless of where they occurred) darkened his mood and made for painful and repeated revisiting of his experience.

One aspect of his treatment was a turning point. We talked about what he might do to get a sense of control and counter the wrong and wronging newspaper account. This thoughtful adolescent wrote a letter to the reporter who covered the event. Two things followed: 1. His comments were published in the newspaper. 2. The reporter researched the statistics pertaining to accidents at the place of injury and wrote another article detailing the danger. The city council then investigated the matter and made the intersection safer.

Where does that leave you?

You can, of course, hold your hands over your eyes and plug your ears. The avoidance of TV and radio is a close equivalent, as is holding to an agoraphobia-like self-protective self-confinement. Though understandable, these strategies must eventually be set aside lest you continue to remain terror-prone.

Another patient of mine, long after her father died and mother denied (in my presence) that any sexual abuse happened, chose to return to her childhood home. This was the site where years of sexual abuse by dad occurred with mom’s knowledge. She traveled 500 miles to get there. As it happened, the house was being redecorated and the new owner permitted her to look around. My client left the spot with a sense of palpable triumph. She had faced-down the ghost of her demon in the place of his iniquity.


If you are pained by news accounts in the aftermath of the President’s Executive Order of January 27, other actions commend themselves to your attention. The American Psychological Association offered a concerned Response to this Directive on February 1, 2017. It reads, in part:

‘Refugees, particularly those displaced from war zones, experience stress, trauma and other serious mental health problems,’ said APA President Antonio E. Puente, PhD. ‘Denying them entry to the United States, particularly those who have already been vetted, is inhumane and likely to worsen their suffering. This conclusion is based on extensive research and clinical experience … .’

Such policies can lead to a perception of reduced freedom, safety and social connection for those directly affected, as well as for society at large (my italics) … .

Research has documented serious mental health consequences for immigrant children and/or their parents who have been forced to leave the United States, which may magnify earlier trauma experienced in or upon fleeing their country of origin. Sudden and unexpected family separation is associated with negative outcomes on child well-being that can last well into adulthood.

If you have been retraumatized by the human consequences of your country’s immigration policy, your decision concerning any response may be more personal than most. Others, perhaps less impacted in this way, have marched, attended town hall meetings, written public letters to news organizations; and visited, called, or emailed their elected representatives.

In the end, those without trauma histories would be wise to refrain from judging whatever action you choose or do not choose. The world presents many chances to reinvent ourselves and repair the injuries it inflicted.

Remember, however, that you and your therapist aim to help you distinguish the present from the past, both intellectually and emotionally: to realize you can act today in an effective way not possible before. And to keep the past from recurring in any form by your self-affirming assertive actions.

The top photo is a Syrian Refugee and Her Newborn in Ramtha, Jordan taken by Russell Watkins for the UK Department of International Development. The second image is a World War I propaganda poster called Every Girl Pulling for Victory by Edward Penfield, created in 1917. Both are sourced from Wikimedia Commons.

The Unsung Value of Denial and Distraction: Where Therapists can Go Wrong

Big Eyes

One of my mentors was a psychiatrist of immense intellect and a laser’s capacity to cut to a psychiatric diagnosis. His brilliance as a diagnostician, however, did not extend to gently bringing his well-defended patients down the therapeutic path. He was a surgeon of the mind. Surgeons leave scars.

You might think of psychotherapy’s beginning as a kind of dance, with the patient in motion like Salome, wearing seven veils. The veils and shifting movement are for protection, not seduction. The client suffers “too much” and the covering — any covering — guards against invasion. If you, as doctor, rip the gauzy garments away, you do an injury. Without a shield, the client is exposed, terrified, and likely to flee treatment.

Too much too soon. A good mental health professional doesn’t drain a protective moat until the patient develops the courage to take on the scary world outside the castle (or inside his head). The counselor must avoid retraumatizing the patient, in effect flooding him with emotions he is unprepared for. The irony of hurting when you mean to help could not be more poignant or more terrible.

Young therapists can miss this. So do managed care companies when they want you to push treatment as fast as possible (to cut its cost) or medicate the insured party for the same reason. My mentor was guilty of ignoring the same therapeutic speed bump.

The challenge of focusing on life’s dark side was understood by the mathematician and big thinker, Blaise Pascal, who died just short of age 40 in 1662. He recognized the need to divert oneself from contemplation of the human condition. Students of clinical psychology might benefit from his words. For example:

Being unable to cure death, wretchedness, and ignorance, men have decided, in order to be happy, not to think about such things.

Or this:

I have often said that the sole cause of man’s unhappiness is that he does not know how to stay quietly in his room.

In short, the world can overwhelm such small creatures as we are. Those in most need of distraction are often the least inclined to make use of this necessary method in the pursuit of equanimity.

Pascal again:

However sad a man may be, if you can persuade him to take up some diversion he will be happy while it lasts, and however happy a man may be, if he lacks diversion and has no absorbing passion or entertainment to keep boredom away, he will soon be depressed and unhappy. Without diversion there is no joy; with diversion there is no sadness.

I’d say Pascal goes too far, but his point is a worthy one. I can name many people who seem relatively happy (at least for the moment) because they don’t think about the shadow following them down the street. A memorable patient of mine found escape in diversion and denial: she ate enough carbohydrates to push her well into obesity and diabetes. Yet, while eating, she felt good. Indeed, during stressful moments, she believed she deserved a treat as compensation for her upset.

The therapist’s job is to find a balance between allowing people to use their long-standing psychological defenses while gradually helping them recognize the longer term damage they are doing to themselves by not facing problems. With the large lady in question, it was quite a tightrope walk.

I find myself on both sides of the balance beam. Socrates was right when he said, “The unexamined life is not worth living.” So, however, was Pascal, by implying the deleterious effects of too much “examination,” rumination, and painful memory. The truth is hard to swallow, as the kid in the top photo is about to find out.

I guess if I had to create my own mantra, I’d look to alter the inscription on the Temple of Apollo, which read:

“Know Thyself”

My less pithy version would be: “Know thyself, but not all in one bite. Remember: your eyes (for truth) are bigger than your stomach.”