My most recent read has been The Deepest Well: Healing the Long-Term Effects of Childhood Trauma and Adversity by Dr. Nadine Burke-Harris, a pediatrician and notable pioneer in the treatment of toxic stress.
The Deepest Well - For Trauma Survivors
Dr. Burke-Harris' book highlights her journey in becoming a physician as well as the development of her interest in the connection between adverse childhood experiences (ACEs) and poor health outcomes, and how to treat them. ACEs can include recurrent emotional or physical abuse, sexual abuse, physical or emotional neglect, mental illness in the household, substance abuse in the household, divorce, and more. Burke-Harris discusses real-life examples of how trauma presents in her pediatric patients, describing how it directly impacts their health, growth, and development, and explaining these mechanisms on a physiological level. I would absolutely recommend her book to anyone who wants to learn more about the lasting effects of trauma, particularly through a biological lens.
For trauma survivors, reading the book can be very validating and eye-opening as you unlearn the harmful idea that "it's all in your head" and, in place of that, learn the objective facts regarding the mechanisms underlying the impact of ACEs on health.
Adverse Childhood Experiences & Health
One of the most powerful messages I have gathered from the book thus far as a trauma survivor–although I don't actually think it's a major 'lesson' that the book intends to teach per say–is the idea that it isn't your fault.
In the book, Burke-Harris discusses the notorious ACE study, which demonstrates a strong dose-response relationship between a person's ACE score (how many ACEs they've experienced) and their likelihood of developing poor health outcomes, strengthening the establishment of a causal relationship between the two. One of the most shocking results from the study includes statistics which demonstrate that a person with an ACE score of seven or more has triple the lifetime odds of getting lung cancer and three-and-a-half times the odds of developing ischemic heart disease, the world's biggest killer. Not only that, but a person with an ACE score of four or more is 32.6 times more likely to be diagnosed with learning and behaviour problems–pointing to a phenomenon I have observed (of particular interest to me!) where it seems that I, as well as a surprising proportion of fellow VCUG survivors, have late ADHD diagnoses.
Quite simply, a dysregulated nervous system can have detrimental implications for most other bodily systems (the cardiovascular system, respiratory system, digestive system, immune system, etc.), disrupting homeostasis in significant ways. To some extent, nearly every health abnormality under the sun can be attributed to early childhood trauma and a consequently dysregulated nervous system. Furthermore, the increased risk of lung cancer, heart disease, and autoimmune diseases is independent of the behavioural effects and phenomenon typically observed in those with ACEs (e.g., exhibiting increased substance abuse behaviours as a way to cope with trauma, etc.). This means that even if you do not develop any comorbid mental disorders or negative coping behaviours due to your trauma (though this is unlikely, since these behaviours are often performed not by favourable choice of the survivor, but in mere attempts to survive severe psychological pain), you are still three times more likely to get lung cancer and three-and-a-half times more likely to get ischemic heart disease.
Through interactions with your environment, trauma alters the operation and expression of your genes in order to prioritize your survival in the present over the longevity of your life, the preservation of your health, and your preventative mechanisms against aging. In other words, when you're too busy surviving, your body doesn't exactly care about maintaining your long-term health or preventing you from rapid-aging.
Overall, if you are a trauma survivor, it's important to recognize that your poor health outcomes are not your fault and you are not inherently 'broken' or 'flawed.' Furthermore, inhabiting a traumatized body means that it will do anything that it feels is necessary to survive, so your negative coping mechanisms are not your fault either–you're doing what you have to do to scrape by and stay alive.
Personal Responsibility & Trauma
"But, if it's not my fault, then why does everyone make it feel like it's my fault? Why do I, myself, make it feel like it's my fault?"
Firstly, it's important to remember that when we are children, the default is to assume that everything bad that happens in our life is our fault. If we recall Jean Piaget's stages of cognitive development, we can note that children are inherently egocentric.
