My first book, published in 2010, was a sorry child of neglect. At that time, I lacked the knowledge, the wisdom, and most of all the confidence to do any promotion at all. Ironically, there is also a measure of humility required, it would be a magical belief to assume that “my child, however exceptional, will raise itself!” Oy vey! A recipe for tragic neglect, which is what I did. The book languished in semi-obscurity, although those who read it seemed to like it. It stayed in print and I continue to get an annual accounting from the publisher of some meager number of copies that went out each year. That is not bad, for an eleven year old book, but nothing like it would have been, if I had given it a good start in life. It is an apt metaphor for the shame, grief, loss and anger that so many adult children of childhood trauma and neglect are often bathed in. “What would my life have been like?…”

The two key tasks of recovery from neglect, are “getting a spine and getting a voice.” I learned this from Stephen Johnson, a brilliant pioneer in somatic therapy who wrote a series of wonderful books on character theory. Getting a spine means emerging from shame and hiding, and standing tall and visible. Neglect, with its primordial solitude and the accompanying assumptions about “why” one is “unwanted;” worthless;” “untouchable;” “hopelessly different and alien;” etc, etc, etc, makes for a perennial withdrawal into crouched shadow, and the well recognized stooped posture of shame. It is no way to begin the life of a book, or any life of course, and most especially a book that touts hope.

Voice means having the willingness, again the confidence and the humility to speak up. The child of neglect imagines, if I am not the natural recipient of attention, there is nothing to be done about it. (For an infant that may indeed be a tragic fact of life.) In fact, when I fist began collecting my anecdotal data about neglect, way back at the turn of the century/millennium, a signature or marker that alerted me to a client being a neglect survivor, was the shrugging, default refrain, “I don’t know what to do!” Or “there is nothing I can do!” I had no science back then, but it was a dead give-away. And I also did not realize then, that I too had that gene.

Voice, is besides standing up, using not only spoken language, but certainly using spoken language, to call attention to oneself. In the case of an infant, it is often about essential need. For an adult, it could be anything, even “hey, have a look at my new book!” even if I have not “earned” the attention.

With my new book, that came out on August 31st, I resolved to do it differently. I found myself a rock star marketing person, who has begun to inundate your in-box with unsolicited mail. I hope it does not drive you crazy, but I am also well acquainted with the invaluable “unsubscribe” button that I am not ashamed to liberally use when I receive unwanted mail. Of course I invite you to do the same, should you see fit.

Not one for advice giving, there is one piece I will readily dispense. Any measure of success I have ever achieved, was facilitated by this: find the best consultation money can buy, tell them everything, and do what I am told! So that is what I have done. She said, “write blogs!” Initially I always believed, “who the hell wants to hear it, my random mind wanderings?” But here we are, and I even discovered that I love it!

Some of my close people have long said, “resuscitate the first book!” As you can most likely see, this is what she has done. It is never too late to heal from neglect! She has culled chapters from it that may seem of interest, packaged them anew and sent them out into the world. Again, the child of neglect later in life, comes to experience the world, perhaps later then one would have hoped, but yes, at last.

So here I am practicing what I preach, and modeling what I am trying to inseminate: I am very pleased to announce my new book will appear on August 31st. Although it is first and foremost a clinical book, devoted as I am to teaching therapists to recognize and help the long neglected population of neglect survivors, all my reviewers, have offered the unsolicited feedback, that it can certainly be of interest and utility, and is accessible to the sophisticated psychotherapy client. Meanwhile I am preliminarily hatching the blueprint of the lay-person’s version, which will follow before long.

Should you buy the book on Amazon, please do take a moment to post a review. It is helpful to me to know what does and does not “work” for people. And my friend and colleague, Deirdre Fay, whose excellent new book Becoming Safely Embodied, sprinted to best-seller status in seeming no time, advised me, the reviews that post in the first few days after publication show the most powerful and speedy results. You don’t have to read the whole thing before you say something.

And finally, those with visual impairment, or who simply like to “read” while walking the dogs, or stirring the cheese vat, have requested an Audible version. If you are one of those please do say so in your review, or let me know. My publisher has said if there is sufficient demand they will consider adding that to the roster of offerings. So there, I did it! If you are a child of neglect, you might try this. It didn’t hurt at all!

Feedback, Sound, and Anticipation

Although I am not a mom, I somehow have an image of a small overnight bag, standing by the door. I don’t know if it is an actual memory of when my mother was getting ready to have my beloved little sister. I was only two and a half. Back then, women stayed in the hospital for a week when giving birth, so my mother was getting ready to be gone for a while.  Mrs. Sheba would be staying with my older sister and me. She was an old German lady, who smelled much like our great Aunt Lottie and Great Aunt Gertrud, also old German ladies.  Mrs. Sheba used to say “You vant to go to bett?” which of course we never did, what a silly question.  We had no choice. I don’t know why she asked. 

