Tag Archives: trauma

The language of mental illness

I notice that I feel more comfortable writing ‘mental health problems’ than ‘mental illness’ because the second option seems so much more loaded. The words we use to talk about mental illness are problematic, too. Anxiety and depression are words that really don’t convey the life destroying nature of being overwhelmed by those things.

Years ago, a doctor gave me a questionnaire that talked about being anxious and fearful. I wasn’t those things – I was overwhelmed by terror on a daily basis and unable to function as a consequence and I could not express the severity of my situation in the terms the survey offered. I was then given a CBT handbook to help me manage those small fears that will go away if only you push back against them. Only I was terrified, all the time, thanks to the genuinely threatening things that were going on in my life.

Depression, as a term does not convey the state of being so weighted down that you no longer know how to move. It does not express the experience of being so numb that you no longer seem like a proper person on the inside. Depression does not convey the utter despair and hopelessness that sometimes kills people. Talking about the fatigue that comes with depression does not express what it’s like to be so overwhelmed that even the idea of trying to do something is unbearably exhausting. 

‘Triggering’ is a word that has been sorely abused by people deliberately minimising how trauma impacts on people. Triggering as a word is not adequate to express the horror and loss of control of finding that your mind has been thrown back into reliving traumatic experiences from your history. The word ‘trauma’ alone does not do enough to convey to untraumatised people what that kind of experience this means. And I don’t want to expand on that because not triggering the traumatised folk is a consideration alongside wanting to educate those who don’t really get it.

‘Personality disorder’ is an awful term that has stigma hard wired into it. It’s also a really problematic area of diagnosis – it’s just a label, it doesn’t represent anything that can be measured. How do you tell between these ‘disorders’ and perfectly reasonable trauma responses? How do you tell between trauma in undiagnosed neurodivergent adults, and ‘personality disorders’? This is an area where the problematic language represents a lot of problematic thinking. If this isn’t familiar territory, have a look at the ‘symptoms’ for schizophrenia https://www.nhs.uk/mental-health/conditions/schizophrenia/symptoms/ and consider how many of those might be caused by trauma and by real threats that are assumed not to exist. What happens to an abused teen whose parents frame their behaviour as delusional? 

Often, the official language to describe conditions comes from an unaffected observer, not the people having the experience. This isn’t a neutral process, and the stigma against mental illness and neurodivergence is massive and longstanding. And please, if we’re going to label murderers as being mentally ill, could we at least have a specific label for that illness rather than making it seem like mentally ill people are dangerous to those around them. We’re not. Most of us are far more likely to harm ourselves than anyone else.

Different kinds of trauma

Most research into trauma is based on male experiences – especially the experiences of male soldiers. It focuses on the idea that you have experienced a single, or a small number of traumatic things and that healing comes from contextualising it and de-normalising it. The expectation of flashbacks to specific events as a PTSD response comes with this sort of trauma.

Of course not all trauma takes this shape. If you grew up neglected, or in an emotionally abusive family, there may not be any big events you can point at. Racial abuse can often take the form of relentless microaggressions – any one alone doesn’t look like much, but added together they become traumatic. Gaslighting depends on attrition, not big events. Economic abuse tends to be a long term project. Workplace bullying can be insidious and long term. People emerge from these situations traumatised and also not fitting the traditional model we have for dealing with event based trauma.

Then there’s the intersections – to be traumatised by living as a neurodiverse person while also having to deal with racism and economic abuse. To suffer medical trauma because of your sexual identity and also having to deal with workplace bullying and one instance of being beaten up… People can have multiple trauma sources and those interact with each other and impact on how, and if you might be going to heal.

I’ve experienced event-based trauma and the kinds of invasive thoughts and flashbacks that go with it. I’ve also experienced the kind of trauma that is built of smaller things over longer timeframes. Being triggered around that is qualitatively really different and much harder to spot. If you’re back in the trenches with the shellfire, then afterwards you have a pretty good idea what just happened. If you’re back in the hideous miasma of an awful childhood, or a toxic workplace or an abusive relationship, that mist can settle over you without it being obvious what’s happened.

