Some years ago, I was asked to be a main presenter at a weekend Institute of the American Association of Sex Educators, Counselors and Therapists (AASECT) to teach about trauma and sexuality. I was thrilled. It was my first time ever being invited in that public of a way. I was the main attraction and I could hardly believe it. The director of the program was a lovely woman named Susan whom I had never met before.
I was self-conscious about everything. I never missed a conference, but I had never attended one of the weekend “institutes” I did not really know my way around PowerPoint then, and I had endless nervous questions, while also being embarrassed about having so many questions. Oy vey! What I was soon glad to learn, was that Susan always answered my emails immediately, with patience, care, warmth, and never implying any kind of judgment or sense that my questions were excessive or reflected ignorance (-or idiocy which is how I felt.) I discovered that Susan was much like me: thorough, somewhat perfectionistic and painstaking to do her best. As ever, there is always a song in my head. I asked her “Susan, do you know the old song by Santana, “You Are My Kind?” I love that song, and I felt that very kindred, connected feeling with her. She said she did not know the song, so I sent her a youtube link so she could hear it.
Susan gently guided me through the preparation process for the Institute, and through the Institute itself. All went quite well. As the weekend drew to a close, I was more than a little relieved. Susan did one last amazing thing, that cemented the feeling that she is my kind, (and also brought me to tears.) As the weekend drew to a close and people filed out, she piped our song through the large conference room loudspeaker.
One of the tragic sequelae of trauma and neglect is the shame and grief ridden feeling of not belonging anywhere. The child roams the world orphan-like, like the mythical little bird in the famous children’s book Are You My Mother? In that story, the poor little thing approaches every creature (and even some machines) in its path, asking the same urgent question: “Are you my mother?” It is a profound and primitive primal need to be attached to a caregiver and a pack, certainly when we are young and not nearly able to care for ourselves, but not only then. It is wired in to the limbic brain, that the first line of defense when a child or young mammal is scared or distressed is the “attachment cry.” We reach for connection. Only after that fails, do we then resort to the fight/flight or freeze defense. The need for affiliation, to be connected and secure by being part of a larger group, persists through the lifespan. When that connection is deficient or missing in early life, it can become, as for the little bird, a relentless and gnawing quest. For the child of trauma and/or neglect, the search for a group or family can go all sorts of ways.
I got very confusing messages growing up. My parents both being survivors of the Nazi Holocaust and refugees in the United States, felt on one hand, like strangers in a country that was not ours, while also being immensely relieved and grateful to be there. They felt both welcomed, and a profound fear and mistrust. We were supposed to fit in but not “assimilate” too much and lose our identity. And never quite let our guard down, because you never know when people will turn on you. It was a confusing message for a child. I surely did not know what that identity was. My father often told us “You just don’t know what it is like to go to bed hungry, or live on bread and worms!” So, I knew I was not really like him, and did not know how to be enough like him to please him. My mother’s first major heartbreak was when as a little girl, her best friend turned on her from one day to the next, to join the Hitler Youth, I longed, like all little girls, for a best friend. But not like that!
When I was in college, I became an impassioned political activist. Latin America was exploding with military coups and fascist dictatorships that were enough like my parents’ experience as to make me feel perhaps kindred, but different enough, that I could rebel against my parents. I remember a book I read during that time, the story of a Chilean diplomat, Orlando Letelier, exiled by the dictatorship and living in Washington DC. He was murdered by a car bomb on Embassy Row in broad daylight. It was a chilling account.
Letelier’s killer was identified, as Michael Townley, an American employed by the secret police of the Chilean Dictatorship. The book was largely a character study of Townley, or that is what I remember about it these 40 years later. Townley was a lost soul. He lacked a sense of direction, a sense of home and identity, roots or purpose. Somehow, he wound up in Chile. I don’t believe the book told much of his background. But my experience has been, that whenever a young person travels thousands of miles from family and home, there is always a story. In Chile, he was prime bait for the Chilean DINA, the notoriously vicious and cruel secret police, best known for the torture of thousands after the 1973 coup. Being disenfranchised and searching, Townley was a ready and receptive candidate and rapidly excelled at the job. He was technically skilled, and efficiently orchestrated and executed the bold murder or Letelier and his young assistant Ronni Moffitt. Townley was a vivid example of the disconnected, rootless, most likely child of neglect, being easily seduced and transformed into a tool for some other and that other’s personal agenda. So, in need of someone to please, and a grouping to be a part of, they can seamlessly become even a proficient professional killer.