I remember the stories of how the nurses all buzzed around my dad, who felt queasy and sick in the delivery room, while my mother was as ever, quietly neglected. I can’t imagine her crying out or even complaining. I remember when the beautiful little baby, as yet un-named, came home. When they opened, she would become known for her big eyes. She looked like our dad, and I was in love, and so jealous. Anyway, as we approach my pub date, I feel rather like the expectant mom, waiting for the water. I guess this blog is my little bag.

“Is There Anybody Alive Out There?”

I remember from a Bruce Springsteen concert download, a lively call and response between Bruce and the audience. Bruce in his inimitable way, bellows “Is there anybody alive out there?!” The crowd roars. And the exchange is repeated enough times with building fervor, for the show to start with a loud twang, the starting shot for Born to Run. I guess I feel that kind of excitement. So here’s my call and refrain. I would be delighted to hear from you! 

Being a writer is strange. I spend months holed up in my little home office, all the more blurred by the unreality of Pandemic year, banging on the computer. I churn out my ideas, shared only perhaps with a handful of editors or consultants, stumble through editors’ comments and somehow a finished book reaches the world, or does it? Perhaps it flies out into a mysterious and empty black hole of oblivion, much like the vast empty landscape of the neglect survivor’s world. It is truly unclear if there is anybody alive out there, or if all of this just a backdrop for my own solitary movie, and none of the rest is real. I used to wonder about that when I was young and so alone. 

A writer’s world can replicate that, if we don’t proactively make it different. So, in my overnight bag, is an invitation: Let me hear from you! I’d love to know your thoughts. What is interesting and helpful? What is drivel or psychobabble? Is it enough about me already?!  Is it too much or not enough science?  One reader of my first book told me my citation of the Talmud was erroneous! Oy vey!  I so rarely invoke the Talmud or anything like it. Of course, it was too late to change it. But I was humbled and gratified to learn. My dad would have noticed. Fortunately, although that book was showcased on his coffee table from 2010 when it appeared, until he died in 2020, I am sure he never cracked it open, except maybe to read the inscription.

I recently got an email from a blog reader named Julie. She said she enjoyed reading my weekly blogs, and wanted to keep reading them, but now the pandemic was permitting her to go back to work. She wondered if we could offer an audio version so she could listen to the blogs on her way to work. She said a friend of hers had a feature on her podcast site where you push a button and get an audio version. I thought, what a spectacular idea. We are looking into that. What was most striking to me, was “wow, a live one!” All this to say, talk to me! I may not always be able to respond, but I will certainly try! Thanks Julie!

Sound

Continuing with the theme of audio, my sister who is a devoted mom to her dogs, loves to listen to books out on the trail. She said, “what about an Audible version of the book?” I love audio books too, especially during those long stirs of the cheese vat. I have also heard this from people whose vision makes it hard for them to read print as much as they would like. I asked my publisher, and she said if there is sufficient demand, they will consider that. I don’t know what sort of numbers constitute sufficient demand, but I would ask, if an audible version would be of interest, include that in your Amazon review, or let us know by email. My friend and colleague Deirdre Fay, along with her husband read her new and bestselling Becoming Embodied themselves. Apparently, my publisher still owns the rights, so at this stage, I am just asking you to let us know you might want that.

Reviews

Of course, not much need be said about reviews. Especially Amazon reviews, and especially on or around the pub date, are a great help to getting the word out. Taking that moment to review for Amazon, even if you have not finished the book yet, is a great help. If you have access to some sort of publication which reviews books, even better. Thanks!

Evolution

It is interesting to me, that once I bumped over the hill of Sixty, I became much more aware of age. Oy vey! I never had really thought much about that. I would look at other people and look at myself, and wonder how old I look or how young in relation to them, much as I used to do about weight, where I would look around a room and think about who was thinner and who was fatter than me. 

As an aside, I must add this little anecdote about neurofeedback. When I was in my fifties, my hair started to have salt and pepper sprinkles of gray. Most of my family were already graying by those ages, and I was beginning to follow the family path. In 2009 when I started practicing neurofeedback, I was that graying 54, and mysteriously through avid neurofeedback training, all the gray disappeared! I never targeted that, but it was an unexpected surprise of neurofeedback. It has never returned. At 66 I have never colored my hair and all the gray is gone! Go figure!

That was a digression however. Now when I go to conferences, or when I used to go in person and now virtually, I would feel powerfully moved to see the new generation of young therapists coming up, studying and training to help this complicated and troubled world they are inheriting. I remember 25 years ago when Ruth Lanius was a young medical student I first saw and heard at a conference of a trauma organization, that may not even exist anymore. I remember how the crowd gasped when we saw the early brain scans of this new-on-the-scene young person. Now she is the best in the world. I am getting ready to step aside while new young people pick up the reins. It is my greatest hope to help the invisible population of neglect to be seen and heard, to finally get recognition and help, and to have a chance, to matter as they never have. I used to care about things like selling books, making a name for myself, getting my dad to notice me. Now I just want therapists to learn this work, so the child of neglect can be known, helped, and part of the world.

