Say Something, I’m Giving Up On You

Alexis hugs a pillow to her chest as she swallows hard. “Doc, I know you want me to tell him how I feel, but…It’s like there’s a block in my throat.” She seems to choke on her words when she senses conflict. She describes a fight she had with her boyfriend over dinner last night, and how it ended with her crying while he asked, “What did I do? Just tell me!” as he watched her withdraw into herself. Alexis knows that her voice hasn’t been the same since high school when a supposed friend violated her space and left scars deep within her psyche. Even though many years have passed, she still freezes when she feels threatened in her relationships, hiding behind a curtain of long brown hair and silence.

If you’ve ever loved someone who has been through the burning flames of physical or emotional abuse, there is a possibility that he or she has developed a complex posttraumatic stress disorder. In short, once an individual has been forced to endure the prolonged and repeated infliction of pain at the hands of someone they trust, they may have a hard time trusting anyone again. They may experience symptoms of complex trauma such as problems with emotion regulation, impulse control, focus, dissociation, and interpersonal relationships (van der Kolk, 2014). And the very nature of those symptoms means that it is often impossible for the sufferer to speak about what they are experiencing. Instead, they may shut down or react in defensive anger.

What they may actually be trying to communicate is:

1. When I feel threatened, it is hard for me to speak. The key word in that sentence is “feel.” You may not have actually lifted your hand or said something hurtful, and yet you may have triggered a fear that is mired in his or her past. Survivors of trauma often have overactive adrenal responses to threat, which means that when they register a threat to their emotional or physical safety, the blood rushes from their brains down to their extremities, readying their bodies to fight or flee. These involuntary protective mechanisms place a very real limitation on the biological functions necessary to communicate (Perry, 2009).

2. When I do speak up and tell you how I feel, know that this was a Herculean effort. Steven Porges (2011) identified as a dorsal vagal complex to severe threat, during which the brain shuts down non-essential functions like speech, and lowers metabolism throughout the body, leading to an internal collapse in a state known as “freeze.” This often appears as complete shut down: silence, lack of facial expression or interaction. Therefore, when your beloved survivor does try and speak in moments of conflict, be sure to listen, validate, and honor those words. As Alexis said to me during one tearful session, “just…just treat my words like little butterflies. If you crush them, they’ll die forever.”

3. I might have sudden extreme reactions that only make perfect sense if you understand how they happen. Imagine being plunged into a boiling hot bathtub; you would most likely scream, “Ouch!” Now imagine that the pain receptors in your body have been damaged, and you are in the tub, watching time pass by for a while before you notice third-degree burns on your body. Your scream may be sudden, and loud, and disproportionate to your seeming relaxation just moments before. This actually makes perfect sense if you factor in those damaged nerves.

MRI studies show that adult women who have been abused as children have hippocampal regions that are 18 percent smaller than those of a control group (Vythilingam et al., 2002). This means that the part of the brain responsible for regulating emotions is compromised. The survivor may not know how to read her own internal signals that tell her she is starting to feel hurt or upset. This makes sense because she has learned to ignore her own gut instincts. Therefore, when she finally realizes, with a jolt, that she feels afraid or hurt, she may react impulsively in a manner that seems extreme for a given situation.

4. I might blame myself for things that I have not caused. There are times when I will deny my own needs to reduce or avoid conflict. Object relations theory is an organized way of understanding relationship dynamics (Klein, M. as cited by Kernberg, 1988). The theory posits that infants use projective identification to cope with neglect or abuse. If babies could string sentences together, it might sound like this, “Well my mother is ignoring my cries. It is too dangerous and painful for me, being so tiny and helpless, to believe she doesn’t care about me. So instead I’m going to decide that I’m a bad baby and she is a wonderful, loving mother.” The self-blame is a way for the infant to maintain the necessary illusion of a safe and loving caregiver.

Object relations theory begins in early childhood, but without intervention, those patterns of belief can last way into adulthood. In real time, this means that you may see your loved one blame himself for any conflict in your relationship, even when you are the one at fault. As the concerned wife of one trauma survivor described, “When I get home from work in a bad mood, and he feels the stress radiating off my body, he darts around the house cleaning everything in sight. I don’t get it.” Well, that’s because on a completely unconscious level he might blame himself for your mood.

5. Please do not diagnose or label me. You may think you know what your partner has been through as a child, or you may recognize that s/he has some of these symptoms. Remember that trauma can only be diagnosed by a qualified mental health professional that has performed a comprehensive clinical evaluation. It is possible for children and adults to survive unthinkable conditions without developing trauma diagnoses. It is also possible for people to develop trauma symptomology from incidents you may not think are “that bad.”

6. If you are not up to the task, gently let me go. It is not uncommon for trauma survivors to unconsciously replay the past by choosing partners who have their own relational challenges. This creates the potential for cycles of abuse to continue on and on, hurting both partners in the process. You might feel yourself beginning to fray at the seams and act in ways that do not make you feel proud. You may realize that you are increasingly sacrificing your priorities and needs and feeling resentful as a result. These are signs that it may be time to let go or take a break so that each of you may pursue individual paths to healing.

