First I watched her present on the subject. Standing onstage, delivering her talk on PTSD and substance abuse, Najavits shares a quote from William Faulkner: “The past is never dead. It isn’t even past.” PTSD, she tells us, has a very particular meaning: it has to relate to a physical event in which you were involved—the experience, threat, or witnessing of physical harm. This leaves out the stressors of divorce, poverty, neglect, and more. For diagnosis, you must have had more than a month of symptoms, causing functional problems. Problems present themselves in three core clusters: intrusion, meaning the re-experiencing of the event, flashbacks like “movie clips”; avoidance of memories or trauma discussion; and arousal, such as hypervigilance, startle reflex, and insomnia. Clients often dissociate, she says. I find myself nodding.
Clients describe using to “numb out, using to escape.” In fact, most clients will be identified for their addiction, and not screened for their PTSD issues. For two-thirds of clients, the trauma comes first, the substance use second. However, for obvious reasons, substance users are at a high risk of retraumatization. Again, I find myself nodding.
Sadly, trauma symptoms do not disappear with abstinence. In fact, it often gets worse before it gets better. In sobriety, the person may get flooded with memories of the trauma. Much depends on the event: How intrusive was it? A rape, for instance versus witnessing a car accident? “Both PTSD and substance use require identity transformation,” says Najavits. “Clients typically have worse outcomes because they had more positive views of their substance. And the loss of hope is one of the most profound aspects of both substance abuse and PTSD.”
I find myself nodding.
Trauma-informed care emerged some time ago but is just beginning to receive widespread respect. One of the myths that Najavits is trying to dispel is that clients need to tell their traumatic story: many treatment providers think that clients need to focus on the past, using exposure-based therapy. Typically, this involves the client telling the trauma narrative using all their senses. The theory: if they do it over and over, their intense emotions will begin to wane. But it can be destabilizing.
Seeking Safety has been translated into seven languages, including Chinese—which speaks to the global need for trauma-informed tools. “It’s a present-focused model for addressing PTSD—the lowest-cost model available, in that it can be peer-led,” says Najavits. “The basic philosophy is: no matter what happens, there is always a way to cope safely, and use coping skills. There are millions of ways to cope safely, to recover.”
What does Najavits make of the increased use of alcohol by women? “The story is still evolving,” she says. “Many women believe they are not being supported in so many ways. There is a very clear connection between stress and addiction, and women are under immense stress. The more competent the woman, the more this can be hidden—and we know the nature of addiction is denial. The unseen problems of high-functioning professional women are serious.”
I drank to relieve the symptoms of depression, and I drank to deal with anxiety. I wish with all my heart this wasn’t true, but it is. I also drank to deal with PTSD. In other words, tough stuff happened, and it had lingering effects.
The year I turned sixteen was the one in which my mother’s drinking turned nasty. It’s no coincidence that my first depression hit hard that year: the feeling of too many cats sitting on my chest, coupled with a belt to the solar plexus. It was like this the first time, and it still is—if and when depression returns. And over the years, I’ve learned to accept the fact that it always does.
At sixteen, it whumped me hard, and I had nothing with which to whump it back. No pills, no therapy, no understanding of what was happening. I breathed deeply, slept poorly, ate virtually nothing. I wrote in my journal, read a lot of Leonard Cohen, and was utterly isolated and depleted. For the first time at school, I was affectless. I sat at the back of the class and perfected my pencil drawings of artichokes, layering leaf upon delicate leaf, all up and down the margins of my notebooks. At the end of the day, I would wander home, without enthusiasm.
One teacher reached out to me, my English teacher: she urged me to apply for early admission to Radcliffe. But this was the year of the shootings at Kent State University. Four students were killed by the Ohio National Guard. When I brought up the notion of an American university with my mother, she flatly refused. My father was out of the country. There was no discussion.
I hid in my room, wrote in my journal. I was confused and sad, without hope. And then, after eight months of hell, it lifted. It seemed like a miracle. Life regained its color; I regained my humor.
