Unraveling Trauma

Just a few months before Hurricane Katrina struck, my house burned down. A switch that kept my dryer from overheating failed, and the fire that started in the laundry room quickly spread. I stood across the street and watched flames consume my home and its contents.

My 8-year-old son wasn’t in the house at the time of the fire. The next morning we went to the property and looked through the windows. Then we visited our cat being treated at the veterinary hospital. The firefighters found her hiding in the closet, brought her out and administered oxygen. Even with the best veterinary care, she died three days after the fire. My son and I buried her in the back yard. 

My son started having nightmares. He feared that a bus would crash onto the second story balcony. He was convinced that our cat was alive and trapped in the box from the newly purchased computer printer. It’s like his brain was scrambled.

My parenting coach recommended a therapist who specializes in childhood trauma. After an evaluation, Cathy, the therapist, diagnosed my son with PTSD. 

She recommended her trauma protocol that includes and builds on a treatment called Eye Movement Desensitization and Reprocessing or EMDR . To explain it, she asked, “Have you ever gone to bed with a problem that seemed to be solved when you woke up? 

When we treat people with trauma, the problem we solve for is how to let the brain know that the dangerous past is over and that the present  moment is safe. The challenge is that we have to communicate this to the brain in a way it understands, and trauma limits the  brain’s ability to understand words. You can tell a soldier with PTSD, “Look you’re safely back in the US” but it doesn’t help. 

There’s evidence that the back and forth eye movement seen during REM sleep activates some internal self-healing response, sort of like turning on a self-cleaned oven. 

We think that the results we see with EMDR are a result of signals crossing between the left and right hemispheres of the brain.”

Cathy told me she added another layer to EMDR. To prove to the brain that the past was over, she would ask my son to see a series of pictures in his mind that captured the days and weeks that followed the fire. Then she would take him through the timeline.

She explained that it’s easier for kids to see these images when their eyes are shut. So, instead of using eye movement, she would get signals to cross between the left and right hemispheres of the brain by alternatively tap my son’s right and left knees. In addition, she would ask him to wear headphones that alternatively delivered sounds to the right and left ears. 

She shared with me the extraordinary results she had gotten with other children. 

Cathy asked if I had any questions about the proposed treatment.

I wanted to ask, “Are you also going to slip ruby slippers on his feet, ask him to tap his heels three times and think, ‘There’s no place like home.’” This treatment sounded crazy to me!  I never heard of eye movement treatment when I was in medical school.

I told her I didn’t have any questions.

She asked: Would I consent to this treatment?

Quite honestly I doubted it would help. But I consented because I didn’t think it would do any harm.

I was present during the treatment sessions. Cathy told my son,“Here’s your job and it’s really easy. I’m going to ask you to  imagine you had a camera in your head that took a picture of something special from each day. If I asked you to share a picture from yesterday what would it be?” 

He said,”Going to the Mariners game with my Mom.” 

She said, “Great.” 

She said that the only question she would ask him was whether or not he could see the picture. Other than saying yes or no, he didn’t need to say anything.

Then she explained that she would also ask him to wear headphones and asked for his permission to tap his knees.

They got started. She asked my son to picture the day of the fire. Did he see the picture? Then she asked about picture of the next day and then the next day and then the next until she got to the current day.

.

At the end of the second session, she asked my son to tell her about his cat. He said, “She died in the fire. I’m sad she died. I loved her and I miss her.”  Cathy asked if the cat was in the printer box, and he said, “No. Her body’s in the dirt.”

Had I not seen in with my own eyes, I would not have believed it. It’s like a switch went on and his brain was unscrambled.

Let’s talk about trauma. 

The word trauma means different things to different people. 

In this conversation, we are going to use the medical definition of trauma, as stated by physician and trauma expert Dr. Gabor Mate. He says, “Trauma is not what happens to you. Trauma is what happens inside you as a result of what happened to you.”

Trauma is from the Greek word meaning wound. For a person diagnosed with trauma, the traumatic episode changes their nervous systems in a specific way that leads them to feel unsafe in the present moment, even when the traumatic event is in the past. 

A person has trauma in the same way a person has OCD.

What happens in the brains of people with trauma? We can understand it through the lens of evolution.

During the Paleolithic era, we were both predator and prey.

The brain is obsessed with a single question. “In this moment, am I safe or am I in danger?” 

The nervous system—the brain and the spinal cord and the nerves that carry information to and from the spinal cord—is like a finely tuned orchestra.

The autonomic nervous system is its conductor. It automatically responds to meet the physiologic needs of the moment. It automatically speeds up you heart rate when you exercise and then slows it when you rest. If you’re a diabetic you know how profoundly your life changes when you take over glucose management. And that’s just one of the thousands of jobs your nervous system automatically manages. 