Anticipation

Finally, I plan to write a lay people’s book about neglect, once I recover from finishing this one. My early readers have commented that this clinical book is somewhat accessible to “lay” audiences, which I have always thought of as kind of a mixed blessing. Perhaps it dilutes my impact in either direction. I am not so sure. I hope this book will be of use to as wide a readership as possible. And of course, as I embark on the next project, I’d like to know what is helpful, unhelpful or lacking, to make sure to include it in the next tome. So input is invited and welcome. Thanks!

Well, I did not expect to pack this much into my little overnight bag. I guess I am ready to deliver. Hope I won’t shriek. But I don’t know!

My book “Working with the Developmental Trauma of Childhood Neglect: Using Psychotherapy and Attachment Theory Techniques in Clinical Practice” was published on August 31st. It provides psychotherapists with a multidimensional view of childhood neglect and a practical roadmap for facilitating survivors’ healing.

Way back when I was first training to work with couples, I studied with the renowned relationship expert and researcher, John Gottman. By now Gottman is about as familiar to the mainstream as a movie star, known for his 40 plus years of longitudinal data about what makes marriages “succeed or fail.”  In that early training, Gottman often referenced the work of Paul Eckman, who studied emotions.

Eckman’s unique contribution was to discover the vocabulary of the face. He found through extensive and copious research and travel, a universal lexicon of facial and sometimes even body expressions correlating both cross-culturally and trans-historically to the specific emotions. This means that human beings (and some other mammals) configure their faces, and (with some emotions the body as well,) in a consistent, recognizable way, even identical way. In effect we do read and respond to the feelings of others with some accuracy.  Thus there are silent (and often deadly) lengthy conversations, often outside of our awareness, transpiring much of the time.  

This can be an advantage, however, and particularly with trauma and neglect of course, the complication is not the “read.”  Often the survivor is impeccably attuned to the subtleties of shifting emotion in others, obviously in the urgent mandate to pursue safety. The problem rather is in the interpretation. Survivors may quickly perceive and register anger, for example, but through the lens of their histories. So of course they may take it to mean “that it is anger at me” and then react to that.  Sadly, many of our relationship nightmares are based on these redundant, mutual and usually escalating dynamics of mis-interpretation.  And this is what can make the world of relationship a minefield, a waste-land, an elusive promised land or fiercely avoided “no man’s” land for survivors of all kinds of trauma.

Eckman devised a system for learning to read emotion quickly, and I remember buying the sets of CD’s (remember those?) and spending hours in front of the computer, flipping through the images of the many faces trying to improve my speed and accuracy at naming the corresponding emotion. Eckman went on to become an expert on lying and the ability to discern when an individual was lying. He became a high level consultant to the CIA and a sought after expert witness in high (and lower) profile criminal cases. Eckman himself struggled with his own anger, and I once heard him tell a remarkable story of how he worked with it.  It would be too long to include in this blog but is retold in the book he co-wrote with the Dalai Lama, Emotional Awareness: Overcoming the Obstacles to Psychological Balance and Compassion. Well worth the read!

Shame

A persistent and agonizing emotional consequence of trauma is shame. Our understanding of this is even more pronounced, now that the trauma field has identified and named ”moral injury” which is the category of trauma where the survivor has committed some heinous act, which was outside of their control. Veterans may suffer profound moral injury for atrocities that they were forced to perpetrate in the line of military duty.  Medical personnel and first responders during the height of the COVID Pandemic similarly had to “let people die;” or choose who was to receive the ventilator when there were not enough to go around.  But victims of violence themselves who did not in reality bring it in any way upon themselves, often feel responsible or as if they “deserved it” or did, in fact bring it on themselves somehow.  Irrational as it may in fact be; they are haunted by that.  Shame is an emotion that is most difficult to treat and alleviate, as it is so deep in the psyche and as we are now learning, the brain. 

The Feeling of Shame

Many of us have at least heard the term Sensory Integration. For myself, before I learned more, I associated it  to school kids with learning or behavioral problems.

It really has to do with connectivity and regulation between the various channels of sense perceptions, and other brain functions. We are all familiar with what are commonly thought of as the “five” senses: sight, hearing, smell, taste and touch. What we may be less aware of is the other three: introception, proprioception, and balance. Introception is the experience of what is going on inside the body, the sensation of a pounding heart for example, pain or tightness in the throat which may come with sadness and tears; the welling in the chest that might come with love or a burst of compassion. It also refers to pain, dizziness or numbing. 

Proprioception is the body awareness of where we are in space, the demarcation between “me and not me” and physical closeness versus distance from other people and objects.  I always wondered why I was so completely inept at catching a ball, or parking a car squarely between the lines,  Balance of course, refers to equilibrium and solidity or grounded-ness. 

