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Wednesday, February 20 , 2019, 2:16 am | Fair 44º


Russell Collins: Your Relationship on PTSD

Research yields new discoveries about how old wounds create turmoil

This is your relationship on PTSD.

Russell Collins
Russell Collins

We fight constantly. Not about big things — about anything. I don’t really understand it, but he says something, then I say something, and we’re gone. And we don’t come back for a couple of days.

If you’ve ever been to a psychotherapist, you’ve already had a little experience with the treatment of post-traumatic stress. This is because psychotherapy itself springs from a discovery about emotional trauma by medical science late in the 19th century.

Emotional reactions to traumatic events from the past have the capacity to induce persisting and painful altered states in the present. Sigmund Freud called these states “double consciousness,” while his French contemporary, Pierre Janet, called them “dissociation.” More than 100 years later, recovering memories about fearful events from the past, and revisiting them in the present-moment safety of the therapy room, is still the basis of mainstream trauma therapies. And pretty much all therapy is some modification of Freud’s original “talking cure,” where painful life events get called up from memory and reprocessed or reinterpreted in some way with the therapist.

Way back in 1896, Freud triumphantly made the claim that he had discovered the root cause of the chaotic mental state — called hysteria — that was almost epidemic among middle-class women in late 19th-century Vienna. Hysteria is most likely related to the present-day diagnosis of complex PTSD, and Freud believed he had cracked the mystery of its formation: It was caused by early childhood sexual abuse.

Unfortunately, his announcement was met with chilling silence by the medical community of his day. Sensing a major career mistake, Freud soon retracted his claim. “Scenes of seduction … were only fantasies that my patients had made up,” he famously recanted. And for the first of many times in the brief history of modern psychiatry, the idea that your confusing, irrational, highly reactive emotional states and behaviors might stem from being traumatized was quietly backburnered.

Post-traumatic stress disorder, or PTSD, is a psychiatric diagnosis that Americans have become familiar with mostly through stories of our veterans returning from Afghanistan and Iraq. These stories are both dramatic and disturbing because they involve horrifying events, such as the deaths of close friends, bloody injuries, the brutal tactics of our enemies, sudden dismemberment and mutilation, etc. But while it is new to many Americans, PTSD — under various names such as combat neurosis, shell shock or traumatic neurosis — has ridden through sequential waves of interest and disregard for more than a century, in a pattern roughly corresponding to the level of American involvement in foreign wars.

Having bombed out in Freud’s early formulation, PTSD began getting traction again as the emotional anguish of “shell shock” spread among soldiers involved in the grinding horror of trench warfare in World War I. “Men began to break down in shocking numbers,” Harvard professor Judith Herman writes in Trauma and Recovery, her groundbreaking analysis of emotional trauma. “Confined and rendered helpless, subjected to the threat of annihilation and forced to witness the mutilation and death of their comrades without any hope of reprieve, many soldiers began to act like hysterical women.”

Herman’s connection between the horrors of war and the Victorian epidemic of hysteria is neither critical of the soldiers nor accidental, but part of a larger and quite convincing argument that the study of emotional trauma has been highly influenced by important social trends and political agendas.

After World War I, emotional trauma largely slipped off the psychiatric radar again until World War II, when it resurfaced, then faded again before gaining the final acceptance of the psychiatric establishment after the Vietnam War. Titled Post Traumatic Stress Disorder, the illness was finally inscribed in the official canon of the psychiatric profession, the Diagnostic and Statistical Manual of Mental Disorders.

Along the way, a fundamental but poorly understood aspect of trauma was been brought to light. Trauma is an injury to human connection. Herman puts it this way: “Traumatic events call into question basic human relationships. They breach the attachments of family, friendship, love and community. They shatter the construction of the self that is formed and sustained in relation to others. They undermine the belief systems that give meaning to human experience.” The trauma of war, of childhood sexual abuse, that of domestic violence or rape are now seen as causes of the same psychological syndrome, PTSD, and all have a largely social foundation. Experiences of abandonment, betrayal, isolation or separation either exacerbate or directly cause emotional trauma, while experiences of connection, esprit d’ corps, loyalty, love and protection can mitigate or even prevent its painful effects.