The highest and most important job of the orchestra of your nervous system is detecting danger and getting you back to safety by fighting, fleeing or freezing. 

There is always music playing in the background of your life, and the conductor—your autonomic nervous system- decides which of the three symphony the orchestra plays in any given moment. The symphony is chosen on the basis of whether or not you feel safe, and the nature of the threat. 

The first symphony is the Song of Safety. The autonomic nervous system plays it when it creates the physiologic state you enjoy when you feel safe. Let’s call this the green zone. Consider this your home. You are the best version of yourself when you’re in the green zone of safety.

If there’s a saber-toothed tiger near by, the autonomic nervous system tells the orchestra to play the Song of Flight. Maybe it’s even a version of the Flight of the Bumble Bee. The entire nervous system creates the physiologic state to help you fight or flee. Your heart beats faster. Your blood gets diverted from the digestive tract to your muscles. Your vision narrows. When you hear the Song of Flight, your autonomic nervous system creates a physiologic state we’ll call the yellow zone.

After your escape, the autonomic nervous system changes the music back to the Song of Safety. You shift your physiologic state from the yellow zone of danger to the green zone of safety. 

Sometimes when you’re in danger you can’t fight or flee. The saber-toothed tiger has you cornered. When the autonomic nervous system thinks that death is near, it activates the freeze response. Maybe the orchestra plays the score for the movie Jaws. This creates the third physiologic state that helps you feign death and dissociate from your body, presumably to make death less painful. Let’s call this the red zone. 

Once you’re back to safety, the autonomic nervous system shifts you from the red zone to the green zone.  

Here’s there most important part.  You experience the world differently in the green, yellow and red zones.

I once toured a botanical garden with a friend. On the ride home, we reflected on what we liked the most. The things above my friend’s head —the trees—caught his attention. The things below my head—the perennials and shrubs—caught my attention. It’s as if we toured two different gardens.

So, too, in the different zones you see different things. You hear different things. You respond to people differently and think different thoughts.

When you feel safe, you see safety. When you feel threatened, you see threats.

If the physiologic zone of safety or danger is so important, you should consciously decide, right? 

That’s not how it works. Your autonomic nervous system—not your conscious thoughts—automatically determines if you’re in the green, yellow or red zones. This is out of your control.

However, you can learn skills to recognize what zone you’re in, and master skills to shift back to the to the green zone of safety. 

Trauma is the condition in which you get stuck in the red zone. You cannot shift back to the zone of safety—the green zone. It’s like Groundhog Day, only it’s a day you wish you never had. To make things worse, trauma changes your nervous system in a way that makes it hard to forget.

Why would we be vulnerable to this kind of wound? The lens of evolution might offer an explanation.  

Imagine our paleo ancestors foraging on the savannah. A tribe comes across a bush with a new berry. They don’t know it, but the berries are poisonous. Some of the tribe members witness the deaths of the people who ate the berries.

Doesn’t it make sense that the nervous system would bookmark this event. When you see the berry, your body brings you back to the awful moment to remind you to not eat the poisonous berries. 

There’s evidence that trauma changes gene expression. This means that trauma can be communicated through the generations. The parent who never saw the berry can have a child who knows this berry is poisonous.

Maybe trauma was designed to keep the tribe—not just individuals—safe. 

While we can only speculate about  whether trauma was adaptive in the Paleolithic era, we know with certainty that trauma is maladaptive in our world. Trauma leads to tremendous disability.

How common is trauma? Data suggests that about 6% of Americans have trauma, as compared to 4% with OCD. Undoubtedly the numbers are much, much higher. 

You might not be surprised to learn that people with OCD have trauma in their past. My son certainly did.

In his  book about trauma called The Myth of Normal—which I highly recommend — the previously mentioned Dr. Mate told his own  story. He was born to a Hungarian Jewish woman at a time in which the Nazis were gathering and killing jews. In an effort to save her 2-month-old’s life, his mother handed him over to the arms of a woman who would keep him safe. But this 2-month-old with is preverbal brain knew that his mother abandoned him. This left a deep wound.

His trauma still shows up in his adult life. He describes a time in which his wife was not able to pick him up at the airport. He was so angry he didn’t speak to his wife .

His wife understood what was happening, and she gave him time and space. But after 2 days of silence, she told him, “Enough.” And that was the end of that episode. Gabor returned to his adult self. 

We can only guess at the number of people experiencing intergenerational trauma today.

We can only guess about the long term impacts of social media on the incidence of trauma. Algorithms feed you a steady stream of content intended to take you out of the zone of safety and into the zone of danger. Why? Our brains preferentially pay attention to threats. It keeps you on the platform longer.