Interestingly, the brain areas corresponding to body experiences are tightly connected to the limbic system, home of the emotions.  And the limbic system is tightly connected to the prefrontal cortex, which is our “thinking cap:” executive branch. The prefrontal area regulates, not only cognition, but planning, agency, and sense of time, among many other functions. Just like the old song my dad used to sing to us “the shoulder bone’s connected to the arm bone…” etcetera, etcetera down the skeleton, all these various functions are fundamentally interconnected. It makes sense that we might register (or not!) our various feeling states all kinds of ways. Some of us are very fluent at this, whether accurately or not. 

When the primary experience is “incident” or shock trauma, the cataclysm of something that did occur, the individual might feel too much; when the primary experience is about missing experience or the overwhelming lack or what did not happen, the default might be to feel very little or even nothing at all. 

One of the most pronounced and identifying features of a neglect history is the tragic poverty of mirroring. Mirroring is the reflection back from the caregiver of what the child is feeling, and perhaps attempting to express.  Now at last we get to shame.  When an infant looks up into the parent’s eyes, and “I see reflected back, a loving image of me,” that is when a sense of self begins to emerge and come online in the little nascent brain. With repetition, it becomes the default sense of self: “I am worthy, I am loveable, I am seen.” When accompanied by an accurate read of my bodily and emotional needs, it is re-enforced. That is, if my hunger is accurately understood as such and gratified with food, my cold with a warm embrace or “blanky,” my fear or loneliness with comfort and/or company, I learn not only that I am worthy, but with luck, learn to associate the need with its appropriate “remedy”  and with luck, even learn the names for the complex of varied feelings. Sense of self ; self worth; the ability to identify, name, ultimately express feelings; and what is needed to fulfill or regulate them, all this is the product of accurate and sufficient mirroring. 

No parent does it perfectly! In fact the attachment researchers tell us that the most attuned parents, who raise the most securely attached children, get the attunement accurately 30% of the time. 30 %!  And all the rest is regulation and repair, which is how self regulation is ultimately learned.

In the case of shame, the poverty of mirroring means much of this fails to occur. The child may look up and see no-one or nothing there, an angry, fear stricken, hateful, troubled or disconnected face, and the result is confusion and anxiety. As the brain develops, the child will wonder why? Why am I hated, alone, not taken care of, cold hungry and afraid? The brain is ever in search of answers. Without a reliable source, we make one up: most likely, “I am worthless.”

 We default to cowering, hiding, searching for a way to be worthy enough: perfection? Helpfulness? Some way for compensating for one’s “deficit?” The universal posture of shame is one of cowering, shrinking inward, pulling back, down and inward, almost as if to weather a blow. This unattractive and consistent body organization is a universal measure of shame. It is not sloppiness or laziness, not ugliness, but rather it is “Nature’s Way of Telling You Something’s Wrong…” Most of you are probably too young to remember that wonderful song.

Working With the Posture of Shame

Working with the emotion and identity of shame is one of the hardest aspects of trauma healing. It begins so early and is so deep in the brain and non-verbal memory systems. Many of us have been at it for decades and it is still a work in progress! The method actors have long known however, that the deep interconnections between bodily, emotional and cognitive experience are multidirectional, or accessible via different access routes. They have found that if they put on, even feign the expressions that correlate to a particular emotion, the accurate emotion comes up, and perhaps even a personal memory. Or they might enter from the memory, or the body configuration and whichever way in, the skilled actor produces a believable replica or performance. Many survivors default to performance as a means of attempting worthiness, or a facsimile of relationship. I am not suggesting that!  However a good body worker can help advance the progress of working with this complicated and hard to reach emotion.

So to sum up, a few suggestions, (and warning, none of these are easy to follow!):

• At the very least, try to stem and eradicate any shame about shame! It comes with the territory.
• Know that it takes time and work to change this!
• Remember that self-love is the learned experience drawn from having received and felt the love of another! If you lack the ability for self love, there is no shame in that! If is rather a point of grief!
• To just “stand up straight” may be very difficult! It maybe unsustainable, it may produce physical pain, it may be scary, it may feel very “fake” at least at first. Go gently.  

A reputable form of body therapy with a skilled and knowledgeable practitioner can be an essential and expediting addition to healing. 

My book “Working with the Developmental Trauma of Childhood Neglect: Using Psychotherapy and Attachment Theory Techniques in Clinical Practice” is out now. It  provides psychotherapists with a multidimensional view of childhood neglect and a practical roadmap for facilitating survivors’ healing.