With that kind of triggering, you can end up thinking, feeling and reacting as though you were back in hell. It can make the current situation look like the previous one. All the coping mechanisms come out – but they won’t be relevant or helpful if you aren’t in the same situation. They may even harm you. Everything is incredibly confusing and disorientating and you may feel as though you have gone entirely mad.

Getting help for complex trauma is much more complicated. Finding an expert who understands the layers of things you may be dealing with isn’t easy. Even recognising that you’ve got complex trauma impacting on you can be hard because when it isn’t event based, it plays out so much more subtly.

When traumas collide

This winter, Tom and I have done a lot of very deliberate work on changing our relationship. We both came to this marriage with a lot of history and with triggers – some of which we knew about, and some we didn’t. 

Usually when people talk about triggering, it goes like this: There is a person with a trauma history who encounters something that evokes that trauma. They are then thrown back into that history, like a soldier thrown back into the trenches by the sound of an explosion. Once you’re back in the trenches, everything you experience seems to be part of that scenario, and the original terror takes over.

When the trauma involves relationships, and when both of you have triggers, it’s entirely possible for both parties to set each other off. One person’s trauma response can become the other person’s trigger. Historical coping mechanisms can also be a big issue in all of this. If you have one person with a freeze response to panic, and one person whose emotional abuse history includes being totally ignored as punishment, that can be a messy combination.

It’s taken us a long time to get to the point of being able to talk about what happens when historical experiences collide like this. When it happens, we’re effectively functioning in two totally separate realities, not making sense to each other, unable to help each other and often adding to each other’s distress. It’s been messy at times. It’s taken work to get to the point of being able to pick it open and make changes.

One thing we’ve found that helps is to flag up problems as fast as possible. Tom tends to freeze around panic, and that intersects with what his ADHD brain does when he’s not coping. However, if he can tell me that he’s having processing issues, I don’t then take it personally, and we’re better able to work things through. 

I tend to make things worse because, thanks to my history, I act from the expectation that basic needs won’t be met and that in asking for small things I will be asking for too much. This creates the impression that the help I need would be impossibly difficult to achieve – an easy thing to persuade someone of if they’re used to being put under pressure to deliver impossible things. This means I don’t get the help, reinforcing my feeling that I don’t deserve to have my basic needs met and thus making me less able to ask for help. It’s really easy to get stuck in vicious circles like this.

I’ve learned to push back against my panic to ask clearly for what I need. Often it’s things like needing to be talked to so that I’m not simply trapped inside my own head with my escalating panic. You can see how well that works with Tom’s tendency to freeze when panicking…

Mental health problems aren’t solitary, personal issues. We didn’t get into this on our own. Much of where we are both struggling has everything to do with what happens around other people and in the context of relationships. Healing as a single-person project has never really worked. However, working together to support each other, deal with difficulties and find strategies for coping, is proving really effective.

Contemplating Brains

For various reasons, I’ve spent a lot of time in recent months looking for information about both neurodivergence and personality disorders. I minored in psychology back in the day and have remained interested in brain stuff ever since.

There are a lot of conditions that are defined by symptoms. When it comes to brain stuff and personality stuff this means as an adult, self reporting to someone who will then make a subjective assessment of how you’ve presented yourself. It’s not like looking at a broken bone, or how much insulin you produce. Given the way in which neurodivergent people tend to be traumatised, and how so-called personality disorders look a lot like pathologizing trauma responses, there’s a lot here that worries me.

I note with concern that diagnosis often has everything to do with how much of a nuisance you are to other people. Kids who act out at school are more likely to get checked out. Quiet but miserable kids may go unnoticed. I know historically that working class kids were less likely to be identified as dyslexic and more likely to be labelled as ‘thick’ and ignored. Girls who are shy and socially awkward but polite are more acceptable than boys having similar problems. Girls are socialised hard to be nice, in a way boys aren’t, all of which no doubt has a big impact on who gets diagnosed with autism. Boys underperforming with ADHD often get taken a lot more seriously than their female counterparts who get labelled as chatterboxes or as ditzy daydreamers. There’s a lot of sexism and classism tangled up in diagnosis, and more so in the past.

If you are a problem to your workplace, you might get an adult diagnosis. Otherwise it seems to be prohibitively difficult for a lot of people. There seems to be a general feeling that people who are high functioning and have viable workarounds don’t really need help. Be that with mental health or neurodivergence. These issues aren’t approached based on your suffering, it’s far more about the inconvenience you might cause to those around you. I think to some degree this is informed by lack of resources. There’s certainly not much support available for many people who are struggling.

