This book was published in 2014, but I revisited it in preparing some work on trauma informed practice in conflict resolution. The book is a powerful and often heart-breaking account of the development of knowledge about trauma, its symptoms and its treatment.
While not specifically about how to conduct a trauma informed practice, it provides a depth of understanding about trauma that is an essential foundation for such a practice. Part 1 explores PTSD in returned defence veterans, and developing understandings about the mind, brain and neuroscience. Part 2 considers your brain on trauma, covering the threat response, the body-mind connection, and the impact of trauma on one’s sense of self. Part 3 is about trauma in children, and these chapters I found particularly difficult to read. Part 4 is about the impact of trauma, particularly on memory. Part 5 is about paths to recovery and explores various treatments and therapies.
Some key points I found useful from the book:
Trauma is much more than a story about something that happened long ago. The emotions and physical sensations that were imprinted during the trauma are experienced not as memories but as disruptive physical reactions in the present. When triggered, people who have experienced trauma can become reactive and disorganized; their filters stop working—sounds and lights bother them, unwanted images from the past intrude on their minds, and they panic or fly into rages. If they’re shut down, they feel numb in body and mind; their thinking becomes sluggish and they have trouble getting out of our chairs. Traumatized people are terrified to feel deeply. They are afraid to experience their emotions, because emotions lead to loss of control. This is also why traumatized people tend to be afraid of conflict, because they fear losing control and ending up on the losing side again. Emotional regulation is the critical issue in managing the effects of trauma.
Trauma leads to chronic vigilance for and sensitivity to threat. While the traumatic event itself, however horrendous, had a beginning, a middle, and an end, the subsequent flashbacks can be even worse, as people who have suffered trauma never know when you will be assaulted by them again or when they will stop.
Under normal conditions people react to a threat with a temporary increase in their stress hormones. As soon as the threat is over, the hormones dissipate and the body returns to normal. The stress hormones of traumatized people, in contrast, take much longer to return to baseline and spike quickly and disproportionately in response to mildly stressful stimuli.
Trauma results in a fundamental reorganization of the way mind and brain manage perceptions. It changes not only how we think and what we think about, but also our very capacity to think.
Images of past trauma activate the right hemisphere of the brain and deactivate the left.
When something reminds traumatized people of the past, their right brain reacts as if the traumatic event were happening in the present. But because their left brain is not working very well, they may not be aware that they are reexperiencing and reenacting the past—they are just furious, terrified, enraged, ashamed, or frozen. After the emotional storm passes, they may look for something or somebody to blame for it.
Deactivation of the left hemisphere also has a direct impact on the capacity to organize experience into logical sequences and to translate our shifting feelings and perceptions into words. Without sequencing we can’t identify cause and effect, grasp the long-term effects of our actions, or create coherent plans for the future.
Being able to feel safe with other people is probably the single most important aspect of mental health. Social support is the most powerful protection against becoming overwhelmed by stress and trauma.
This book is essential reading, along with those written by many of the other researchers and therapists mentioned in this book (including Bruce Perry’s “The boy who was raised as a dog” and Stephen Porges “Polyvagal theory”). None of these books are easy reads, including quite distressing accounts of trauma, but they have invaluable lessons for anyone who works with people who may have experienced trauma in their lives