Around that same time period in my life, one night my apartment mate in Berkeley, brought home a young woman she had encountered on the street. The child-like woman was sobbing uncontrollably, and blubbering unintelligibly, clearly under the influence of some unidentified drug. She was terrified and grief stricken, and probably no more than 18 at the most. My friend found her curled up and shaking on the sidewalk, in the vicinity of a “spiritual” cult there dancing and chanting on Telegraph Ave. All we could discern was that she had been lured her to join them, and drugged into this barely conscious state. We kept her safe overnight, and in the morning when the drug had worn off and she could talk, we learned that she also, was a disenfranchised, survivor of some sort of trauma, again, a ready target for a “group” or a place to belong. I don’t remember the rest, but just remember making the connection with Michael Townley. How deep and sometimes blinding the loneliness, longing, the driving attachment need can be! It can over-ride coherent judgement and land the child of trauma and neglect (at any age) in some community or role, they might never have chosen.
Although I always understood climate change as a concern, it was never at the top of my hierarchy of concerns. I was always most compeled by causes with a more directly human cost and exhibiting palpable human suffering- until I read Thomas Friedman’s book, Thank you for Being Late. The book is one of those good books that are about 200 pages longer than necessary, but I did soldier all the way through it. In the chapter about climate change, it described how in countries of East Africa and the Middle East, climate change resulted in such drought and water shortage as to kill whole crops. Farmers were desperate both to make a living and to feed their families; and food was in short supply. Due to climate change, people were starving. And hungry people did not feel taken care of by their governments, like neglected children, they were left to fend for themselves. Many men began to migrate to other places where they might at least earn enough to feed their families. Many of course died. And many enraged by the neglect and by hunger, were readily receptive to terrorist ideologies and larger group identifications, spawned at that time. I can only imagine and guess, that those receptive to become terrorist killers and members of cultlike organizations, had an antecedent of neglect, an old rage ready to be ignited and erupt, and an urgent need for affiliation, activated by hideously neglectful governments. Again, what role might neglect play in dangerous or deadly dynamics we see in the world? These are questions that roll around in my mind.
The need to attach and belong is ubiquitous and primal. We share it with all mammals and some birds and invertebrates too. It is not to be underestimated in ourselves. Susan made me feel connected, cared for and like I mattered. That profoundly affected what I felt able to do, as well as my mood of joy and love through the process of preparing and delivering my presentation. All the more reasons why we must heal neglect, both positive and negative. Humans function better and feel better when they/we are part of something. And when we are not, our desperation can make us even perilously vulnerable. We can easily find ourselves in the “wrong” relationships, one way or another. We must be passionately present for our own children, and we must learn how to facilitate healing in the adult survivors of neglect and interrupt both the suffering and any intergenerational transmission.
To end on a positive note, have a listen!
I have a special affection for leopards. As I love to say, “you know the old adage ‘A leopard can’t change its spots?’ Well, I can. And I change my spots every chance I get.” Healing is all about that. The “Decade of the Brain” and neuroimaging technology taught us that “Neurogenesis” is possible, that we can grow new neurons. Before that we believed we were born with our life’s quota of neurons, and that was that. We now know that with neurofeedback, psychedelic assisted psychotherapy, somatic therapies, mindfulness practice, and yes even the old fashioned “talking cure,” we can generate not only connections, ie networks, but molecules. This is wonderful news for all of us, both with respect to our own brains and our clients’ brains if we are practitioners of some kind. So why do spots have such a bad rap?
I remember when I used to drink alcohol, I had to either stop wearing white, or switch from red to white wine. All my pretty white blouses were speckled with unsightly red spots. Oy vey, I always was a sloppy drinker. As an adolescent, ugly facial spots, we called them “zits,” were referred to in commercials for acne products as “blemishes.” Spots were blights on the skin, and on faces that in so many cases already housed shame and self-doubt, or self hatred. Spots were like nature’s “mistakes.” But nature, for the most part, does not make mistakes. If left to itself, it has a brilliant unshakeable plan. Occasionally there is an aberration or mutation, as with the Corona Virus for example, but perhaps we will ultimately come to discover what the ecological (or existencial) intention of that was to be. Most likely it is human intervention that produces disasters of nature, or so is my jaundiced and not-research-based speculation.
Once I had the privilege to visit Milan, Italy. I admit, in my love for pretty things of many kinds, I love clothes. Milan is a wonderland as the fashion hub of the world. Of course, we had to visit the Armani showrooms, a veritable museum of haute couture, clothes I could and really never would buy, but love to look at like I love looking at art. I was struck by a theme, that in every window in a long seeming small city of windows, each of the numerous masterpiece garments, whether on a mannequin or a hanger, had a conspicuos wrinkle in the way it was hung or draped. It was striking. I wondered, “what is he trying to say?” My husband did not notice until I pointed it out. Was he trying to teach us something about “mistakes?”