We don’t actually get taught much about how our minds work. It would be useful if more people better understood what might be going on with other people’s heads, and their own. Education is always a good choice for reducing stigma and being more inclusive. Children who stand out as different may get help learning how to fit in, but why aren’t we teaching everyone how to better accommodate difference in the first place?

There’s so much more to quality of life than whether we can fit in at school and function in a workplace. I think there’s a lot of distortion created by how those aspects of life are prioritised. I wonder what different kinds of approaches to brains and health might be possible if we were willing to be a bit more thoughtful about it all.

Trauma Recovery

Last year, the cat in our household had two very unpleasant experiences with loose dogs. One of those has left my son with a scar, the second resulted in the cat hiding in a tree for four hours. My Anderson only goes out on a lead, so it was evident after the first incident that he’d become really fearful of all dogs. The tree incident was an overreaction to a situation that had too much in common with the first event.

Being a lively young cat, he really does need to go out for some exercise when he can. So, we started doing things to try and reduce the stress of dealing with dogs. Tom would pick him up when there was any dog around and I’d put myself between him and the dog. We talked to him, trying to sound reassuring. It wasn’t long before he was treating dogs on leads as much less of a threat and at this point he doesn’t simply panic when he sees a loose dog. He’s still very cautious, but he’s learned that the traumatic incident wasn’t normal and he’s recovering.

When it comes to humans, it’s often the case that recovery is tied up with getting to feel that the trauma is not the new normal. That of course has implications for anyone trapped in a traumatic situation. You can’t heal until you’re out of it. For a while, all dogs looked like a threat to Mr Anderson, and being a small cat, there wasn’t much he could do to change that. What’s helped him recover is that we’ve done things he could make sense of that have helped him feel safer and from there he’s been able to gather evidence that not all dogs are going to try and attack him.

In humans, we tend to treat recovery from trauma as the job of the individual. A therapist might hold safe space for you to think about things, but the odds are you’ll have to deal with the unsafe situations and try to overcome what happens to you. That’s really hard. It’s much easier to feel safe when you have people around you who are actively helping you to feel safer.

Mr Anderson has gone from reacting like he was afraid all dogs were going to try and kill him, to reacting as though he thinks some dogs might be friendly. He didn’t do that on his own.

When you can’t reboot

Healing – whether we’re talking about the body or the mind – is often framed as getting back to how things were before. This assumes that there was a before, and that you can return to it. There can be a lot of ableism tied up in the idea of getting people back to how they were. Where experience has been impactful, it’s often a lot more useful to embrace the change and focus on how to move forward to best effect.

A return to normal as a proposed goal can distract you from coming to terms with things as they now are. Even if your body can be put back pretty much as it was, a dramatic experience of injury or illness will change you. I think it’s really unhealthy not to give people room to be changed by that. How you feel and what you want to do with your life may be very different after the event, and it may have you questioning you previous ‘normal’ choices and priorities.

You can’t un-know trauma. You can’t re-wind and re-set to become the person who did not have that experience. Traumatic experiences change your perspective. You become more aware of the dangers, of the potential for loss. You can’t have that innocence back. You will need to form a new relationship with the world that includes what the trauma showed you, but holds it in a way that allows you to function.

There may be nowhere to go back to. If the damage – bodily or psychological – happened early, you will have no memories of what other people think of as normal. If you’ve never felt safe you don’t have the knowledge to draw on to overcome your difficulties. A lot of the available support material depends on the assumption that you can reconnect with your pre-trauma self and use that as at least a point of reference for a reboot. Not everyone has a pre-trauma self.

This means that for some of us, healing cannot be a reboot, because there’s nothing to reboot from. Healing means building from scratch things that other people take for granted. Trust. Self esteem. Confidence in the world, in people, in your right not to be hurt… these are hard things to develop later in life if you’ve grown up in an unsafe or inadequate environment. If you’ve never felt good enough or worthy of love, it’s a hard thing to grow that from scratch. Running into self help material around this can feel a lot like having it suggested that you’d be fine if you just grew a tail. And it doesn’t matter how obvious it is to anyone else that growing a tail should be easy and simple, if you’ve never had a tail, it’s intimidating and may well seem impossible.