Regulation and Affiliation for the “Diaspora”

For some reason I have long had a fascination with athlete biographies, autobiographies and memoirs. Willie Mays, Arthur Ashe, Andre Agasse, even tennis star Alice Marble, of whom I had never heard; and Steve Young whom I decidedly did not like. I especially like the athletes who have taken a political stand like Jackie Robinson, Billie Jean King and James Blake. I have already pre-ordered Colin Kaepernick’s book, even though it is not yet written. Odd, as I am not a fan of spectator sports at all. I have never watched a football game in my life. The closest I have come is watching the halftime show at a Super Bowl where the Rolling Stones performed. I have attended a couple of baseball games when my beloved nephew was playing, and I have humored my husband by joining him at the screen for a moment or two when he is enthusiastically watching the Tour De France. That is about it for me.

I was the girl last chosen for the sports team, as I was uncoordinated and had poor hand eye coordination and poor perception of where my body was or a ball was in space. I have since learned that the vestibular system or the balance system of the brain, is compromised by trauma and neglect. That network includes the senses of interoception and exteroception. Interoception is the perception of what we are feeling or what is happening inside the body; exteroception is the perception of where we are in space. Both are essential for catching a ball or landing it inside a basketball hoop; or over a volleyball net. 

When I discovered running and bicycling, it was a wonderful thing. I found that not much talent was required, only strength, and perhaps willingness to hurt. Endurance of course was my expertise, and I found both that I could out-endure pretty much anyone. I also discovered that running and riding enabled me to put distance between myself and my family home, which was both empowering and made me feel free. I did not know the word regulation when I was a young adolescent running 20 plus miles a day. I just knew it made me feel better. And I was pretty good at it. In my middle forties I was working out with a personal trainer, and he called me an “athlete.” I was amazed, I had always thought of myself as a misfit trying to calm down.

The truth is that exercise and sport is a highly effective method of self-regulation, or calming down, that many survivors of trauma and neglect discover and come to rely on. And reading the many memoirs and biographies of athletes reveals similar beginnings. I found it interesting that certain sports attracted survivors of certain kinds of childhood experiences. Many of the ‘individual” sports like running cycling or even tennis, attracted survivors of neglect, as did endurance and most especially ultra events. These people are accustomed to solitude, loneliness, being in a quiet one-person world, or residing in the “default mode network,” the quiet, self- reflective region of the brain. And endurance. Baseball, which although it is a team sport, seemed to be a magnet for neglect. It is a team sport, where each team member acts much as an individual with not that much interaction, except perhaps between pitcher and catcher. And there is a lot of standing around and waiting. These were interesting things to think about for someone like me.

The 2021 Tokyo Olympics

I once had a client; a man with a heart breaking neglect history. With a confusion of fathers, he was literally like the old Talking Heads song that says “I don’t even know my real name…” He was 23, movie star handsome, very bright, and a phenomenal athlete. From the outside he seemed “perfect.” His chosen sport was crew, and by the time I met him he had been doggedly training for the 1992 Olympics for quite a few of his young years. He trained with a team, and put in the hours of a fulltime job. Barcelona, where the Games were to take place, was the True North of his life. His little team of four rowers, was like the family he never had. When he did not qualify for the team, it was as if the bottom had fallen out of his life. He seemed to “lose” rowing as a way to make himself feel good, he lost his little “family” and he lost his focus. Not oriented to psychotherapy before, suddenly he found himself so bereft as to search out someone like me.

As a non-spectator, I have not been a watcher of the Olympic Games either. The last time I remember watching them was in 1972 when I had my wisdom teeth out. I remember because it was when “Little Olga Korbut” the tiny Soviet gymnast burst on the world scene and blew everyone’s minds by seemingly taking gymnastics to a whole new level. If not for being otherwise incapacitated, I probably would have missed that too. 

In more recently times, the 2021 Summer Games garnered a fair amount of news coverage for a number of reasons. Some was to do with the contagion of the Corona virus which made for a fair amount of news about athletes getting sick or competing without an audience. There was also news around a variety of political stances, governments and athletes which I vaguely followed some of.  What I found most interesting was that there is now a new awareness of athletes’ mental health: the incredible pressure and stress upon these young people, on top of the major blow of the 2020 Olympics having been cancelled, which must have been massively disappointing and disorienting for them, having been organizing their lives around them for years, like my former client. And of course, the dramatic case of gymnast sexual abuse.

What really got my attention at that time, however, was a story I heard on NPR that both surprised and moved me. In 2015, ten athletes after their lifetimes of training, were displaced from their home countries due to either natural disaster or political terror. As a result, they had no country to represent in the 2016 Rio de Janeiro games, and therefore no team. The International Olympic Committee hatched the idea and raised the funds to create an International Refugee Olympic Team. This group afforded them affiliation, and the possibility to proceed with their life plans. Hearing interviews with a few of them, it made a world of difference in their lives. 

In 2016 the Olympic Refugee Team had 10 members. In 2021 there were 29 members, competing in 12 different sports. They hailed (originally) from Syria, the Democratic Republic of Congo, South Sudan, Eritrea, Venezuela, Iran, Afghanistan, and Cameroon. So, 29 traumatized young people, who probably needed the regulation and familiarity of their sport, and the affiliation of a team more than ever, did not have to give up the dream and the hard earned opportunity to compete in the Olympics. What a brilliant idea, certainly the best thing I have ever heard about the IOC! Bravo!

