Thursday, December 27, 2012

Learner therapist (27)…… Valuing your injured self

Learner therapist (27)……
Valuing your injured self

Torrey Orton
Dec 27, 2012

"…When will I get over this…or, will I ever?"

Over the years a recurrent challenge for many of my patients has been handling a sense of wasted life that they carry with their various injuries. The repetition of the question "Will I ever get over this?" emphasizes the difficulty of their recovery challenges. It contains a hope that they could return to some pristine pre-injured state (in themselves) or status (in the eyes of imagined knowing others) struggling with an expectation that they have been inescapably tarnished by their histories.
Part of this sense comes from the victim's perception that he is the author of his own injuries. Another part comes from the injuries being seen to be his fault when it cannot be – childhood violations of numerous kinds are imposed by powerful others (usually close ones). While I may wonder about the value of my life, as many of my acquaintances do about theirs, I'm not confusing this with the wonder of patients whose injuries are deep and long term. The shared part is the human self-evaluation drive. Victims' self-evaluation drives are hyper-vigilant versions of a natural drive, like their threat detection systems which sense danger all the time, correctly but inappropriately.
Valuing the injured part
Certain injuries carry an almost irrepressible shame/guilt – especially those of a sexual nature. As patients' lives unfold in various attempts to create workable ones, they may gather up a trail of partial starts at this or that, or long term stuckness in not ever 'good enough' occupations, relationships and life-styles. How can such a life trajectory be seen to be valuable in more than a pollyanaish way (well, you tried hard, dear) that seems to default to dismissal of the injury? My belief is that most traumas can be valued, at least a lot more often than they may be, and that they must be valued for a final escape from their fate of victims (by embracing them for all to see).
Certainly there are people who have risen above congenital injuries and war injuries which left their bodies deprived of parts and processes. And most of them "carry" their injuries in more or less visible ways. My patients "carry' theirs without others, and sometimes themselves, knowing it. Memory of early psycho-social injuries is notoriously unreliable. Sometimes the injury can only be perceived in the tracks of present relationships and life processes. These early memories are often blocked as well, and the over-developed capacity for blocking distorts the aspects of life where the injury was experienced decades before – again, most notably, blocks to feeling, expression, and imagination in relationships.
If we judged the virtue of being injured from the treatment of those injured on our behalf – for example, our soldiers, sailors, fire-fighters, and police – we'd keep them hidden. And so it is with those of us who carry our injuries to the soul, spirit, and self silently and unobtrusively, and are quickly pushed back in their containers by the deft hand of others' instantaneous disregard whenever we let them slip into their view. On a good day our slips might be deigned to a treatment from another – 'what you should do is…' type stuff. A different push back in the box. Not often a call to 'share'.
Strength from adversity
As a collective matter, the bearing of active systemic disregards of ethnicity, race, gender, religion or class yield peculiar strengths in those who survive by quietly putting up with them. These strengths include insight into the real dynamics of the oppressive system(s). Ask the nuns about the church; ask the women about the men, ask the blacks about the whites….though a 'consultation' about exploitation by the exploiters (openness and transparency and honesty and all that) is likely to be characterised by impenetrable withholding by the oppressed which the oppressors will not seek to penetrate while at the same time discouraging any expression of the perceived oppression. Notice our long social unhearing of the sexually victimised. Any unguarded 'sharing' of perceived oppression (say, of sexist or racist behaviour in any of the footballs) will be put back in the box with defensive disregard – 'it's just a joke', 'it was just a bit of fun'…It's hard to progress bullying, harassment, and hazing in the systemic fog of oppressors' denials.
As a personal matter, the abused/oppressed often find sustenance through success in parallel systems – e.g. the violated child whose gifts translate easily into school success. These successes are all quite normal; the unoppressed do them, too. Personal development, normally, involves a bunch of small steps of increasing complexity and intensity. Progress – that is, a completed development stage – is marked by internal and/or external 'tests' when a normal performance of a life task is required and achieved for the first time in its fullness or wholeness. Some of these developments are required of all humans as foundations of living. Many are possible for all humans, while very high standard performance is possible only for a few and usually only in a few task domains for any individual. The renaissance man/woman is a figment attested by its scarcity.
Acknowledge trying
What recovery from an injured self particularly strengthens are virtuous habits: persistence, focus, assertiveness, etc. As a result a victim made something of herself in unpromising conditions. She tried and tried again as the Quit ad now correctly encourages smokers!! Al Anon has done this for alcoholics for decades. As I've noted elsewhere, success cannot be the measure of a life's quality since the internal and external conditions for high achievement, or any achievement, are not equally available to all. Trying can be expected, and that trying which occurs in the face of a powerful socio-politico-economic headwind is universally well thought of, honoured even.
But, when the headwind is also psychological, the right of the person to honour for their efforts is compromised. We still do not think the injuries of abuse are injuries like a car accident, a road side bomb explosion, a bush fire and so on…all things which have very definite time and place boundaries. They can be seen to be finished and the damages are often visible. The socio-psychologically injured tend to take on themselves this debasing of their emotional currency and so may disable their acknowledgement of their trying.
Another value to be acknowledged is the "functional" parts of themselves which are the basis for what appears to others to be a normal life. The injured often do not even acknowledge these objectively assessable parts. They wince when a compliment is extended for a clearly, undeniably, and externally validated good piece of work. They shift from 'I' to 'you' as subject of their discourse. They cannot put together words of self-approval like 'I did X well', or even 'OK'.