Mental Health Awareness

It’s Mental Health Awareness Week. One of the things I wish to make people particularly aware of, is that for many people, mental health problems are not some kind of tragic accident. There are people for whom wonky brain chemistry is to blame, but for many of us, mental health problems have causes.

Trauma causes mental health problems. This should be pretty obvious. Consider (or look up) the figures for domestic abuse, and sexual violence. Have a look at some of the definitions of borderline personality disorders and ask how those might relate to traumatic experience.

Work stress causes mental health problems. You can’t run people like machines and expect them not to break down. Inhuman work practices (Amazon, I am looking at you) destroy mental health.

Poverty causes mental health problems. Firstly because poverty and insecurity are immensely stressful. Secondly because if you are poor, you’ll have less access to resources that might help you. There will be no money for sport and fitness – activity often being recommended to help with mental health problems. You’re less likely to have a garden or to be able to access green space. Your poverty diet will undermine your physical and mental health. You may be socially isolated as a consequence of poverty. In societies that punish poverty, your self esteem and confidence will be harmed by the stigma of being poor.

If you are disabled, your long term condition may well also be undermining your mental health. Further, being physically disabled radically increases your chances of being in poverty, see above.

We have seat belts and safety rails, lifeguards, firemen, laws about smoking, workplace health and safety to reduce accidents. We take the protection of bodily wellbeing reasonably seriously. We don’t have the same attitude to mental health. We treat it like an individual problem, and not like something that could be damaged by the crimes and negligence of others.  We treat poverty as a personal failing, not a societal one.

Please be aware that mental health problems are not tragic accidents suffered by the unfortunate few. It’s not weakness, or lack of resilience. Unless we take stress and poverty seriously, we’re going to make ourselves ill. Until we deal with abuse in our societies, we will make people ill. When we shame people for being poor, we promote poor mental health.

Pain speculation

To be very clear, what I’m sharing in this post is speculation based on personal experience. I can’t point anyone at any evidence that backs it up. I’ll start with what we do know – that there does seem to be a relationship between inflammation based pain, and trauma history. People with fibromyalgia seem to be more likely than not to have trauma history. There is growing evidence that what happens around trauma doesn’t just impact on your mind and feelings and that there can be bodily consequences – hardly a wild though, it is all the same system after all.

One of the psychological consequences of trauma, can be hyper-vigilance. You’re always looking for threats, you can’t relax. Busy spaces, people behind you, noise, unexpected touch or sounds – all of these things can cause panic and ptsd responses for some people. But of late I’ve been wondering whether that really is a purely psychological issue.

I carry a lot of tension in my body, and this contributes to experiencing pain and stiffness. Anxiety and stress in the body manifest as fight/flight/freeze/appease responses – that’s been established. So, we might fairly assume there is some kind of process that precedes fight, flight etc. Normal people do not spend all of their time poised to run away, and get to be happier and healthier as a consequence. Cortisol and adrenaline are part of this mix, for sure. What if being on alert all the time is a bodily process? What if hyper-vigilance is something that happens not just in my head, but in my tissues? Could that be why I spend so much time sore and in pain?

If that’s so, then the next question is, how do I persuade my body to stand down? How do I persuade my body that I am safe enough now, and that I do not have to be poised to run away or ready to freeze and disassociate? How do I teach my body to feel safe? I shall be exploring this and will come back if I make any progress.

Trauma and basic needs

It occurred to me last week that trauma can be understood as what happens to us when our most basic needs aren’t met. I’m finding this a helpful re-framing because ‘trauma’ as a word suggests drama, but it might not always register that way. Sleep deprivation is considered traumatic enough to count as torture under international law. One or two bad nights clearly don’t impact traumatically, but when your sleep is consistently undermined over longer time frames, it becomes maddening. A few missed meals aren’t traumatic, necessarily, but starvation certainly is.

In really mundane ways, we can lose our safety. Being shouted at every day. Being threatened and harassed. Not being allowed to rest. We experience damage from trauma not when there’s some abnormal drama that we can understand as exceptional, but when the trauma becomes normal. One loud explosion probably won’t traumatise you. Dealing with it every day was what gave soldiers shell shock. Once trauma becomes normal, the world no longer feels safe and everything is potentially threatening and more dangerous.