Which brings us back to the arguing couple at the top of the article. One of the mysteries that a couples therapist often confronts is partners who clearly love each other and want to stop fighting, but can’t. While the problems returning combat veterans face in reintegrating with their families is well known, the problems of normal couples in therapy have not — until recently — been associated with mental states resulting from emotional trauma.

But what if there is a connection between elevated couple conflict and altered states related to Freud’s “double consciousness,” where a couple’s everyday experience of each other unhinges from present reality and links back to earlier memories of trauma. This sounds exotic, but when I think about the arguments I’ve had with my wife over the years, I can remember (as you might be able to, also) a kind of irrational drivenness, a primitive energy that arises along with the drumbeat litany of familiar complaints: She always … she never. This energy, and the alterations in biological activity that accompany it, are just out of scale with content of the argument. We’ll ask ourselves later, why did we get so mad? Why did we keep arguing so long? Why did it matter? Why were we driven to say things we later came to regret, not just because they damaged the relationship, but because they’re so obviously not true?

One of the official criteria for PTSD is that it stems from an “event that is outside the range of usual human experience and that would be markedly distressing to almost anyone.” But new research is telling us that PTSD symptoms may be far more common than this suggests, triggered by events we don’t usually associate with trauma, such as job loss, relational distress or divorce. Earlier this year, Jordan Robinson and Christine Larson of the University of Wisconsin conducted a large study to see if events considered stressful but not traumatic could trigger symptoms of PTSD. They found overwhelming evidence that symptomatic emotional states such as hypervigilance, suspiciousness, anger, irritability and re-experiencing of traumatic events — states common to both PTSD and arguing couples — can be triggered by nontraumatic stressful events.

Susan Johnson of the Ottawa Couple and Family Institute and author of Hold Me Tight, calls these noncatastrophic events “relationship traumas” and says that even these can “injure us so deeply that they overturn our world”. Johnson says relationship traumas co-occur with “times of intense emotional stress, including the birth or miscarriage of a child, the death of a parent, the sudden loss of a job, the diagnosis and treatment of serious illness.” These events Johnson describes are obviously not “outside the range of usual human experience.” On the contrary, you could say they practically define the range of human experience.

It’s important not to confuse the reactive emotional states triggered by relationship trauma with the far deeper injuries sustained by victims of war or sexual abuse. But the good news about the budding recognition of these lesser dissociative-like states produced by relational traumas is that it gives us tools to work with the rigid, persistent and irrational patterns of conflict that are the everyday experience of most couple therapists, and perhaps even most couples.

Even just the notion of an altered state where we suddenly see our partner as a caricature of selfishness and ill will, where the universe itself has turned against us, where trusted friends (and therapists!) can suddenly be seen as enemies — even just this concept is helpful in giving couples a glimpse of the hypnotic nature of these moments. It’s a physical and mental state of automatic reacting for primitive survival purposes: the crocodile brain at its most hostile. More importantly, though, the treatment PTSD has made great progress in the 30 years since its introduction, and the treatment tools and the understanding of trauma that has come with it is now being applied to working with couples. And when couples work includes revisiting, processing and recontextualizing relational trauma, it is, almost by definition, healing to the individual’s trauma as well as the relationship.

This is vitally important to the still-emerging field of marriage and couple therapy, because it holds the promises of further breakthroughs in treatment. Even more important, increasing our understanding of the powerful effects of trauma on couples relating gives legitimacy and dignity to the difficult work of couples who can move beyond the usual disregard our culture holds for the serious work of building long-term intimacy.

Nature didn’t design us for decades of emotional vulnerability and closeness with a partner. We evolved to protect ourselves and survive. Couples who take on the project of intimacy deserve not only credit, but the efforts of serious research and study into making this a reality.

— Russell Collins is a Santa Barbara psychotherapist and divorce mediator. Click here for more information.

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