Once in a training with the somatic therapy genius Peter Levine, we were instructed to make four “mistakes” in every practice session. It was an intentional part of the assignment. The idea was to integrate the idea that mistakes are inevitable in this work. And to develop the humility to tolerate and learn from them. And then to learn to repair them. So many of us who grow up with trauma and neglect, come to learn that mistakes can be life threatening, or have the “hubris” to strive to be “perfect,” blameless or safe from retribution; or worthy of love. A futile aspiration.
In relationship, “mistakes” are an inevitable ingredient in development. The attachment researchers teach us, that even in the ideal secure attachment, where the attunement of primary caregiver and infant is “good enough,” the optimal percentage of accurate attunement, the best we could hope for is 30%. 30%!! That means that the other 70 percent of the time is the delicate dance of rupture and repair, rupture and repair. That is how we learn about relationship, and really about being. How sad that in the world of trauma and neglect, these skills are rarely learned, so the inevitable ruptures are terrifying, even life threatening. And relationship comes to in effect be an icon for suffering, however much it is longed for.
Much like Peter, the attachment research people teach us that the “mistakes” of rupture are invaluable, and much better training than smooth sailing without rupture. As my husband exclaimed many years ago when we emerged from the nightmare of chronic cycles of triggering and reactivity, “Wow, knowing how to recover when we disconnect is such a relief! I don’t have to worry so much about screwing up, because I know we can get back together if I do. I don’t feel so chronically unsafe and fearful around you anymore!” What a blessing!
As long-time serious bicyclist, my nemesis became potholes. I have only had two serious crashes in my in my 50 plus year cycling life, and in both cases I lost consciousness, so I don’t really know all of what happened. I admit, that I am grateful to have had those two traumatic events so I could experience different trauma modalities on those sorts of “one-time” incident traumas. What I did know was that I came out of the accidents with anxiety about bad road surface, and a veritable phobia of potholes.
Riding in Cuba, was like a dream come true. Just going there was a bucket list item of many years. I could not believe it when we were riding through the beautiful scenic countryside, carefully dodging chickens and navigating around horse drawn buggies carrying crates of fresh eggs. Coming around a bend to the base of a hill on our first long riding day, I happened upon the most colossal potholes in the known world. Of course, after six decades of being suffocated and strangled by the world political economy, the Cubans certainly had not had resources for infrastructure, especially as they used the meager resources they had, to first take care of people. The roads were tragically un-maintained. I gasped. It was only our first day of riding!
Embarking on that pothole scarred road, out of nowhere I was visited by a flashbulb image. Back before the pandemic when I drove to the office every day, I was routinely stopped by a traffic light, just as I was getting off the freeway. At that street corner was a little skateboarding venue, a little “park” of concrete, fitted out with sharp hills and walls, obstacles and vaults to jump, slalom type circles. Groups of adolescent boys (I never once saw a girl!) in baggy hoodies wildly flying round and round, jumping, crashing, rolling up the steep sidewalls, clearly having a blast. From the large graffiti on the walls, it appeared they referred to themselves as “punks.” As I waited for the long red light to change, I loved to watch them, always thinking “You wouldn’t catch me doing that!” Never!
Well suddenly that day in Cuba, the “light changed.” Was it a neurofeedback “moment?” I don’t know…Suddenly the Cuban potholes reminded me of those kids, who intentionally sought out the bumpiness, the vertical crashing and landing on their wheels upright, the slalom curving and dodging and missing each other, they do this for fun! Suddenly I imagined myself one of the ”punks,” having fun with the Cuban potholes. For the rest of that trip, I made a game of pothole dodging and jumping. Missing infrastructure, and prior trauma became my game: joy, fun and triumph!
Another symbol of transformation that I love, are butterflies. However, I‘ve never been fond of caterpillars. I even have a terrifying childhood memory from when I was three or four, of a park in New York where there were so many squiggling caterpillars that I literally could not put my little feet anywhere without stepping on them. All I remember is just wailing “Daddy, Daddy carry me!” I don’t remember if he did, just the terror. Anyway, those unsavory little creatures somehow become butterflies. Which are beautiful and I love them!
Interestingly, we call nervous excitement “butterflies” in our stomachs. I remember Peter Levine’s reminder that in the body, excitement and fear feel very similar. The Cuban word for potholes is “paches.” Que Vivan los Paches!
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:
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:
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