Back then, I was confused about what had happened. Maybe it was just a bad patch? Maybe it was our family’s move, from a little northern town of 1,800 to Toronto? There was a pervasive sense of dislocation in our highly dysfunctional household. My depression was behind me, and I had no wish to look backward. In my last year of high school, I moved to a new school, my second in two years, made new friends, thrived. A year later, I headed off to university, made new friends in my first year, thrived.
And then it came back—only this time it was much fiercer. This time my depression had teeth. It dug in deeper. Suicide was on my mind.
This second bout of depression arrived in the heat of August, the summer in between my first and second year of university. It was a particularly bad time at home: there are things that happened that summer I am not willing to revisit or discuss. Let’s just say this: it was dire, extreme. I remember feeling a desolation unlike any other, claustrophobic in its intensity. There was no way out—or there seemed not to be.
Late one night, alone in the house, I made a suicide attempt. It was feeble, but serious all the same. When I told my mother, she said: “Don’t ever tell your father.” That was all that was said.
Once fall came, I found it impossible to get out of bed for class. I was a residence assistant—called a don—on a first-year floor: these duties were primarily night-related, and I had no trouble fulfilling them. I would help first-year students overcome their homesickness, their heartache, their confusion. But once morning came, I found it virtually impossible to move. By early November, when the sky turned slate gray and my mood had not budged, I was desperate. I dragged myself to the student health clinic, but left before I saw a doctor: I knew the student working at the reception desk, and the stigma of seeking help was too great. I trudged home, prepared to endure another several months of psychic pain.
When the depression lifted five months later, I maintained the illusion that it had been a one-off event. Maybe I had a breakdown after all the stress of home? This is how I decided to see things. My third and fourth years of university were productive and depression-free. I dated, ran a campus arts festival, and graduated. One week later, I headed as far from home as I could possibly imagine, to Jasper, Alberta.
And that’s where my life took an abrupt left turn. Working in the Rockies, in the computer room of Canadian National Railways, I met a tall, worldly man with a wicked sense of humor and a golden outlook on life. A Gene Wilder clone with a dash of Donald Sutherland, and a beatific smile. Bill to others, I called him Will. He smelled like April, when the pale green shoots of the trees reach upward, shimmering and electric. I fell in love, and so did he. He lived in Europe in the winter and worked the trains as a brakeman in the summer. Come fall, he was heading overseas to the London Film School.
That summer, the world seemed to crack open like a seed pod, full of possibilities. We moved in together, sharing a single bed in an impossibly small room. If I had my doubts, they were small ones. I was in love. And I was certain that depression was in my rearview mirror.
Six months later, I followed Will to London, perching with him in a borrowed room in a heavenly flat in Notting Hill. He had mono, and was struggling while he went to school. Still, we managed to get out and about: he had a cherry-red Mini and we zoomed around the city, parking sideways in the tightest spots. During the day, I wrote. Six months later
we headed home to Canada, renting a cottage for the summer in the Lake of the Woods area. Come fall, we packed our few belongings in a bright yellow station wagon and headed to Toronto to seek our fortunes in the film and magazine businesses.
At twenty-three, I married Will. In doing so, I found a way to be adopted into a family as calm as mine was turbulent, a family filled with humor and predictability. His father was wise and had a twinkle, and we had long conversations; his mother had achieved as a community leader. I loved my birth family, and I adored my in-laws. If there were some concerns on our honeymoon, I chose to dismiss them. Life was rich.
In Toronto, Will and I began as interns in our chosen careers. We bought a beautiful, unreliable Karmann Ghia convertible, rented a minuscule apartment in the Annex neighborhood of Toronto, and rescued a stained couch from the street. In less than a year, we had a larger apartment; two years later, we had our first house. A year after that, we flipped that first home for a larger one, and a hundred-thousand-dollar profit. We bought a piece of property by a lake. We had each begun to flourish at work, he as a film producer, I as a member of the staff launching Canada’s first weekly newsmagazine, Maclean’s. We were on our way.