We can only guess how many people will be diagnosed with trauma as a direct result of living through the COVID pandemic. 

The pandemic had the most profound impact on children. Trauma changes the brain, and a child’s developing brain is most vulnerable.

Could you or someone you love have trauma?

Everyone lives through traumatic episodes. How do you know who has trauma? 

Let’s get back to my house fire. I remember the final session of my son’s treatment. His therapist Cathy asked him to draw a picture of his cat. 

While he was drawing, Cathy asked me how I was doing. I just laughed and told her I was too busy to think about myself. I had too much to do. 

I confessed there were days I sat immobilized in a chair overwhelmed by my to do list. I felt all alone. The challenge seemed too big and I was too small to take it on. 

Then I forced myself to get out of the chair and get going. 

Cathy said, “I’m just curious. Did anything traumatic happen to you when you were a child?” Then it clicked.  Yes, something did happen! Our family lost our house when I was 6, and we had to move. My parents didn’t want to talk about it, so my brother and I were left on our own to make sense of what was happening and find comfort. 

Cathy said, “How interesting. You and your son were displaced from your homes at about the same age.“

She told me she had an idea about what was happening for me. If she was right, the same therapeutic process that helped my son could help make my life easier and more manageable.  Would I like to set up an appointment for myself?

Yes, I told her.

In our first session Cathy took my history and then explained her hypothesis. 

She asked me to imagine that humans grow and develop like trees. If you look at the rings of a tree, you see some rings are thicker in the years when growing conditions were good, and thinner during the stressful years.

Sometimes you see a scar in an isolated ring. This happens when  the tree sustains a nonlethal injury say by fire.

So, too, humans grow and develop, and we do it the best when we feel safe. There are stressful years, but growth continues. Sometimes, though, dramatic and traumatic things happen. 

Cathy asked me to imagine saying to my eight year old son, “I have my own things to do so I’m leaving. I’ll stop in now and then to make meals and do the laundry. While I’m gone, I want you to rebuild our house and our lives.”

That was your childhood experience. You had some big powerful feelings, and there was not an adult there to comfort you or guide you. Your wound was caused by trying to manage adult-sized problems all on your own with your child-sized tools. It doesn’t work. This is your scar—your trauma.

If your parents told their 6-year-old daughter what was happening with your house instead of keeping secrets, answered your questions instead of avoiding them and helped you process your feelings, you could have healed at the time. The ring from your sixth year might look look normal.

Hopefully your son’s eighth year ring will normal rather than scarred because of this intervention. 

Right now I had a scar in my 6th ring. She was clear that she was not blaming my parents. They were parenting you the way they were parented. They might have passed along the exact same wounds that scarred them. This is one way trauma passes through the generations.

“Today you’re living in your outer ring with access to the wisdom and skills you’ve collected in your whole life. Of course your house fire would bring you back to the 6 year old version of yourself. It’s just something our human brains do.

She suggested, “It’s the six year old version of yourself sitting  immobilized and overwhelmed in the chair. Of course this job is too big for her. Of course she feels poor equipped to get the job done. Of course she feels alone now because she WAS alone when she was six.”

All of this made sense to me. My nervous system eavesdropped on my thoughts, “I can’t do this. I’m alone, this is too big for me and I can’t find help.” I tripped into my trauma, and my autonomic system did what it does so well. It instructed the orchestra to play the music from Jaws. It created the physiologic red zone. I froze. Suddenly I was 6 years old again.

With her hybrid EMDR treatment, Cathy suggested we could remind my brain, “Hey, I’m not six years old any more. I’m an adult with car keys and credit cards. I know how to feel my feelings. I can reach out for help. That would help me bring my adult self to the monumental task of recovering from the house fire. I got this.”

I agreed to become Cathy’s patient for my own trauma work.  

We worked through the timelines just as she did with my son. At the end of the first time through the timeline she said to this 6-year-old version of me, “You’ve been working very hard after the fire, and we all appreciate all your efforts. The reason it’s been so hard for you is that this is an adult problem. The good news is that I have a plan to help you get back to the your important job of being a kid. You can hand off all the house fire jobs to the adult Vicki. Think of her as your new mom. She’ll also take care of you, and keep you safe as she rebuilds your house.”

We went through many timelines in many sessions. I found that I spent more of my time as my adult self. 

So my unrecognized trauma was making a hard situation harder, and I didn’t even know it.

Not everyone with trauma can say the same thing. 

After several tours in Afghanistan, John suffered from PTSD.

His wife describes John as a great guy with dark secrets.

