I worked at the San Francisco VA for one year to the day. It was March, 1989-1990. I remember it well because it was the year of the historic San Francisco earthquake. I was definitely not cut out for that work, but I definitely recommend that any trauma therapist do a stint at a VA as there is so much to be learned there. In 1989 there were still plenty of Vietnam vets cycling in and out. And yes I do mean cycling. It was a wacky system, I don’t know if this has changed since then, but at that time, if a veteran recovered, or if PTSD symptoms even partially abated or remitted, their benefits were systematically cut. “service-related disability” was measured in percentages, and dollar amounts were proportionally calculated. So there was built in incentive to not get better. Of course we really did not have good treatments back then either.
One of the great lessons I in my time at the VA was about “triggering.” Admittedly I try to avoid that term, preferring to use activating or stimulating old trauma. By definition, trauma re-sets the brain to ferociously defend the organism against letting the trauma happen again. So any stimulus even vaguely reminiscent of the trauma, can activate a cascade of sensory, emotional, body sensation or whatever that individual retained of the original experience. I don’t like the word “triggering,” because in my mind it conjures gun violence, which in many cases is accurate, but also in many cases not. In my work with traumatized couples, who activate one another quite readily, unfortunately, such language can sound accusatory in suggestive ways that can exacerbate conflict. However, it is hugely important to learn about this, and the veterans taught me well.
My most potent teacher was a man whose entire platoon was wiped out before his eyes by a helicopter bombing in Vietnam. All of his buddies were dead, and he was the sole survivor. The SF VA is in a beautiful location perched on the ocean. The view is serene. I remember one scenic afternoon a helicopter passing overhead in the blue cloudless sky. This man was instantly sent into a tailspin of abject terror. He was screaming as he rolled under the nearest bench shaking. It was as if it were happening right now. That particular helicopter chopping innocently by was benign, like an unthinking partner often can be. It was a dramatic depiction I will never forget.
The word “triggering” has also found its way into common parlance, where it is used to mean all kinds of things, even just generic unsavory emotion. I am very picky in its use as it has an important and precise meaning, whether or not we choose to use that term. I insist on precision as it is vitally important for healing, to learn when we are activated, or activating the other.
In couple’s therapy, when one partner is activated and truly believing it was the other partner that upset them this much, I will routinely say something like, “…this feeling you are having right now, what does it take you back to from your childhood? Tell your partner a story about a little girl/boy who felt just like this.” The point is to get to the original trauma material, that the partner is simply stimulating. The stimulus is not without merit, but it is a small proportion most of the time. This is an important lesson in both psychotherapy and couple’s work.
In a session the other day, I was sitting with a lesbian couple. It was a calm moment, and one of the partners, a child of tragic neglect, bravely said to me “…There is something I need to say to you.” I prepared myself. She said, “You know how you say, ‘tell MaryAnn (not her real name of course,) a story of a little girl who felt just like this…’ that really upsets me…”
I expected I knew why. Children of neglect are often frustrated by a gaping poverty of interpersonal memory. That is often the diagnostic marker that tips me off when I first meet a new person. They also generally have a hard time knowing what they feel. I expected this client’s frustration with me, to be one of those, or both. I was humbled and surprised by what I heard instead. She said, “My mother always treated me like a little girl, dressed me up in girly clothes, made me get the girls’ sneakers that wear out in three days, instead of the boys’ Keds with the rubber caps. But I never felt like a girl. I did not exactly feel like a boy, but I definitely did not feel like a girl! I tried and tried to tell my mother this. She just ignored me, as she did about most things. I felt unheard and unseen, completely not known.” (All classic traumatic markers of neglect.) And most decidedly “I felt like I did not exist!” And “when you say that to me, I feel again, like I do not exist!”
Needless to say, I was horrified! I could not believe I had made that terrible, ignorant mistake! Here I am supposed to be so knowledgeable about neglect, and more, I am a sex therapist! I had thought of myself as scrupulously mindful about sexist language, and issues of sexual orientation; I had thought I was sensitive and self aware about all things sexual. I felt terrible about my unthinking binary assumption. Much more than a “micro-aggression,” it seemed like a “macro-aggression” if there is such a word. I fell all over myself apologizing. And I thanked her for educating me.
Although I am well familiar with the current discussion about pronouns, apparently not so much as I thought. I can see I really did not get it! Until now. I am immeasurably grateful! I am grateful that my client had the “spine” and the “voice” to tell me. By spine, I mean agency, or the ability to operationalize purposeful action on their own behalf. Voice, being the ability to express out loud and in relationship, what is genuine and authentic. These are the greatest tasks of healing from neglect.
I recently heard an interview with rock musician, Tory Amos. Certainly not any kind of fan of hers, I was driving and almost always tune in to Public Radio in the car. She apparently had just written a book, so that was nominally the focus of the interview. The interviewer asked her, “So how was it for you writing a book?”
Amos answered, “it was hard!”
The interviewer queried,
“—so, what was hard about it?”
“My first language is music. Spoken word is my second language. It was like writing a book in my second language.”
I thought, “how profound!” Something as seemingly elemental as language, is so easy to not think about. Easy because of cultural, ethnic, cisgender, able-bodied chauvinism, narcissism or sheer blindness. It is so easy to take for granted that the language in my head or tongue is the predominant or majority language. Particularly in a world of neglect, that is so solitary, it is so effortless, and actually one’s default mode, to create one’s own whole world, without even realizing it. My husband used to say with a laugh, “You mean you are not in my head?” He really was only half joking. It is so easy to just assume.
With gender as with race, culture, gender and sexuality, bodiedness, age, so many categories, it is so important to watch our language. Oy vey! So many languages to learn. Alas it leads us back to the foundational missing experience, taking the time, having the care and the bandwidth to actually learn who a person is. With mindful attention, thoughtful presence… it seems so simple. And simple it is, but not easy. If only that simple ingredient were part of everyone’s daily lexicon, and everyone’s early experience, how much trauma and early life trauma would be eliminated? And without trauma, as Bessel van der Kolk so sagely proclaims, “The DSM would be a pamphlet!” Not to mention much of the menu of physical illnesses, whatever that manual is called. I was immensely grateful to this client for having the guts and the gumption as well as the articulateness to correct my sloppy delivery, and to teach me. I think it was a healing moment for us both.
Learning from Experience
One of the great gifts of the 1990’s the “Decade of the Brain,” was to learn that the brain is plastic. Ironically, that fateful year at the VA, rattled by the earthquake, also engendered that! We had previously thought we were born with a lifetime set of neurons, rather like our life’s quota of ova should we happen to have female anatomy. That is what you get, we thought. We now know we can regenerate, and birth new neurons, and we can learn. Our dogs and other mammals can too, if we have the patience and generosity of spirit to teach them. What a blessing! We have more than one chance!
The brain can change, and even the mind! Neurofeedback is based on this principle in its very obvious beeping way: “operant conditioning.” Psychotherapy as well, and none of us would engage in it unless we had some remote belief, at least some of the time, that change is possible. Of course in many cases we must do our part to make it happen. And in many cases we can. As the saying goes “Pray to God (if that is one’s paradigm of course!) and keep rowing to shore.”
Now it is my task to integrate what I have learned, to remember and make use of it, with this client, and in the world. My world is enlarged when I do, and how healing to others to be accurately seen and heard, not to mention my own pleasure in seeing the appreciation in the eyes and body of the other. Because we are designed for interdependence, the brain also kicks in a bonus reward of its own with a dopamine surge, for re-enforcement! More joy and love are in circulation. In this COVID-weighted world, so sorely needed. Can you beat that?