Were those happy years? Many times, they were. Camping on our new land, cooking dinner over a wood fire, we were in lockstep. As friends, Will and I lived life smoothly. We supported each other and were endlessly good to one another. But romantically? There was constant tension, and the tension escalated. He and I both knew, in our hearts, that we had each married our best friend. Before we had been married four years, we were in counseling.
We drank regularly in those years, and we drank well. I remember a five-week five-star trip to Europe, a trip to save our marriage. Tours of vineyards, rosé at lunch in Cannes, Veuve Clicquot at sunset, Saint-Émilion at dinner, Grand Marnier to close the evening. I began to wake at 4 a.m.: something was not right. This was too much for me. We returned to Canada and slowed it down. It was a conscious decision: we were dedicated to each other, and that included an open awareness of what had gone wrong in my family.
Six years into our marriage, we decided to have a baby. Life was on the upswing.
And then it wasn’t.
Toronto, Winter of 1984
Five months pregnant, in the office. Six o’clock on a Tuesday.
Most of my colleagues have gone home. One last task before I leave: going over a book review with a writer. She and I are deeply engrossed in editing.
My boss appears at my door, pointing a gun.
I know this is some sort of twisted joke. It’s not the first time he’s pulled this sort of stunt. He has a bullwhip in his office, abortion tools on his bulletin board. He’s unpredictable. A clever bully, with a big reputation.
“Don’t point a gun at me, Alan.”
“I’m not pointing it at you.”
He aims it lower, at my stomach.
“I’m pointing it at your kid.”
“We’ll have the review to you in the morning.”
He leaves. I drive home. Only then do I feel loathing turn to outrage. I call a friend. Her husband overhears the conversation. “A firearm? A guy pulled a firearm in the office?”
The next morning, I tell my editor I won’t report to Alan until he removes the guns from his office drawer: target pistols, apparently. And the bullwhip. I don’t mention the abortion tools on his bulletin board.
Alan denies the incident ever happened. He forgets there was a witness.
My editor insists on the status quo.
The gun incident is reported in a city newspaper. Half the office is on my side. The other half believes I was a poor sport.
My job is no longer a pleasure. I count the days until my baby is due.
Fall of 1984
Nicholas is five weeks old. Will is elated, and so am I. We head to London for a film market. For one glorious week, I retrace my steps in the city where I spent one memorable winter: up and down the steps of the Tate gallery, with my blond baby in tow; through the National Portrait Gallery; in and out of big black taxicabs with the stroller. At night Nicholas sleeps in a dresser drawer in our hotel room, one we have placed beside my side of the bed—one the maids make up with enthusiasm. Life feels complete.
On the final day, I collapse. Something is terribly wrong. In the cab home, I am on all fours.
Two weeks later, I have lost masses of weight. I have emergency gallbladder surgery. After that, postpartum depression and encroaching, terrible darkness. The constant feeling of many cats on my chest. The elevator is stuck on down.
Depression is coloring my entire world. I am weepy at dinnertime. Alone in the house with my new baby, I feel a pervasive darkness. Meanwhile, there has been a seismic shift in my feeling of comfort around my place of work. Professionally, I feel derailed and vulnerable.
Alone with Nicholas, in my nightgown. The mail arrives: Barbara Amiel, a former colleague and the future Mrs. Conrad Black, now a newspaper editor, is straddling a chair on the cover of a magazine, under the headline “Boss Lady.” One thought overwhelms me: the job I once loved will never be the same.
Winter of 1985
I return to work. My instincts are correct: what was once fulfilling is openly difficult. Alan is still my boss. Within months, I apply for a leave. I win a fellowship, one that allows me to spend a year at university. The depression only deepens. On sunny days, it seems worse. Something is terribly wrong. I see a counselor.