John would have moments when he just wasn’t there—even when he was there physically. He recoiled when strangers approached him. When they went anywhere the first thing he did was look for the exits. He seated himself in a room so that his back was never towards the door. He had nightmares. He sleepwalked.

John had been through PTSD treatment at the VA. His wife said the one thing that made the biggest impact on John was the time he found out that someone in his support group died from a heroin overdose. In the addiction community, substance use is thought to be a maladaptive effort to manage trauma. 

Then John got a service dog, and it transformed his life. 

His dog seemed to know what to do to restore John’s sense of safety. John’s nightmares and sleepwalking eased off.

Here are some common indicators that suggest the presence of the kind of major trauma that leads to disability:

Vivid and distressing memories of the traumatic events arise unexpectedly

Recurrent nightmares related to the trauma

Avoiding places or people or activities that remind you of the traumatic event.

Feeling numb

Being easily startled by loud noises or movements

Detaching from relationships 

Sometimes, the effects of trauma may not surface until months or even years after the event. Additionally, everyone experiences trauma in a different way.

Trauma and OCD

Here’s the real reason I’m recording this episode about trauma for a community of people managing OCD.

Trauma and OCD are connected.

One study finds that about half of patients diagnosed with OCD lived through a traumatic episode. 

Up to 30% of people being treated for PTSD have been diagnosed with OCD. In fact, the VA sees enough cases of in which patients develop OCD after PTSD so that they’ve described a entity they call trauma-related OCD.

Both OCD and trauma deal with this question about how and where you draw the line between safety and danger, and the challenges of moving from the zones of danger back to the zone of safety. Trauma and OCD are  cousins.

Here’s what we know about people diagnosed with both OCD and trauma. 

Trauma can intensify OCD symptoms This is particularly evident in cases where the trauma is related to the obsessions or compulsions themselves. For example, a person with contamination themes OCD who witnesses a COVID-related death may find their symptoms become more severe.

Trauma can influence OCD themes  A person who has experienced a traumatic event related to harm or violence may develop obsessions about causing harm or compulsions aimed at preventing it.

OCD can serve as a coping mechanism for people managing  trauma. Engaging in repetitive rituals may offer temporary relief from the distressing emotions associated with the trauma.

Let’s say you’re diagnosed with both trauma and OCD. What you you do then?

It's important to approach treatment in a thoughtful and integrated manner.

It begins with a thorough assessment by a health care professional experienced in diagnosing both OCD and trauma. 

Your health care team will most likely address your  immediate safety. Trauma makes you FEEL unsafe; if you actually ARE unsafe someone can help you get to a safe environment. 

Educate yourself about both OCD and trauma. 

Build a treatment team. You may get trauma treatment from one therapist and OCD treatment from another. Ideally your team members talk to each other.

Sequence treatment. Generally treatment begins with trauma-focussed therapy. Once you’ve made progress in processing and coping with trauma, shift focus towards managing OCD symptoms. Remember, exposure and response prevention (ERP),  is the gold standard treatment for OCD.

Embrace the habits that promote optimal brain function. Get regular sleep. Eat healthfully. Exercise. And don’t forget the other vitamin C—Connection. We are more likely to shift from the zone of danger to the zone of safety when we’re with people who already feel safe. 

As we wrap up, here are the most important trauma take-aways:

Trauma is not what happens to you. Trauma is what happens inside you as a result of what happened to you. 

Trauma is not a psychologic disorder; it’s a physiologic disorder. Trauma is like a jammed clutch of the Autonomic Nervous System making it difficult to shift from the zones of danger back to the zone of safety. 

Many individuals with OCD and trauma suffer. They might not even have a formal diagnosis. They might not have found the right healthcare professional or the treatment that works best for them. 

Yet.

I’m optimistic that the future holds the promise of effective treatments for both trauma and OCD. Maybe it will not be about what healthcare professional do TO you or FOR you. Maybe it’s something they do WITH you. What if treatment is a collaboration that unleashes the self-healing powers of our nervous system.

I wonder if our therapist Cathy did, in fact, serve as our own personal Glinda offering my son and me the ruby slippers to get back to our home of safety. Maybe she reminded our brains to activate its own healing magic we didn’t know we had. 

What can we do today to alleviate the pain and suffering of OCD and trauma? 

Anyone who wrestles with OCD or trauma know the critical value of creating the feeling of safety within our families and in our communities. Safety is particularly important for people with neurodiverse brains. They live is a world they experience as unsafe. It’s not safe to be different. It’s not safe to tell others what you want or need. It’s not safe to learn and communicate differently.  

Getting and staying safe is a team sport. You know this if you or a loved one wants to be freed from OCD.