“The Refugee Olympic Team sends a great signal about what enrichment refugees are for our Olympic community and for Society at large. Watching them compete is a great moment for all of us, and we hope everyone will join. The athletes are welcome in our Olympic community, among their fellow athletes – competing with them but also living with them under one roof.” – Thomas Bach, IOC President, 2021

With a surge in the numbers of people being displaced from their countries of birth, I hope this will continue to become part of the fabric of the Olympics, reflecting our increased understanding of what it means to belong.

Today’s song:

The PTSD diagnosis only appeared in the DSM in 1980. To me that seems like an “augenblick” as my German mother used to say, the blink of an eye. I realize that many of my readers may not have been even a glimmer in anyone’s eye in 1980. By now “trauma informed” is almost cliché, on everyone’s lips, thanks in part to Bessel van der Kolk’s block buster book The Body Keeps the Score, which everyone has read. If you haven’t of course, you must, and you can find it in at least 10 languages if need be.

The PTSD designation was born out of the experiences of returning Vietnam veterans. Their devastating symptoms were stumping the VA as to how to help them. Many still wander around homeless and addicted, certainly in my area which is close to Haight Ashbury. The diagnosis was designed for young adult sufferers and pretty much only veterans could check all the boxes for diagnosis and treatment then.

At first we correlated the PTSD symptom profile with overtly physically violent life experiences. It later came to encompass traumatic events such as car accidents, and then domestic violence and rape. In the 90’s violence against women and children came to be understood as traumatic the culture began to recognize the prevalence of these. Before that even physicians in training had no clue that they might be looking for evidence of these incest for example, it was not anywhere in their medical training.

In 2010, Ruth Lanius et al quietly wrote another epic, The Impact of Early Life Trauma on Health and Disease. It is another must read but most people haven’t. In it Lanius and her co-authors widened the lens, to include a much wider range of life experiences that fit the definition and also the neuroscientific profile of traumatic experience; and also to include the medical impacts. In this book neglect shows up.

I have been studying neglect doggedly since about 1998. I am not a researcher so I have no evidence basis, just a treasure trove of anecdote,  and my own personal theory and practice. Fortunately, now Lanius and van der Kolk and others are presenting the evidence and even the visuals to demonstrate it. And it is all still slow. It is still a rare therapist that recognizes neglect. The clients themselves usually don’t, and because they are not aware that something “happened” to them, they wonder why they feel so bad, and therapists do too. Their missing story is about missing experiences, and it is difficult to see what is not there. I have found that clients who discover the neglect profile, and match their own feelings and patterns to it, have been so wildly relieved and grateful. That is why, I have been on a mission over these decades, to amass information and to share it.

In 1995, the mammoth medical group Kaiser Permanente, undertook a two-year study of what they called “Adverse Childhood Experiences” or ACES. They recruited 17,000 subjects, all drawn from their membership, which skewed the sample somewhat. The subjects were all employed and insured which implies a certain class affiliation; and so the researchers would not have expected to find what they did. The ACES encompassed among others:

• experiencing violence, abuse, or neglect
• witnessing violence in the home or community
• having a family member attempt or die by suicide

Also included are aspects of the child’s environment that can undermine their sense of safety, stability, and bonding, such as growing up in a household with:

• substance use problems
• mental health problems
• instability due to parental separation or household members being in jail or prison

The results were astonishing. 61% of the subjects had experienced at least one, and one in 6, had experienced four or more. Imagine if the study had included subjects of poor, unemployed and a wider range of backgrounds. And yes, neglect appears on the list. This was 1997, when the results went public. How come no one noticed. Now, like “trauma informed” which some of us were desperately trying to bring into the psychotherapy mainstream for years, the ACES are on everyone’s lips. Why did it take so long? And how many survivors of childhood neglect, have slipped through the cracks un-helped and remained invisible all this time?

For at least 5 years van der Kolk and his research group has fought to get “Developmental Trauma Disorder” (DTD) into the DSM. The last edition rejected it. So there is still no formal diagnostic category to legitimize it, and also to facilitate insurance re-imbursement. To my knowledge, developmental trauma is not yet part of graduate school curricula.

Now the list of traumatic experiences continues to grow. We are coming to understand “Minority Stress” ie the continuing threat and insult to identity of racism and discrimination, and the danger of violence it often includes; and “Moral Injury” which is the shame and grief associated with having committed unbearable acts oneself. This was a feature of the Pandemic, when health care workers were unable to save patients from dying; or had to choose who got the ventilator and who died; and of course war veterans and first responders who commit heinous acts against other human beings. These are traumatic experiences that bring similar brain aberrations and symptom patterns to those that we recognize.      