"If you are the sole purpose of the universe, and something bad happens, it must be your fault. Believing otherwise would imply that sometimes bad things happen for no reason at all, and then what could you trust? Entire religions have been built around negating the idea that sometimes bad things happen for no reason at all. Is it so surprising that a child would rather blame themself than accept the idea of random mischance?" -Quora user, 2017
In a way, children live their lives based on the assumption that the world revolves around them, and this is not because children are selfish but simply because they are not yet at a stage in their cognitive development where they can comprehend that other people are separate from them or that the things they experience aren't always about them. When bad things happen then, as children we feel that we must have something to do with it. We feel that we must have some blame to claim in the matter. In reality, this obviously is not always true–especially in the instance of trauma, where it is not true at all. There is nothing a child can do that should warrant abuse or neglect, and children are not responsible in any way for their own parents' divorce or substance use/mental health issues.
Additionally, if we never receive any messages otherwise, we can proceed into adulthood operating on the belief that everything bad that happens is our fault.
The unfortunate fact is that despite your trauma not being your fault, you are still the only person who can take responsibility for your own healing. This can be difficult to accept because it seems so unfair.
On a separate note, The Deepest Well briefly mentions the fact that Western culture generally places a lot of stock in personal responsibility–as if we are responsible for the trauma that others have caused us; as if it is due to inherent errors/flaws of an individual's brain that they experience something as traumatic. This culture alienates trauma survivors and propagates the stigma that persists surrounding those who survive trauma and how they choose to cope with it. This creates feelings of shame and guilt for those who are trying to deal with their trauma and the psychological pain that comes with it, which further alienates them and often prevents them from accessing help. It also perpetuates the feelings of shame and guilt which come from simply being a trauma survivor by sending the message that your trauma is not real, it's all in your head, and you should be able to move on and function normally without resorting to 'unhealthy' coping habits, which invalidates the impact and pure phenomenon of trauma, and attempts to skew the scientifically-proven fact that trauma is psychologically and physiologically damaging and has very real consequences, into a myth supposedly conceived by people who are just somehow "making everything up." Worst of all, trauma survivors who are told this can end up internalizing this idea, which puts healing at an even further distance from them. All I have to say to anyone who contributes to this harmful culture of placing all stock into personal responsibility is: people do not lack responsibility, you just lack empathy.
But I still hold empathy for you. Want to know why? Keep reading.
Our Purposeless Universe
Now we've established that this ideology is harmful, outright ridiculous, and not based in science. But anyways...
Why Do We Put So Much Stock In Personal Responsibility?
Here is where my desperate seeking of an understanding of the mindset that upholds trauma disbelievers/invalidators comes to fruition.
We've heard the saying a thousand times: hurt people, hurt people. Trauma survivors themselves may place an emphasis on personal responsibility, not just those with an uninformed and narrow understanding of the impact of trauma on the brain and body–although it is important to note that the two are not mutually exclusive (a person can be a trauma survivor and not have any understanding of how trauma affects the mind and body/how their trauma has affected them). That's the funny thing about the brain–it does whatever is necessary to survive and protect itself from unwanted unconscious turmoil, even though bringing that turmoil to the conscious in a controlled and healthy manner could actually allow healing to take place.
Hear me out: my theory is that putting an emphasis on personal responsibility is a coping mechanism for feelings of loss of control, which almost always accompany trauma–especially childhood trauma. Avoidance of thinking about and accepting the events of the past is, undeniably, easier than the alternative.
Okay, I'm going to get a little philosophical here... bear with me.
To accept that we can be harmed despite trying our best not to be would be to accept that we live in a purposeless universe; that nothing we do is able to stop something bad from happening to us and it is the universe–not us–that has complete sovereignty over whether we get to prosper or suffer. Evidently, this acceptance is no easy feat, since as mentioned previously, humans have built entire religions in attempts to repudiate conceptualizing the fact that bad things can happen to us for no reason. Accepting this fact naturally makes you feel scared for the future. It introduces a sense of powerlessness and lack of control which is incredibly difficult to accept and confront consciously. So, instead, some choose to reject it altogether, sometimes using belief systems such as religion to cope with the harsh reality that bad things can happen for no reason whatsoever, and keeping this fact buried and unacknowledged in the unconscious mind. I can't blame them–I often find myself believing in the concept of karma even though I'm aware that I don't really have any logical reasons to do so.