Winter of 1986
For the first time, I find myself drinking much more than I had expected. Not often: just two or three times. Those evenings surprise me. I realize that I am drinking to escape. I find myself slurring when I intend to be witty. This is not working.
In fact, very little is working: my husband has asked for a separation; we have a beautiful two-year-old, a century-old home with a view of the water, great jobs.
We decide to give it another try, but each day is difficult. I know our marriage is on trial, and my future is at stake. My husband brings me white wine spritzers, a peace offering. At first I say no. Too risky: I know I want them for the wrong reason. But gradually, I say yes. We begin to see a new marriage counselor, and I see her separately, for depression. Will I take antidepressants? she asks. No, I say, I’ll tough it out. My mother’s experience with Valium haunts me.
Winter of 1990
My marriage ends. Nicholas is only five. I am determined to keep my little family together, despite the separation. On Sunday nights, Will comes for dinner. Each evening, after we put Nicholas to bed, we find ourselves having several glasses of wine, discussing how this will unfold. We are apart, and still deeply connected. Nothing makes sense.
One of the strongest predictors of alcohol abuse is childhood sexual abuse—also related to PTSD. According to Stewart, how the abuse is dealt with has a major effect on whether the individual will develop PTSD. She says, “If someone steps in and protects you, it can change how you deal with the event.”
In Karin’s case, no one stepped in. A former advertising executive from the American Northeast, Karin is aware that her drinking began a couple of years after her older brother began doing his “sexual experiments” on her. A vibrant, petite woman in her early fifties, she pauses many times to collect herself as she tells her story, her big eyes filling with tears. Sitting in the generous kitchen of her country home, she is dressed in her fitness clothes, ready for a morning workout. Clearly, she has steeled herself for this interview. Still, it stops her in her tracks more than once. She begins slowly: “Let’s just say there’s a lot of shame to my story.”
The daughter of an alcoholic mother, she was the youngest of four children, with much older brothers. “Our house was like a war zone—my mother didn’t have the skills or capacity to be a real mother to me.”
She started drinking at eleven, and was allowed wine with dinner every night. Each night, her parents would eat upstairs, and Karin would slip down to the basement to eat in front of the TV alone. “I w
ould often get a second glass of wine, and I was allowed as long as I was quiet.” She remembers first getting drunk when her beloved great-uncle died shoveling snow. She was thirteen. “I went straight to the basement and downed the better part of a bottle of wine,” says Karin. “That’s not what normal thirteen-year-olds do.” A “binger” in university, she worked hard during the week, then did “silly, reckless things” on the weekend.
Married, with two children, Karin had severe postpartum depression, plus serious bouts of depression for the better part of three decades. But throughout her entire career, her work life has been stellar. Both times after she took maternity leave she came back to a better job and a bigger title. As she rose up the ladder, she began to drink nightly, staying out at least one night a week to drink with others from the office. “I would get home around two in the morning, and head off to work still fairly loaded—I wasn’t alone in that. Once I got caught barfing in the plants in the morning—I said, ‘Sorry, I’m pregnant.’ The booze enabled me to cross all of my moral boundaries. It was like a lawless society: we had a strong sense that we could do anything we wanted to.”
Karin and her husband always drank a lot together. “We used to pop a champagne cork out the sunroof on the way to our country place on Friday nights, arriving fairly loaded.” Slowly, her self-loathing began to grow. “I used to think I was resilient, but my resilience came in a vodka bottle,” says Karin. “At the end, I would have two tumblers before dinner, a bottle of wine with dinner, and more vodka afterwards.”
Now fifty-three, she remembers training for a triathlon when she was in her forties, one she completed. “I’d get up every day and say to myself, ‘Clearly if I can do this, I can’t be an alcoholic.’ Running provided enough endorphins to ease my depression, and enough structure and discipline to keep me drinking. One of my friends said to me, ‘What are you running from?’ I knew I was running from my drinking. I began to see a therapist. As I told her I had vowed never to become my mother, I was watching myself do just that.”
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