All those among us who try to open their hearts following abuse: they are true heroes. We can honor the bravery of complex trauma survivors by tuning into their needs and creating a space for connection and trust. Within that secure space, we may get to see incredible strength, the kind that can inspire us to be better versions of ourselves. And when we embrace those who have survived the worst sorts of mistreatment, we can ensure that hate will not win in the world around us.

References

Kernberg, O. F. (1988). Object relations theory in clinical practice. The Psychoanalytic Quarterly.

Perry, B. D. (2009). Examining child maltreatment through a neurodevelopmental lens: Clinical applications of the neurosequential model of therapeutics. Journal of Loss and Trauma, 14(4), 240-255.

Porges, S. W. The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-Regulation. Norton Series on Interpersonal Neurobiology (New York: WW Norton & Company, 2011).

van der Kolk, B. A. (2015). The body keeps the score: brain, mind, and body in the healing of trauma. NY, NY: Penguin Books.

Vythilingam, M., Heim, C., Newport, J., Miller, A. H., Anderson, E., Bronen, R., … Bremner, J. D. (2002). Childhood Trauma Associated With Smaller Hippocampal Volume in Women With Major Depression. The American Journal of Psychiatry, 159(12), 2072–2080.

Who Wore It Best?

by Dr. Sara Schwartz Gluck, PhD, LCSW

“You look great in that dress! Sooo skinny!”

I’m sure you’ve heard that type of comment in any situation where 2 or more women are present. The ultimate compliment- so skinny! When I hear this, it’s usually tinged with just a little bit of envy, like a green sliver peeking through the cloud of admiration. I call it the “jealous compliment.” Weird thing, comparing ourselves to the people around us. Without even realizing it, we scan the room and decide how to feel about ourselves based on how everyone else looks on the outside.

Social psychologists have a name for this. In the 1954, Leon Festinger called it the social comparison theory. According to him, it’s human nature to base our own self worth on how the people around us are doing. Hence, the idea of “keeping up with the Joneses.” Way back then, Festinger laid out his idea of exactly how this happens: We look at the people around us. If they are worse off than us (weaker, poorer, less attractive) we are cool with that. If they are better than us (smarter, faster, stronger) we either: Find a way to match up to them (spending more time at work to earn more income) OR find a reason to dismiss them (oh they’re only wealthy because they cheat on their taxes).

The strange exception to this rule is women and body image. When we compare ourselves to unrealistic beauty ideals that we see in magazines or in person, we keep trying to meet those ideals, even if deep down we know it’s impossible. Think about the millions of dollars we spend on makeup, plastic surgery, Botox, and diet products each year, in an effort to make ourselves thinner and more model-like. It’s beyond what seems rational.

My theory is that Festinger could never have predicted this, because he lived before the age of streaming Internet and color screen TVs. There would have been no way for him to imagine exactly how harmful those influences would be. Many of us are numb to the subtle messages we watch and see each day, and we don’t even begin to realize that they are slowly seeping into our minds. The good citizens of Nadroga, Fiji, were completely naïve to our American media in 1995. That’s when the first television sets were brought into the region. Some researchers (Becker, Burwell, Herzog, Hamburg, & Gilman, 2002) took a look at what happened next, and it was frightening. Before the introduction of TV, the native Fijians thought that robust and curvy women were beautiful, and they saw no need for dieting. The rate of bulimia? Zero. Three years later, most of the population had TVs, and 74% of the people surveyed said they felt “too big or fat” at least some of the time. And 11.3% of those said they vomited in order to lose weight. A total of 77% of those who were surveyed stated that television had influenced their body image, and many articulated that they wanted to look more like Western television characters.

1995- BEFORE TV 1998- AFTER TV
Robust body types valued

Bulimia rate- 0%

Body Dissatisfaction: Low

Thin body types valued

Bulimia rate: 11.3%

Body dissatisfaction rate: 74%

While we can’t always control the images that flash before our eyes, what we can control is whether we choose to let the media and advertisers tell us which characteristics are attractive. And we can help our friends, family, and our children by calling attention to things other than how they look on the outside. Next time you feel like commenting on someone’s dress size, try looking a little bit deeper, and saying something that is truly meaningful.

“You look radiant with joy!”
“You seem so confident right now.”
“Your smile just lights up this room!”

Let’s give ourselves a break from the cycle of comparison, and relax in our skin, cellulite and all.

 


Sara Schwartz-Gluck is Clinical Director at the Five Towns Wellness Center, located in Cedarhurst, NY. At The Five Towns Wellness Center we created a safe, private place to treat an individual’s needs with the specific care necessary to help conquer obstacles to health and happiness. FTWC was established in order to provide comprehensive psychological care to children and families while treating problems such as anxiety, depression, trauma, domestic violence, ADHD, oppositional behavior, and developmental disorders. We provide therapy and tools for living that children and adults can use to better cope with life’s challenges such as divorce, illness, and loss. Our goal is to help our clients develop practical skills and inner strength so they may live their best possible reality.   If you or your child is struggling call us for a phone consultation.  There is no need to feel alone.  At FTWC, we are always here for you.