The denial of their uninjured self, or its obscuring in the tailings of the injury, is a collateral damage of the original injury. Learning to accept their own achievements and intentions and valuing by others is competitively as challenging as overcoming their inappropriate guilt for their injury. Resistance to doing so is one of the public signs of hidden injury.
Build self-acknowledgement
How to work on this self-acceptance of injured part(s)? (1) Build self-acknowledgement. I've tried recently to directly confront a self-denigrating thought by amplifying the patient's success achieved in parallel systems (work, school, play). I do this by persistently, sometimes irritatingly, recognising all achievements a patient lets pass unacknowledged, even if mentioned by them (as if they are dead, or recognition would be a kind of dying) and contradicting all implicit disavowals of their own worth (which are an actual piecemeal reinjuring of the self). The disavowals are easier to see as the surface disturbances arising from deeper self-denials. Once started on the pathway to self-acknowledgement, homework of various kinds can target and reinforce self-acknowledgment. A sign it is 'taking' as a normal self is an improved rate of unconflicted positive self-report in session – for example, the steady disappearance of apology as the first step of entering a session and growing into taking charge of session agenda setting.
Understand family history
A different stage in treating injured parts is (2) to pursue understanding how the family (or other systems) became damaging to oneself over time. Knowing that one or both damaging parents were themselves damaged by damaging parents over successive generations gives a perspective which modifies the sense of injustice about one's own trauma. To some extent it no longer has the intensely personal feel it always did. The mining of family history produces appreciation of one's place in it, and usually of one's place in a long history of trauma that is not merely familial. Rather often regional, social, cultural, national or global.
This generation's family trauma is fired by the unexpressed / unacknowledged traumas of the previous ones. Look for the family members who carry undiscussables damages which they sustained for the benefit of future families – the warriors who survived wars for example; the workers who never recovered from depressions...!! Follow the pathways of alcohol and violence within and across generations. Expect to find traumatic peaks in tandem with social, economic and political troughs. Note that there was a 40 year trough between 1910 and 1950 covering two world wars and a global depression. That's enough to affect two generations directly, the latter being the Boomers' parents – the parents of our patients.
Seek acknowledgement from abusers
Next, (3) there's getting acknowledgment of their injuries from those responsible – an experience which redeems life from the pit of self-blame. This can be obtained from others, but often defaults to oneself when the others are even more injured than oneself. The process of seeking, demanding even, acknowledgement of their responsibility from those who perpetrated the traumatic events is a critical step, even if often only a virtual one because the blameworthy are beyond reaching – dead, decrepit, demented….
…this step is critical because through it patients achieve confirmation of their historical experiences, relieving themselves of the paranoid process of retaining the injuries as secrets and creating reliable facts about those experiences. It may be that what is confirmed is their own memory and that has to be accepted without validation by the other(s) concerned. Either way, confirmed or not, self-acceptance as injured is central to recovery. This should lead to apology, completing the guilt erasure process, and may be supported by reparation for damages experienced and guarantees no further ones will occur. These four steps are the basics of a reconciliation cycle.
Create personal power by confronting
To work through this cycle requires development of a further capacity – the capacity to act in the face of explicit and implicit challenge. In other words, patients have to increase their personal power to do any of the above. I work on this by making that objective explicit quite early in the work, saying 'If you want to work through this thoroughly you will need to increase your personal power, and working through steps (like those above) will have that effect'. Many patients are surprised / shocked and then pleased with this idea. The pathway to power is a bit more challenging than accepting or embracing the objective of becoming more powerful. Some of my earlier posts on communication interventions for relationship improvement suggest details of the work.
A major step in confronting abusers is what I call 'self-outing'. It may start with coming to therapy. Finding friends and others who can be trusted to accept the offer of the patient's pain is often an important prior step or early result of therapy. This finishes with confronting victimisers, especially the family system which keeps the family secrets. Some patients go further to join victim advocacy organisations. This is courageous work since each offer of the injured self is a chancy move – even the best friends and colleagues cannot be guaranteed to be good receivers. They, too, may reject the patient's experience. Public advocacy is an invitation to re-experience abuse, since to advocate is to speak into a prevailing breeze of social disregard, if not condemnation, of the matters and people advocated. Another form of whistle blowing.
I am aware that in the background of my working over this post stands the question of what is a technically traumatic life experience. I offer a simple definition for therapists which I use as a guideline for my listening with any patient who appears with serious, endemic anxiety or depression – what they consider persistently life-distorting feelings and behaviours and outcomes. I also offer it to the afflicted as a search guideline for themselves. The definition is:
DIMRS = a quintet of experiences with collective traumatic impact
Death-threatening – the victim feels in danger of death, though not necessarily physical death; spiritual or emotional death will do just fine for a verdict of worthlessness; and
Inescapable – a feeling of hopelessness because he / she is caught in the grip of another on whom they are totally dependent for their survival, both physically and emotionally / spiritually; and
Multi-dimensional – damages occur in many dimensions of well-being: self-care, self-image, aspiration(s), emotional hyper-vigilance; and
Recurrent – the threat is present more or less all the time for years, sometimes up to the present adult time in which they appear in therapy – more or less all of their lives to date; decades in their minds and present living; and
Systemically distorting – the victim's capacity to enter into and sustain relationships of many kinds is restricted by profound distrust expressed in bad choice of potential partners of many kinds (intimate, peer, work, etc.) and inappropriate levels of commitment: too much or too little, sometimes oscillating between the two; the distrust extends to their own perceptions.

No comments:

Post a Comment