A Distorted Reality
An intriguing quote from Burke-Harris' book reads: "It's possible that we marginalize the impact of trauma on health because it does apply to us." This reflects the theory that some people may choose to hold disbelief in or minimize the validity of the concept of trauma because they themselves are traumatized, and their brain is not yet ready or doesn't yet have the capacity to confront it consciously.
Once again, if you remain in survival mode, your brain's top priority will not be to bring all of your repressed trauma to the surface of your consciousness and make you deal with it. In a way, by ignoring the effects that one's own trauma has had on oneself, the survivor is taking back control of their situation. By convincing themself that trauma only exists as some mythical concept, they can more easily deny the existence of their trauma and subsequent powerlessness, disregard their trauma's effects/attribute it to other things, and control whether or not something bad (in this case, the bad thing would be dealing with their trauma as this often prompts reliving it) happens to them. They can take back their sense of control by twisting their own reality through denial and distortion, which also means that in their new warped reality, trauma cannot have an impact on other people either, because then the whole foundation of the safe but false reality they've created for themself would fall out from under them.
So, that may be why someone is invalidating your trauma. In creating their distorted reality, these individuals can also evade the need to confront, process, and accept their trauma and the incredibly difficult emotions that come with it, and so they may believe that their way of doing things is the easiest and most pain-free, which leads their way of doing things to inherently impose itself on others. Maybe it's also possible that these people hold an internalized envy towards those who are at a place where they have the capacity to confront, process, and accept their trauma, as well as take responsibility for their own healing. This could be based on the incorrect assumption that healing is linear and looks the same for each person. It's extremely important to recognize that healing is not linear and every aspect of it, including timing, varies for every trauma survivor.
In essence, the people who tell you that your trauma and its effects on you are "all in your head," no matter who they are, may be traumatized as well and may be projecting their own survival mechanisms onto you. Does this justify them invalidating your trauma? Definitely not. But, it does provide perspective as to why they think the way they do, and it serves as a concrete reminder that the only reality in which your trauma is "all in your head," is a distorted and fictitious one.
What Happened to You Is Not Your Fault
All of this is to say that when it comes to childhood trauma, it is important to internalize the fact that your trauma is valid and real. No one else gets to minimize it for any reason–not to mention the fact that they have not the slightest idea of what you've been through. You did what you had to do to survive, and what happened to you is not your fault even if you felt like it was for as long as you can remember. There was nothing you could have done differently to prevent your trauma from happening. You might look back and think that you could have done things differently, like spoken up or done something more to stop something, but the truth is, that was never your responsibility and you never should have been put in that position in the first place. VCUG and sexual abuse survivors alike are sometimes told things like "why didn't you just say 'no'/fight back," etc. Most often, children are unfortunately unable to fight back or escape in these situations (and this is particularly the case for children undergoing a VCUG), and thus, their brain and body resorts to the freeze and dissociate trauma response. Statements like "why didn't you do something?" can cause survivors to feel unwarranted and harmful feelings of blame for an uncontrollable response to trauma. In reality, it is not the responsibility of children to fight back and children should not be put in any position where they need to be fighting something back. Personally, throughout my life as a VCUG survivor, I have often found myself in deep states of reflection, envisioning what I would do if I was once again put in a position similar to the one I was involuntarily put in as a toddler. Quite frankly, in these situations, from a young age I have always imagined myself clawing people's eyes out, ripping faces apart, tearing skin off. But why should I have to? Why should I even be imagining these kinds of things, especially as a kid?
All of us were children once. Put simply, childhood trauma survivors deserved a better childhood. As children, we were owed protection. Our only job was to be a child, and we should have had the chance to be a child. We should not have had to fight to survive the way we did and be strong when we deserved to be soft and for it to be easy.
We deserved to feel safe, supported, cared for, and loved, and our pure existence should have been enough to warrant that.
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