Thankfully the ACES study is coming to be known and considered, at last. Maybe Developmental Trauma will become recognized and understood, and clinicians will be learning about neglect. I’d like to see neglect come out of the shadows, and a vast population of invisible sufferers come into view at last

At the ripe age of 63, it bit me. After 30 years of impassioned work in trauma and sexuality, and immersion in a wonderfully satisfying if challenging world of healing, someone happened to give me a book. It was a beginners’ book about how to make cheese at home.

I have always loved cheese, enjoyed making my own wild yeast French Bread, and had a distant and vague interest in cheese making. For some reason I cracked the book and tried one of the simplest cheese recipes, and I was instantaneously hooked. Puzzling as this was to me, cheese rapidly coagulated into  a consuming, even obsessive avocation. I found an unimagined joy in the complicated and endlessly challenging process , that began to overtake first my kitchen, then other rooms and my surprised mind. Even with a 50% failure rate at first, the fascination mushroomed on. My library of cheese books grew, and by 2018’s end devoted bookworm that I am, I had only read one book that year that was on another subject than cheese. Baffled by the delightful intrusion, I just went with it as I continue to do today. And everyone seems to love the cheese.

I have discovered that this ancient and multicultural art is rich with metaphor. As a couple’s therapist, I have been fierce about disallowing metaphor in teaching communication, as it confuses precise understanding with yet more subjectivity, But in this realm, the wisdom that steams forth is irresistible and invaluable. Thus this story.

My most beloved teacher is Gavin, a charismatic Australian man I discovered on Youtube. Prolific and generous with his didactic videos, I could learn from him on my own crazy sleep defying schedule, and never exhaust his some 300 and ever growing library of recipes. He also offered a weekly livestream where people like me from all over the world shared questions and information. It amazed me that over two thousand years, around the globe, across cultures and time, people discovered this unlikely fact, that rotting milk turned into a delicious, nutritious and enduring food. Interestingly, it is primarily variations in cultures and time that make for the  vast variety of different cheeses that are all made from the same one ingredient.

Gavin is a self taught, “do it yourselfer,” environmentalist, very much the purist.  Always outspoken about his disdain for processed cheese and his unsavory childhood memories of Kraft Singles, he politely but firmly refused the suggestion to try making American Cheese in spite of the occasional request from one among 160,000 Youtube followers. I echoed his sentiments. Even when a highly regarded community member named Larry talked poetically about his quest for the “perfect melt” and how nothing produces the widely loved grilled cheese sandwich like American, Gavin held firm. Of course I with my European parentage, agreed with Gavin. So one day we were all surprised to find that Larry had gotten him to do it, they had made a video together about how to make American Cheese. And since it was Gavin, of course it got my attention.

I learned from their video that  the one ingredient that American Cheese has that traditional world cheeses do not, is Sodium Citrate, which is a combination of baking soda and lemon juice. That sounded relatively benign. Basically you grate any cheese you have lying around, add it to a solution of Sodium Citrate and Water, let the cheese melt and stir it together, and it is “emulsified” into the exquisitely meltable “cheese food” we all remember. Mildly interested but unmoved to try it,  I soldiered on with the “real thing.”

Until some time later, I was struggling with my Shropshire Blue, a beautiful and intriguing cheddar with the addition of Roqueforti. After nearly three days of stubborn trouble shooting it persisted in refusing to cohere into the wheel promised by the recipe.  It came out of the cheese press a defiant basket of orange and blue rocks.

 Exhausted and discouraged, I threw them into a bowl. I did not want to throw them out, but what to do with a pound of un-aged blue and cheddar rocks?

After ruefully avoiding the obtrusive bowl for a day or two, I had a thought. Well, I could try making it into American Cheese. I hate waste and had nothing to lose. So I bought some Sodium Citrate and executed the quick and simple recipe. Stickler for the visuals, I poured the liquid into pretty molds, just for the fun of it, and left it to chill and set. The next morning I unmolded them, and was delighted. They had turned into this:

I proudly showed my husband, most proud of all at how I had somehow over-ruled old beliefs and tried something new even after a frustrating defeat. Being a practical guy, he wanted to put them to the test. So that night’s dinner was grilled cheese sandwiches. And lo and behold: we enjoyed a delicious and perfect melt.

When I was barely more than a toddler, living in Manhattan, I learned a very big word: restitution. My parents, both survivors of the Nazi Holocaust, had not lived in this country too long. It was 1959. We lived in a large, old brick apartment building, where all our neighbors seemed to have numbers on their arms. I easily imagined that to be the norm, true of all people. One day, my parents received a letter in the mail. It said we would be receiving a small check each month: restitution. The German government was attempting to compensate Jews for the pillaging of possessions they had suffered. Of course they could not replace the 6 million murdered, but it was a gesture of reconciliation. It was the first I had learned of such a concept, attempting to repair broken trust or damage perpetrated. Although it was small consolation for my profoundly traumatized parents, it was still somehow gratifying and certainly much needed.