It is also fundamentally dehumanising not to have basic needs met. These include basic needs for emotional security and comfort, for shelter and dignity. Emotional abuse – especially in childhood –  can rob a person of their sense of personhood.

Basic needs are essential things that we can’t do without for any length of time. These include our physical needs, our emotional and our social needs. How we experience losing those will vary, but the harm is considerable. In my experience, one of the problems is how easy it is to have genuine need start to seem trivial and not to be fussed over. The need to feel safe becomes being fragile and over-reacting. The need for anything can be minimised and treated as unimportant, adding a gaslighting element to an already problematic situation. When you start to believe that your basic needs don’t matter, that you don’t count in the way ‘real’ people do, you become incredibly vulnerable.

I’ve realised in recent weeks that one of the long term consequences of such experiences, is that I don’t know how to reliably prioritise my basic needs. I don’t know how to feel safe flagging up problems when they happen. I don’t know how or when to ask for help when basic needs aren’t met. I am easily persuaded that my doing without something I needed is a fair solution to other problems. This is going to take some unpicking. To heal, to be safe I have to make sure my basic needs are reliably met, but having internalised abuse and gaslighting, I’ve become part of my own problem. I can change that but it will take work.

The idea that I am fundamentally entitled to have my needs met, to ask that my needs be met and to raise it as an issue when they are not, is a very large thought for me. We should all have this, and I am painfully aware that for many people in the world, getting basic needs met is not a question of learning how to ask. It’s a question of systemic oppression, international abuses of power, war, climate chaos and exploitation.

Dealing with fear

I’ve been dealing with fear for years. Here are some things I’ve learned that may be useful. If you want more insights, I’ve written a lot of notes from the journey – search for blogs here about anxiety.

Your fear is not unreasonable. You’ve lived through something, or the threat of something that has taught you to be afraid. If the world seems hostile, dangerous and unkind, this is because you have found it to be so. Your fear is rational. If you are in a dangerous situation, treating your fear like it’s an irrational response will keep you in danger – often an issue in abusive relationships. If you are not in danger, historical fear can make your life hell.

It is really important to notice the fear. If it becomes normal, this may take more effort. Accelerated heart rate, overwhelming feelings of threat, futility, powerlessness and everything going wrong are not normal. If you’re feeling those a lot, or all the time, you are feeling fear.

Risk assess. Sit down, breathe slowly and look at what you’re afraid of. Ask yourself how real the threats are, and try and go through them as slowly and carefully as you can. If you find you are in real danger, seek help. Take it seriously. If the danger is based on past experience, question it. Don’t let it take over. It is reasonable to be afraid if you have been through trauma, but it doesn’t mean you are always in danger.

Breathing slowly and deeply is often a good way to control fear in the body. Moving is good. I find I have to literally run away sometimes to control the flight responses. I get out and walk. If you freeze up with fear, try and coax yourself into some small, gentle movement. Flight, fight and freeze responses are all signs that fear has taken you over.

It is really important to eat well, get exercise, rest and sleep, and to do things that comfort you. Alcohol doesn’t really help. Many of us find herbal interventions like St Johns Wort, chamomile, valerian and lavender to be helpful, and you’re in control of those, which helps. If your body is run down, exhausted or malnourished it has good reasons to be afraid, and that won’t help.

This is really hard stuff to deal with on your own. You are not obliged to deal with it on your own. Fear may tell you no one will help you, or that they will use it as an opportunity to hold power over you. Find the people who also live with anxiety and work with them. It is easier to dismantle this sort of stuff as part of a team. It is easier to think about other people’s experiences than your own. By sharing your experiences, you can help someone else. By supporting each other we can make safe spaces to defend ourselves from fear.

You didn’t get here by yourself. Fear will tell you that people will judge you and think less of you if you need help. This isn’t always true. Some people will do this, but not everyone, and the people worth having in your life are the friends and allies who will not kick you when you are down. Get out as far as you can from situations where people will use your vulnerabilities to hurt you. Find the people you can trust. Even if it’s just some random blogger like me. You aren’t alone, and you can get the fear under control and have some, or all of your life back.