It was hard to believe when I heard on the news that it was the anniversary of the brutal murder of George Floyd. How has that time passed already? As an attachment theory-oriented therapist, I am still haunted by his cries for his mother in those last nine minutes of his life. “Mama, Mama…” As a somatic therapist who is regularly teaching clients about breath and a the calming power of intentional breathing, the words “I can’t breathe…” the same words gasped by Eric Garner in a similar police murder in 2014, have gained a whole new traumatic meaning. What have we learned in this ensuing time since Floyd’s tragic death? Does anyone remember Eric Garner? Will anything be significantly different for the poor, disenfranchised and of color in our country and the world, or will this be just one more episode, like a traumatic flashback, that recurs and persists and continues to perpetuate pain and enduring dysregulation and dysfunction?

As a relationship therapist, I am constantly trying to teach clients and often couples the power and magic of apology. Most do not really know how, having never heard a meaningful apology for harm done to themselves, and also living as we do, in a culture of blame. Many even view apology as an admission of defeat, so it is a humiliation to take responsibility for relationship repair. If made at all, apology is tinged with a self-canceling defensiveness, and so have no impact at all. In a memorable episode of the long discontinued television program, Sopranos, when one character, Christopher, while under the influence of heroin, sat on and suffocated his girlfriend’s beloved little dog to death. He shrugged his shoulders dramatically and exclaimed to his devastated girlfriend “Hey! I’m sorry!” Of course this had no meaning to the bereft young woman.

Eve Ensler, now known as “V” published a profound book that appeared in 2019: The Apology. Before that, I had found little literature of use on this crucial subject. For some years I have been gestating a book on the subject, which I still intend to write. But V’s view on the subject was the closest to my own that I have encountered yet. In it, more than 30 years after his death, she writes the letter of apology from her viciously abusive father that she had always hoped and longed to receive from him, but never had. It is written in his imagined voice, and in chilling detail he recounts and owns what he did to her over decades. Without defending it, he also tells the story of is own trauma, which does not excuse the harm he perpetrated, but somehow makes sense of it for her. Oh yes: the intergenerational transmission of trauma. The book affected me so deeply, that I bought dozens of copies to give to friends, in my quest to spread the word.

Again, most of my clients, survivors of trauma and neglect, have never heard an apology for what they endured.  And clients ask me, “Wasn’t she doing terrible wrong? I am so angry! And I feel guilty that I am so angry. Could she just not help it? Was she just doing the best she could?” Both are true. But more importantly, how do we interrupt this insidious legacy? Restitution is a noble symbolic gesture, and certainly moves in the right direction, but it does not go deep enough. Or it is effective but not sufficient. As Janis Spring Abrams, who writes eloquently about the trauma of infidelity, “cheap forgiveness” skips the depth of pain and rage, and fails to restore or create true, reparative intimacy. We need to fully experience the unsavory emotions for the apology/forgiveness to “work,” and have impact.

I believe the way forward, besides transforming dysregulated brains with neurofeedback, and every way we can, is teaching the elusive practice of authentic empathy. A relatively recent concept, empathy only first appeared in the Oxford English Dictionary in the Nineteenth Century. It is still poorly understood. And it stands in contrast to the simpler, more familiar concept of sympathy. Sympathy is feeling compassionate and assumably understanding emotion on the other’s behalf, but still squarely from one’s own point of view. It is drawing on one’s own reservoir of experience to imagine the feeling of the other, attempting to speak from that. One can still remain lodged in one’s own narcissism, and even feel superior. Empathy however, is stepping if momentarily into the other’s world, and working at truly feeling how it is for them. Not to agree or “give them a pass” so to speak, but rather to make sense of how this could have happened. V’s father was the product of a horrific and unprocessed history. That by no means excuses wrong perpetrated! But rather makes sense of what is otherwise incomprehensible and unforgiveable. And forgiveness benefits, more than anyone else, the forgiver. V felt tremendous relief. It did not retrieve lost years, and the protracted storm of agony, or the thousands of helpful and unhelpful therapy dollars, but provided a sea change of direction. Granted, these perpetrators never chose to do their own work, which is part of what makes the questions complex unanswerable.

In cheese-making, the essential first ingredient is the starter culture, an interesting and unintended double entendre. The culture is an organic compound that stimulates or catalyzes the milk to “ripen” changing its chemistry to make it receptive to the agent of transformation, which miraculously transforms the milk from liquid to delicious solid. A certain amount of time is required for this magic to transpire, for the cheese to “mature.” For the cheese-maker, patience is more than a virtue. I believe that empathy and the teaching of empathy, better yet, a culture of empathy, is an essential first step in breaking chains, of both oppression and intergenerational transmission of trauma and neglect. And of course continuing to stir the vat!